Introduction and Summary
If you are frustrated or feeling self-conscious about acne blemishes on your skin, you’re not alone—as the most common skin condition in the United States, up to 50 million Americans are affected by acne. While acne is most common with teenagers, people of all ages can experience acne, including babies and adults.
Areas of your body that naturally produce oil, including the chin, forehead, and back, are likely areas for acne outbreaks. Thankfully, almost all cases of acne can be controlled with the right treatment protocol, though you may need to try several acne treatments before finding what works best for your skin.
In this article, you’ll learn:
- What Is Acne?
- Types of Acne
- Acne Symptoms
- What Causes Acne?
- How To Treat Acne
- Acne Prevention
- Risk Factors and Complications
- When to See a Doctor
- How K Health Can Help
What Is Acne?
Acne is a skin condition in which pores become clogged with excess oil, bacteria, and dead skin cells, resulting in breakouts of visible blemishes on or underneath the surface of the skin. Acne blemishes most commonly appear on the face, forehead, chest, upper back, and shoulders. Blemishes range from small, red bumps (pimples) to large cyst-like lumps.
No matter the size or type, all acne blemishes begin with a blocked pore. Pores—small openings in our skin—are either oil pores or sweat pores.
- Oil pores: These openings are at the top of a hair follicle that contains sebaceous glands (oil glands). These pores not only allow hair to grow out of the follicle, but they also allow dead skin cells, natural bacteria, and the sebum (oil) our bodies produce to come to the surface. This process is important for moisturizing and protecting our skin.
- Sweat pores: These pores that allow sweat to escape from our body and are much smaller than oil pores, and can’t be seen with the naked eye. Sweat pores are not responsible for acne.
Acne occurs only in the oil pores when our bodies produce too much sebum, or when the opening of the pore becomes otherwise blocked.
When the body starts making too much sebum, the excess oil causes dead skin cells to stick together and build up inside the pore rather than rising to the surface where they can be shed. If the pore closes with oil and skin cells are trapped inside, it will produce a whitehead. If the pore remains open to the air, the dead skin cells trapped inside will darken, producing a blackhead.
Natural bacteria that live on our skin may also get trapped in a clogged pore. Once inside the pore, these bacteria can multiply faster than usual and fill the pore, causing it to become inflamed. If the blocked hair follicle becomes inflamed or infected due to bacteria, it will produce a pimple—a swollen red bump with a white or yellow center. If the inflammation develops deep inside the hair follicle, it will produce a lump (cyst or nodule) beneath the surface of the skin.
Types of Acne
Acne can come in a variety of different forms and affect people of all ages.
Adults and teenagers with acne can have mild cases with a few blemishes, or they can have more serious cases of cystic lumps under the skin. Acne falls into two main categories: noninflammatory and inflammatory.
When pores clog with oil and dead skin cells, but don’t get clogged with bacteria, the pores don’t become as swollen or red. This is considered noninflammatory acne and it responds relatively well to at-home remedies and over-the-counter treatments. The primary symptoms of noninflammatory acne are blackheads and whiteheads.
When pores clog with oil, dead skin cells, and bacteria, the bacteria multiply, causing the pore to become inflamed. Inflammatory acne may result in either red, swollen pimples on the skin’s surface or painful, solid cysts underneath the skin. Inflammatory acne is harder to get rid of than noninflammatory acne, although many at-home remedies are helpful for treating both types. Serious cases of inflammatory acne may require the help of a dermatologist or prescription medication to treat these flares.
While acne is most commonly seen in teenagers and adults, babies can also have acne. Baby acne may be defined as neonatal acne or infantile acne, depending on the age at which it develops.
Roughly 20% of newborn babies develop or are born with neonatal acne in their first six weeks of life, though it most commonly appears when babies are about two weeks old.
Neonatal acne—also called newborn acne—may occur anywhere on your baby’s face, including the cheeks, nose, forehead, and chin. It may also spread to the neck, back, or chest.
If your newborn is breaking out with red pimply skin, don’t panic. Neonatal acne isn’t serious and typically resolves on its own without any scarring.
Infantile acne describes acne that develops after six weeks of age, normally when babies are between 3-6 months old.
While neonatal acne is nothing to worry about, infantile acne should be checked by a doctor. Because it’s less common, it may be a sign of a different condition, like eczema, psoriasis, or a skin infection.
The primary symptoms of acne are visible blemishes on the skin, which range in nature depending on the severity of the condition. When clogged pores become infected or inflamed with bacteria, they may sit on top of the skin as raised bumps (pimples) or under the surface of the skin as lumps (nodules or cysts).
Types of acne blemishes include:
- Whiteheads: Whiteheads are closed pores that are clogged with oil, bacteria, and dead skin cells. When the pore closes up with this debris inside, it creates a small bump that looks white or may be the color of your skin.
- Blackheads: Blackheads are open pores that are clogged with oil, bacteria, and dead skin cells. If the pore remains open, the oil, bacteria, and dead cells are exposed to the air and turn dark brown, appearing as a black dot on the skin. These dots aren’t dirt.
- Papules: Papules are small, red, bumpy pimples that often feel hard to the touch and may look like a skin rash. These are caused when excess oil, bacteria, and dead skin cells push deeper into the skin creating inflammation. The skin around the area may be swollen or feel like sandpaper when touched.
- Pustules: Pustule is the medical term for a pus-filled pimple. Similar to papules, these are red bumps on the skin, but unlike papules, they contain a yellowish fluid called pus. This makes the bump appear with a yellow or white center.
- Nodules: Rather than appearing as bumps on the surface of the skin, nodules are large, solid lumps that sit beneath the skin that are often painful.
- Cysts (cystic acne): Similar to nodules, these large, solid, painful lumps under the surface of the skin are filled with pus and are more likely to cause permanent acne scars.
While acne may be tender, itchiness is not a common symptom of acne. If you develop a red skin rash that is very itchy, you may be experiencing an allergic reaction or may have a different skin condition like eczema, psoriasis, dermatitis, or a skin infection.
What Causes Acne?
Acne is caused when the body produces too much oil, in turn blocking hair follicles with oil, dead skin cells, and sometimes bacteria. The most widely known and studied causes of acne include:
Androgens are a type of hormone that causes our sebaceous glands to enlarge and make more oil. Androgen levels naturally increase during puberty for both boys and girls, often leading to hormonal acne (also called acne vulgaris).
Other hormonal changes to the body, such as becoming pregnant or using oral contraceptives, can impact the amount of androgens and oil production. Acne may be caused or worsened by hormone imbalances. This is why many women experience acne breakouts at times when their hormones are fluctuating, including:
- Around or during their periods
- During pregnancy
- During menopause
- When stopping, starting, or changing birth control medication
Although it’s not a direct cause, research shows that experiencing ongoing stress may worsen acne breakouts. When we are stressed, our bodies produce more androgens—the hormones that enlarge our oil glands and trigger more oil production.
It’s possible to be genetically predisposed to developing acne if you have a close relative with acne. It’s believed that people with a genetic predisposition to acne are more likely to have acne in their adult years.
Some research suggests that foods rich in carbohydrates, including breads, chips, and pasta may make acne breakouts worse as these foods can raise your blood sugar rapidly, triggering the body to produce more sebum. That blood sugar spike can also promote bacterial growth.
More research is needed to determine why certain foods may contribute to acne symptoms, and whether dietary restrictions can effectively be used as a treatment for acne.
Some prescription drugs can cause acne as a side effect, particularly drugs that impact hormone levels, including drugs containing corticosteroids, testosterone, androgens, and lithium.
Underlying health condition
A sudden onset of acne in older adults may be a symptom of an underlying disease or other medical condition. If you haven’t suffered from adult acne and you suddenly experience acne blemishes appearing on the skin, speak with a doctor.
How To Treat Acne
While some types of acne are harder to treat than others, nearly every case of acne can be controlled with home remedies, over-the-counter medications, prescriptions or procedures—it’s a matter of finding the best treatment for your skin.
Home remedies and skin care
Home remedies to take care of your skin and help prevent of reduce acne include:
- Wash your skin twice a day.
- Wash your skin after sweating. Perspiration can make acne worse, especially if you’re wearing a hat or helmet as this traps sweat in.
- Use a gentle, non-abrasive skin cleanser.
- Apply any skin cleanser with your fingertips—don’t use a washcloth, mesh sponge, or other application item, as these can further irritate the skin.
- Opt for alcohol-free skin products.
- Be cautious with astringents, toners, and exfoliants—many of these products irritate the skin.
- Avoid scrubbing areas with acne, as this can make acne worse.
- Rinse your skin with lukewarm water.
- Shampoo regularly, or daily if you have particularly oily hair.
- Refrain from popping, picking, or squeezing pimples, whiteheads, and other acne blemishes. This will delay the healing process, making your acne last longer and increasing your risk of acne scars.
- Avoid touching your face and other acne-prone areas throughout the day.
- If your acne is painful, especially in the case of nodules and cysts, ice the area to relieve pain and reduce inflammation.
- Avoid extended time in the sun and don’t use tanning beds, especially if you are taking acne medication. Some acne medications cause the skin to become sensitive to the UV light that comes from the sun and tanning beds.
Most acne medications are topical treatments that you apply to the affected area of skin. Some are designed to kill bacteria in the pores, while others reduce oil production.
The most common topicals are available over-the-counter and contain benzoyl peroxide or salicylic acid. It’s recommended to use topical treatments for 4-8 weeks to determine whether your acne is improving.
If over-the-counter medications aren’t working, you may want to make an appointment with a dermatologist who may prescribe a stronger topical acne treatment. Prescription topicals may contain a retinoid, antibiotic, or prescription-strength benzoyl peroxide.
If topical treatments aren’t effective, or in cases of swollen cystic acne, a dermatologist may prescribe an acne medication—which is generally taken orally. Rather than treating the infected area directly, acne medicines work inside the body to kill bacteria, reduce inflammation, or balance hormone levels.
Prescription acne medications include antibiotics, pills to regulate hormone levels (such as birth control pills or spironolactone), or isotretinoin.
Acne treatment procedures
If your acne is severe, painful, or long-lasting without improvement, your dermatologist may recommend one of multiple procedures to get rid of acne:
- Laser or light therapy: This procedure uses a light-producing device to target and reduce the amount of P. acnes bacteria on your skin.
- Chemical peel: These chemical peels are stronger than those at a drugstore and must be performed by a dermatologist.
- Acne removal: In the case of a large acne cyst that isn’t responding to any medication, a dermatologist can remove the cyst through a drainage and extraction procedure.
Treating baby acne
In most cases, treating baby acne simply involves being gentle with your baby’s skin while waiting for the acne to resolve on its own. Always seek the recommendation of a pediatrician when dealing with baby acne.
Don’t apply any acne medications or products to your baby’s skin unless specifically recommended by your child’s doctor. In the meantime, use only soaps, shampoos, and lotions intended for baby’s skin.
In most cases, acne cannot be fully prevented because many factors can play a role in your acne, including hormone levels, stress, genetics, medications, or underlying conditions. Certain lifestyle changes and skincare habits can help to reduce breakouts and prevent acne from getting worse.
Practicing the following healthy skincare habits may help prevent acne:
- Wash your skin twice a day, any time after you’ve been sweating, and after being in a greasy environment (such as a kitchen where foods are being fried).
- Use gentle, non-abrasive skin products that are alcohol-free.
- If your skin appears dry, red, or otherwise irritated after using a certain toner, exfoliant, or other skin product, stop using it.
- Shampoo regularly, or daily if you have particularly oily hair.
- Avoid touching your face with your hands or phone throughout the day.
Avoid doing the following things that can make acne worse:
- Picking, popping, or squeezing pimples and other blemishes
- Scrubbing the acne-affected skin
- Using a washcloth, sponge, or any item other than your finger to apply topical skin products
- Touching your acne-affected skin frequently
Myths about acne prevention
There are many misconceptions about what causes acne:
- Greasy foods: Eating greasy foods like pizza or french fries does not impact acne. However, working in an environment with grease in the air (e.g. frying foods) can contribute to acne because the oil can stick to the skin and block pores.
- Hygiene: Acne isn’t impacted by having clean or dirty skin, and washing your skin with harsh soap or scrubbing too hard can irritate the skin and make existing acne worse.
- Makeup: It’s likely that makeup has very little to no effect on the development of acne. For people with existing acne, seek out oil-free cosmetics (non-comedogenic), speak with your dermatologist about how to apply makeup alongside acne treatments, and refrain from sharing makeup brushes or applicators that may carry bacteria.
Risk Factors and Complications
Acne most commonly affects teenagers, but acne can affect people of all ages. You may be more likely to develop acne if:
- You are a teenager or young adult
- You take medications that impact your hormone levels and/or that contain corticosteroids, androgens, or lithium
- One or both of your parents had acne
- You work or spend time regularly in an environment with oil and grease (such as a kitchen with a fry vat)
- You frequently wear tight clothing or gear (e.g. backpacks, helmets, sports bras) that create friction against your skin
- You experience chronic stress—while stress alone cannot cause acne, it is known to make existing acne worse
The most serious complication from acne is permanent scarring of the skin. Scarring is more common with blemishes that sit under the skin, such as nodules and cysts, and in cases where a person frequently pops, squeezes, or picks at existing pimples and other blemishes.
Aside from the condition itself, acne treatments can cause their own complications. Some topical products dry out the skin, causing cracking or flaking. Many acne medications also make your skin extremely sensitive to UV rays—meaning patients must avoid exposing their skin to the sun. You should also be diligent when using over-the-counter (nonprescription) acne treatments. Common lotions, cleansers, and other skincare products meant to help with acne can cause a serious reaction in some people beyond mild itchiness or redness. Serious reactions are rare, but it’s important to know the signs, as they require immediate medical treatment.
Seek emergency medical attention if you experience any of the following symptoms after using a skincare product:
- Difficulty breathing
- Swelling in the eyes, face, lips or tongue
- Tightness in the throat
- Fainting or feeling of faintness
When to See a Doctor
If you’ve tried at-home remedies and skincare practices for eight weeks or more and your acne hasn’t cleared up, ask a doctor for recommendations. Keep in mind that it may take more than six weeks to see the results of a new acne treatment, and not every medication works for every case of acne.
If your acne is severe, leaves scars or darkens your skin, or persists even after prescription treatment, you should see your dermatologist to discuss your options.
If you experience a sudden breakout of acne as an older adult, especially if you don’t normally suffer from adult acne, it’s a good idea to see your doctor to rule out a more serious issue. In older adults, the rapid onset of acne may be a sign of an underlying disease.
How K Health Can Help
Acne is very common and treatable. Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.