Acne symptoms & treatment

Whether you call them zits, blemishes, spots or pimples – all these names describe a common, often uncomfortable and sometimes embarrassing, skin condition known as acne. Acne can appear during childhood or adulthood when the pores on your skin become clogged. It can show up anywhere on the body, but it usually appears on the face, neck or chest.

Fortunately, there are a variety of treatment options to help get rid of acne so you can get back to looking and feeling your best.

Types of acne

There are several types of acne, and it’s possible to have different types at the same time. Common types of acne include:

• Hormonal acne: Is caused by fluctuations in hormone levels, often related to puberty, menstruation, pregnancy, menopause or hormonal disorders such as polycystic ovary syndrome (PCOS). These changes can increase oil production in the skin, leading to clogged pores and acne breakouts.
• Nodular acne: Causes large, inflamed and often painful acne breakouts with nodular lumps under your skin’s surface. These nodules may appear dark red or purple and are solid.
• Cystic acne: Acne that produces large, deep, painful, pus-filled cysts, or cystic pimples, on the skin. Cystic acne is the most severe form of acne.
• Fungal acne: Also known as Malassezia folliculitis, fungal acne is caused by an overgrowth of yeast in your hair follicles. This results in a fungal infection that produces itchy, red or pus-filled bumps on the skin. It's important to note the difference between common acne and fungal acne, as their treatments aren’t the same. Unlike fungal acne, common acne typically isn’t itchy.

Newborns can also develop a type of acne, known as baby acne. Baby acne causes small, inflamed bumps on a newborn’s face, neck, back or chest. This common skin condition is temporary and often clears up with time.

Symptoms of acne

Acne can develop on any part of your skin, but it's most common in areas with a high concentration of oil glands like your forehead, chest or upper back. It can also occur in places where you experience friction or pressure, such as from carrying a backpack on your shoulder.

Acne symptoms may appear as:

• Whiteheads: Small blemishes with white-colored heads that appear when follicles become clogged with oil (also called a closed comedone). Whiteheads usually appear on your face, neck and back.
• Blackheads: Very small, dark spots on the skin that are caused by oil build-up in an open follicle, and then darkened due to oxidation (also called an open comedone). Blackheads commonly appear around the nose, chin, chest and shoulders.
• Papules: Tender, reddish bumps that may appear swollen or inflamed. Papules commonly appear on the face.
• Pustules: Similar to papules, pustules are inflamed red bumps that contain yellow or white-colored pus. Pustules usually appear on the face, chest or back.
• Nodules: Red or dark purple firm, painful lumps that form under your skin’s surface. Nodules commonly appear on the jawline, chin, back or chest.
• Cysts: Large and painful red bumps that are deep in your skin. Cysts usually appear on your face, chest, back and shoulders.

Cysts that are not caused by acne are called sebaceous cysts. These cysts grow into moveable, sometimes significantly large (up to two inches in diameter) masses beneath the skin. Sebaceous cysts can grow and develop in weeks, months or even years.

What is the main cause of acne?

Acne is mainly caused by clogged pores. When the pores become clogged with oil and dead skin cells, acne may appear as a whitehead or blackhead.

When bacteria enters the clogged pores and gets trapped along with the oil and skin cells, it causes swelling deep inside the skin. The result is inflammatory, or severe, acne that includes cysts and nodules.

Some studies suggest that stress and a diet high in sugar may exacerbate existing acne. Avoiding these triggers can help improve your skin.

Acne risk factors

Some people are more likely to develop acne, especially if it runs in their family. Other risk factors for developing acne include:

• Genetics: If you have a family history of severe acne, you may have acne prone skin.
• Certain medications: Drugs containing corticosteroids, testosterone or lithium can contribute to acne.
• Cosmetics and skin products: Using oily or greasy products can clog pores and lead to acne.

Acne scarring risk factors

While some people are more prone to scarring than others, any of the following can increase the risk of developing acne scars:

• Deep, severe acne: Swollen cystic acne and nodules are more likely to leave behind acne scars.
• Family history of acne scars: Genetics tend to play a big role in the presence of acne and acne scars.
• Delay in acne treatment: The longer you've had untreated inflammatory acne, the greater the risk of scarring.
• Picking or squeezing acne spots: Popping or picking at acne creates skin inflammation, which increases the risk of acne scars.

How can you clear acne?

While your primary care provider can often assist with acne treatment, it's recommended to see a dermatologist for severe or recurring cases. To provide a diagnosis, a skin specialist will examine the affected skin. You’ll also discuss your history, potential risk factors and symptoms.

They’ll rule out other skin conditions that can resemble acne, such as ringworm rash, eczema papules or inflammatory rosacea. If needed, blood tests can help measure your hormone levels, such as estrogen and testosterone, that are associated with hormonal acne.

Together, you and your dermatologist will create an acne treatment plan tailored to you. The goal is to minimize scarring, reduce acne, improve your skin’s appearance and help you feel your best.

Treatment options for acne

There are several different treatment options available for acne, and the effectiveness can vary depending on your skin type. Your doctor might recommend starting with a skincare routine that involves gentle cleansing at least twice daily to remove excess oil, dead skin cells and bacteria.

For severe cystic or nodule acne, your doctor may recommend chemical peels, dermabrasion or laser resurfacing to treat acne inflammation and reduce scarring. If your acne is caused by a fungal infection, your treatment will include antifungal medications.

It's important to remember that acne treatment can take time to show results. Sometimes, your skin might seem to worsen before it improves. Talk to your doctor if you have any concerns about your treatment or if you experience side effects.

Topical acne treatments

The following are commonly applied directly to the skin to treat acne:

• Antimicrobials such as benzoyl peroxide, topical erythromycin, topical clindamycin and topical dapsone
• Retinoid medications
• Azelaic acid
• Salicylic acid
• Sodium sulfacetamide

Oral acne medications

These are taken by mouth and used mainly for moderate to severe acne:

• Antibiotics: Doxycycline, minocycline, trimethoprim-sulfamethoxazole or erythromycin.
• Spironolactone: Used only in adult women for cystic acne treatment. Targets hormones that can contribute to acne.
• Isotretinoin: Used only for severe acne that doesn’t respond to other treatments (formerly known as brand name Accutane).

Ways to prevent acne

It's not always possible to prevent acne, especially if you have a family history or are going through hormonal changes. However, sticking to a doctor-recommended acne skin care regimen is a good first step. You also can lower your risk of acne breakouts by:

• Applying oil-free moisturizer if your skin feels dry
• Washing your hair regularly and keeping hair (which can be oily) away from your face
• Using noncomedogenic (water-based) makeup and facial products
• Always removing makeup before going to sleep
• Keeping your hands away from your face
• Trying to avoid oily environments, such as working in a restaurant kitchen