Acne: Symptoms, Causes, Types, Risks, Diagnosis, Treatment, Prevention and Prognosis

Face of a woman with acne


Everyone dreads the idea of having pimples fill up their facial skin. Acne is one of the reasons why adolescents and young adults visit their dermatologists. Acne is a chronic and inflammatory skin condition that leads to the formation of pimples and sports, particularly on the face, back, beck, shoulders, upper arms, and chest.

Usually, acne happens when the hair follicles become blocked with dead skin cells and oil. Acne often starts with whiteheads, blackheads and then pimples. These lesions often appear on the forehead, face, upper back, chest, and shoulders.

Acne also affects most people at some point in their lives, but it’s often seen among teenagers. It causes sports, oily skin and the skin, which is painful to touch.


The signs and symptoms of acne may vary, depending on how severe the condition is:

  • Blackheads
  • Whiteheads
  • Pimples or pustules
  • Large, solid and tender lumps called nodules
  • Small, red and painful bumps (papules)
  • Cystic lesions


The skin’s sebaceous glands produce an oily semi-fluid dubbed as sebum. This substance lubricates and softens the skin and hair. The hair follicles and pores of the skin may become clogged with sebum, bacteria and dead skin cells. When this happens, blackheads or whiteheads develop.

The four main factors that may cause acne include excessive oil production in the skin, bacteria, hair follicles that get clogged with dead skin cells and oil, and excessive activity of androgens, a kind of hormone.

In acne, the glands begin to produce more sebum, which mixes with dead skin cells that clog the follicles. These follicles will bulge outward, leading to the formation of whiteheads. If the clogged follicle is open, it creates a blackhead.

Hormones – When a person hits puberty, the body will start to produce more androgen hormone, which will lead to the enlargement of the sebaceous glands. These glands will begin to produce too much sebum. Consequently, since men have more androgen than women, they tend to experience more severe cases of acne.

Bacteria – Normally, the skin contains healthy or normal skin bacteria. These bacteria may mix with sebum and produce irritants that can lead to inflammation.

Family – Hereditary may affect the activity and size of the sebaceous glands, which influences the production of sebum.

Testosterone – Acne that occurs during adolescence can be triggered by the increase in the hormone dubbed as testosterone. The hormone is pivotal in the stimulation of growth and development in boys, particularly of the penis and testicles.

Other triggers

The other possible triggers that may lead to acne include:

  • Cosmetic products
  • Medicines like lithium, corticosteroids, and drugs to treat epilepsy
  • Wearing items that put pressure on the area like a wristwatch, headband or backpack


There are six main types of spots caused by acne, including:

Whiteheads – These spots have a similar appearance to blackheads and may appear firm. When squeezed, it won’t get empty.

Blackheads – On the other hand, blackheads appear as small black or yellow bumps that form on the skin. These usually develop in the lining of the hair follicles.

Papules – Papules are small and red bumps that may feel painful.

Pustules – Pustules are just like papules but they have a white center or tip. There is pus inside.

Cysts – Cysts are the most severe type of spots caused by acne. They have large lumps that are filled with pus. They look like boils and may cause scarring.

Nodules – Nodules are large and hard lumps that develop under the skin’s surface.
They are painful.

5Risk Factors

Some people are at a higher risk of developing acne, these include:

Women – At least 80 percent of acne in adults happen in women. This is due to the hormonal changes that many women experience at some points in their lives like puberty, pregnancy, and menopause.

Menstruation – Some women may experience acne flare-ups during their menstrual period.

Polycystic ovary syndrome – This condition can cause acne because of hormonal changes. It can also lead to the formation of tiny cysts in the ovary and weight gain.

Pregnancy – Some women may experience acne during pregnancy, particularly during the first trimester.

Smoking – Smoking may be the culprit in adults who have acne.


The doctor can diagnose acne through physical examination of the skin. A dermatologist is a doctor who specializes in the treatment of skin disorders. The doctor will examine the skin on the face, back, and chest for the presence of blackheads, whiteheads, pimples and red nodules.

The doctor will determine the severity of the disease through noting how many spots are there and if they are inflamed and tender. Determining the severity of the condition is helpful in creating a treatment plan. The severity of acne can be measured through these grades:

Mild or Grade 1 – Acne is mostly confined to blackheads and whiteheads, including new pustules and papules.

Moderate or Grade 2 – In moderate acne, there are many pustules and papules, which are found in the facial area.

Moderately severe or Grade 3 – In moderately severe acne, there are many pustules and papules present on the face, back and chest. Also, there are a few swollen nodules.

Severe or Grade 4 – In severe acne, there are many painful and swollen nodules and pustules.


Based on the individual needs and severity, the doctor may recommend the following remedies and treatments to control acne. Remember that there is no overnight remedy, they should be used for several times, and even months before they would work and the effectiveness will be determined.

The goals of acne treatment are to control the acne, avoid scarring or permanent damage to the skin and make scars less noticeable. Here are the most commonly prescribed treatments for people with acne.

Topical Medicines

There are many topical agents that the doctor can prescribe to treat acne, including:

Retinoids – Retinoids come in the form of gels, lotions, and creams. These medicines are derived from vitamin A, which is a potent antioxidant.

Antibiotics – The antibiotics can be prescribed by the doctor when there is an infection. These drugs work by killing excessive skin bacteria to reduce redness and swelling.

Dapsone – A type of anti-inflammatory, Dapsone or Aczone is used to reduce inflammation.

Salicylic acid and azelaic acid – Salicylic acid is used to prevent plugged hair follicles and to remove excess leave-on products. On the other hand, Azelaic acid is important in reducing acne and its flare-ups.

Combined oral contraceptives – Some contraceptives like four combined oral contraceptives have been approved by the U.S. Food and Drug Administration (FDA) to be used in women. Also, these drugs have been shown effective in the treatment of acne.

Isotretinoin – Isotretinoin or Clavaris is a potent medicine for people who have severe acne and are not responding to the other drugs.

Anti-androgen agents – These drugs like Aldactone may be used for women and teenage girls if the antibiotics for acne are not working. These drugs are used to block the effect of the hormone androgen on the sebaceous glands.

Various therapies

These are used when the acne does not respond to the other treatment options mentioned above.

Chemical peel – A chemical peel is a procedure that uses chemical substances like glycolic acid, retinoic acid, and salicylic acid to improve acne and reduce the breakouts.

Laser therapy – Light-based therapies like laser therapy and photodynamic therapy are used to help make the skin clear and reduce the breakouts of pimples.

Blackhead and whitehead extraction – The dermatologist may use devices to remove the blackheads and whiteheads gently. However, this may lead to scarring.

Steroid injection – Steroids are used to reduce inflammation and decreased pain.


  • Avoid using harsh and irritating skincare products
  • Do not wash your face excessively because you’re stripping off the skin of essential oils
  • Avoid certain products, such as facial scrubs, masks, and astringents that can irritate the skin.
  • Avoid using skin irritants like sunscreens, greasy cosmetics, and acne concealers.
  • Protect your skin from the sun. Use umbrellas and wide-brimmed hats to prevent excessive exposure to the harmful rays of the sun.
  • Avoid pressure or friction on the affected skin. Protect the skin from contact with items like helmets, tight collars, tight straps, backpacks, and phones.
  • Wash the area with a gentle cleanser
  • Avoid using harsh products on your face or the area of the body with acne. Use a gentle cleanser and do not wash the area excessively
  • An oily skin is prone to the development of acne. Look for products that can dry the excess oils on the skin. Look for products containing benzoyl peroxide as the active ingredient.
  • Always shower every after strenuous activities, particularly if you are sweaty. Sweat os the number one skin irritant that could lead to the formation and development of oily skin and eventually, acne.
  • Always moisturize the skin. Dry skin is prone to being oily and packed with pimples.


Acne is not a life-threatening condition. However, it could lead to permanent scarring.
Also, when a person has acne, he or she could feel embarrassed to face other people and attend social events. There are some instances that the condition may take a toll on their emotional, social and psychological health.