Going through puberty as teenagers often comes with our first experience with pimples and acne. However, acne affects people of all ages and can vary in severity from person to person. Studies show that in Australia, 18.4% of women and 8.3% of men aged 25 and older have acne, while international studies indicate that 64% of people in their 20s and 43% of people in their 30s experience acne.
Some people might experience persistent acne in the same areas, while others might have flares and breakouts that come and go. No matter what type of acne you might have, it’s clear that having bad skin can be tough on your confidence. This guide will take you through the different types of acne, causes, treatment and medications so you can feel good about the skin you’re in.
Table of Contents:
- What is acne?
- Acne causes
- Types of acne
- Acne symptoms
- Acne treatment and medication
- Frequently asked questions about acne
What is Acne?
Acne is a skin condition that causes whiteheads, blackheads or pimples. It usually appears on the face, upper back, shoulders or chest. While it’s very common amongst teenagers, adult acne is also a common condition that varies in severity and persistence for anyone affected.
Pimples and spots can heal and go away, but more serious types of acne can leave scarring, hyperpigmentation or pitting. That’s why it’s important to not only treat blemishes as they appear but also take preventative measures to help keep your skin clear.
Your skin has lots of pores that are susceptible to being clogged by a variety of things that ultimately lead to acne. The most common causes of acne are oil, bacteria and dead skin cells, but hormones and genetics also play a big role. Contrary to popular belief, there isn’t any scientific evidence that proves that there is a link between acne and things like greasy foods, poor hygiene or use of cosmetics.
Skin naturally produces oil through sebaceous glands, which are located near hair follicles to keep your skin and hair soft and moist. They are most prevalent around the face, which is why pimples most commonly appear there; however acne can occur anywhere on the body. When your sebaceous glands produce too much oil they produce a material called sebum. Any combination of excess sebum, dead skin cells, hair or bacteria can enter and block your hair follicles, resulting in oil buildup under the skin and causing pimples.
There are also hormonal factors that might trigger or aggravate acne. Specifically, hormones called androgens increase in production in both boys and girls who are going through puberty. In adult women, androgens become estrogen. Androgens cause the sebaceous gland to enlarge and create more sebum, potentially resulting in acne.
Women might also notice breakouts around their menstrual periods or during pregnancy. The hormonal activity that occurs around these times can increase androgen levels, and thus oily sebum production.
Studies suggest that up to 80% of acne cases are caused by genetics. However, it’s important to note that there isn’t a particular “acne gene;” rather, genetics can determine how effective your immune system is at warding off the strains of bacteria that cause acne. There are also some genetic hormonal conditions, such as polycystic ovary syndrome (PCOS) that can be passed down through genes.
Types of Acne
There are two types of acne: noninflammatory and inflammatory. Identifying what type you have is key to finding appropriate treatment. It is possible to have multiple types of acne at once. Depending on severity you may want to consult a dermatologist. As the name indicates, inflammatory acne is more severe than noninflammatory and is more likely to cause scarring or pitting. Most of what we commonly refer to as pimples or zits fall under the inflammatory acne category.
Different types of noninflammatory mild acne include:
Different types of inflammatory moderate to severe acne include:
Whiteheads are small, white or flesh-coloured spots on your skin. When your pores become clogged with bacteria, oil or dead skin and close up over the follicle, air isn’t able to enter and react with the debris inside so it remains white in colour. That’s also why the scientific name for a whitehead is a closed comedone.
Blackheads, also known as open comedones, are small, black or dark-coloured spots on your skin that can appear slightly raised. Similar to whiteheads, blackheads form when pores become clogged. The difference is that the pore is open and air causes the material inside to oxidise and darken.
Papules are hard, clogged pores that feel tender and usually look red or inflamed. They are a very common type of pimple that occur when pores become clogged with oil, skin cells and bacteria.
Pustules are similar to papules, but have a white tip in the centre of the bump that is caused by a buildup of pus. These types of pimples are very tempting to pop, but it’s not recommended to do so as popping pustules can cause scarring.
Nodules are a more severe form of acne that develops deeper under the skin than papules and pustules. They are large, hard lumps that can be painful but don’t usually contain pus.
Cysts are a severe type of acne that are inflamed, filled with pus and painful. They occur when pores are clogged by a combination of bacteria, oil and dead skin further below the surface than nodules. Cysts typically develop after an infection and often lead to acne scarring. Cystic acne is the most serious type of acne.
While the term “breaking out” is commonly used to describe any version of acne or flare up of pimples, it’s helpful to understand the different types of acne to see what types of acne symptoms you might have.
The symptoms of acne are persistent, recurrent red spots or swelling on the skin that are potentially inflamed or filled with pus. No matter your age or gender, acne can be found almost anywhere on the body, with the most common areas being the face, back, neck, chest and shoulders.
Whiteheads and blackheads, also known as noninflammatory acne, are the most common types of lesions. These appear as small bumps that are either white or black in the center. There might be just a few, or there might be many across a given area of the body.
Papules and pustules are what are most commonly known as pimples. They are small, red, inflamed and tender to the touch. Just like whiteheads and blackheads, papules and pustules can appear in clusters or individually.
Nodules and cysts are more severe forms of acne that may require a dermatologist to diagnose and treat. Because these types of acne develop further below the surface of the skin and are often due to bacterial infection, the symptoms can be quite severe. Nodules and cysts can be as large as two or three centimeters across and are more likely to lead to permanent scarring.
Acne Treatment and Medication
There are many different types of acne treatments and medications to explore depending on the severity and frequency you experience breakouts. Treatment can be topical, oral or a combination of both.
Mild acne can be treated with over-the-counter medications, such as creams, lotions, gels and cleansers. Common active ingredients in these types of OTC acne treatments include:
- Salicylic acid - Removes dead skin cells to help clear acne and prevent future breakouts. Works best on blackheads and whiteheads.
- Benzoyl peroxide - Removes dead skin cells and oil, but stronger than salicylic acid. Also works to kill bacteria beneath the skin. Works best on pustules.
- Azelaic acid - Prevents sebum eruptions and strengthens cells around hair follicles to help prevent clogging. Works well for acne and other skin conditions like rosacea.
Moderate to severe acne can be treated with prescription antibiotic creams and gels. One popular prescription acne medication has retinoids in it. Retinoids improve acne by increasing the rate of skin cell turnover. With a faster rate of new skin cells developing comes a faster rate at which dead skin cells are shed, reducing the potential for them to clog pores. Women who are family planning or are pregnant should inform their treating doctor as retinoids are contraindicated.
Women might also find success treating acne with the birth control pill. Oral contraceptives are anti-androgens. They can take up to 3-6 months to notice an effect. They help by suppressing the overactive sebaceous glands and can be an effective long-term solution for acne. Talk to your doctor about options that suit your symptoms.
Other oral treatments like tetracyclines are antibiotics that can be used to treat acne. These are contraindicated for women planning pregnancy or are pregnant, as well as for children. If tetracyclines are contraindicated, macrolides are available. As always, talk to your doctor about the different options that are suitable for your needs.
You might also try natural remedies for acne like tea tree oil, witch hazel or apple cider vinegar. However, it’s recommended that you consult your doctor or dermatologist first before trying any home remedies for acne.
Frequently asked questions about acne
Can you get pimples from sweat?
Sweat by itself doesn’t necessarily cause breakouts, but sweat sitting on your skin and face can mix with dirt and bacteria, leading to clogged pores. If you’re wiping your face and body with a towel as you sweat and exercise, the germs on the towel might also contribute to spots appearing.
To help prevent getting pimples from sweating and working out, always wear clean clothes and use a fresh towel. If you’re at a gym, wipe down the equipment before you use it and avoid sharing things like protective gear if possible. Consider showering immediately after your workout and use a mild, oil-free cleanser on your face and any other areas that are prone to acne.
What are acne scars and hyperpigmentation?
Acne scars are textural changes and indentations on the skin as a result of severe acne, such as cystic acne and nodules. It is possible for acne scars to fade and disappear over time through proper diagnosis and treatment. Some acne scar treatment options include corticosteroid injections, dermal fillers and laser treatment. The optimal management of acne scars is prevention by adequate acne medical management to reduce scars from appearing in the first place. Consult your dermatologist before considering any acne scar removal options.
Hyperpigmentation is when dark patches appear where blemishes have healed. This is particularly common in Asian populations. While hyperpigmentation from acne is harmless, it can be frustrating to deal with. Your dermatologist will be able to advise on hyperpigmentation treatment for your skin, including both OTC and prescription options.
What about blackhead extraction and facials?
Spa treatments like facials and blackhead extractions can be helpful in preventing and improving acne. However, these options are not a cure for acne and are generally only effective for mild forms. Different types of facials are designed for different things; for example, blackhead extraction will help clear pores and may smooth skin. Others are designed for deep cleansing and exfoliation, removing dead skin cells and brightening tone. While these types of treatments may calm acne, they don’t address the root cause and may not provide lasting results.
Should I adopt a regular skincare routine?
Because acne is caused by a buildup of various materials on the skin, it is helpful to keep your skin clean with a regular skincare routine. Using a gentle oil-free cleanser and moisturiser in the morning and at night can help keep your skin clear. Because everyone’s skin is different, you may want to consult a doctor before trying different types of products.
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