What Is Acne?

Acne Vulgaris, as it is called medically is a skin disorder characterized by development of pimples in the face, upper chest and back. It affects about 80% of the population at some point in life.

Acne commonly affect Teenagers and young adults, both males and females. Brown skinned individuals tend to have severe form of acne compared to light skinned races.

Causes of Acne

There are 5 main causes and factors that trigger acne development. The factors can be grouped as follows:

  1. Puberty: Hormonal changes during puberty (increase in Androgens) cause increased Sebum (skin oil) production by sebaceous glands of the skin. This explains why Acne is common in teenagers.
  2. Pregnancy: Pregnancy induce changes in hormones which alter sebum (skin oil) production. Even menstrual cycle does affect skin composition and lead to development of Acne.
  3. Infection: A bacteria found in skin called Cutibacterium Acnes (Formerly called Propionobacterium Acnes) plays a major role in inducing skin inflammation and development of Pustules.
  4. Occlusive cosmetic cleaners and lotions contribute to development of acne, which is why it is important to check whether you recently changed your face products before having Acne. Oily face Products are the ones that commonly cause Acne.
  5. Some Illnesses such as Diabetes Mellitus and Drugs like Phenytoin, Lithium & Corticosteroids worsen and prolong acne. There is a debate of whether stress causes acne or not

Myths About Acne

There are many stories about acne which are different in many cultures, the following list contain things that DO NOT cause Acne:

  • Inadequate face washing
  • Sex
  • Fish or canned food
  • Masturbation
  • Oily food
  • Milk or diary Products

Signs and Symptoms

Symptoms of acne appear on the face, upper chest and upper back. There are 3 different types of pimples that appear:

Open Comedones (Blackheads)
Open Comedones (blackheads). ©MSD manual
  1. Comedones: Painless papules of blocked sebaceous glands openings. Open comedones are commonly called Blackheads while closed comedones are Whiteheads (see images)
  2. Pustule: Yellow pimples filled with pus
  3. Cyst: These are subcutaneous nodules that are filled with jelly-like substance and pus. It is seen in severe form.
Pustules on face
Pustules.©MSD manual

Classification of Acne

Classification of acne is based on the distribution of lesions on the face. It determines acne severity which helps in the treatment choice to be mentioned shortly.

  • Mild acne: less than 20 comedones (Blackheads/Whiteheads) or 15 pustules.
  • Moderate acne: 20-200 comedones or 15-50 pustules or a total of 125 lesions.
  • Severe acne: more than 5 Cysts or more than 125 total lesions (comedones + pustules).
Cystic acne (severe form)
Cystic acne. ©News24


All forms of acne usually resolve spontaneously by early to mid-20s. A minority of women have acne into their 40s. Regardless of the severity, the condition brings stress to the person who has it since it affects the face.

The Don’ts of Acne

Home treatment of acne should be done with care to avoid worsening it or causing further damage to the skin that is already fragile. Here is a list of things to avoid in acne:

  • Do not delay treatment even if you have mild acne, the healing may leave permanent scars or spots on the face, which does not look great.
  • Do not wash excessively, it messes with pH balance. Antibacterial soap do not offer any benefit in acne.
  • Do not squeeze the lesions as that may cause the infection to spread around. It also causes poor healing.
  • Do not use greasy or oily face products, remember there is excess sebum production already.

Medical Treatment

There are three main Steps that are followed in the Treatment of acne.

Step 1 is for Mild acne, topical keratinolytics such as Benzoyl Peroxide are used. Retinoids are also used to treat blackheads and whiteheads.

For Moderate acne and if Step one Fails, then Step 2 is started. A low dose oral antibiotic, usually a Tetracycline is used for 3-4months in combination with step 1 creams or ointments.

Step 3 is for severe Cystic Acne and failed step 2. Use of either Combined Oral Contraceptives (COCs) in women who want contraceptive benefit, or oral Retinoids which is a Vitamin A analogue is recommended. Caution needs to be taken by individuals who use Retinoids as they are Teratogenic.

Do you have any questions or other skin problems? Ask on comments below or on Facebook page.

Read Acne Treatment Tips.

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