Acne vulgaris, commonly known as acne, is a condition that causes flares or breakouts of pimples, zits, and blackheads in the skin. These breakouts are the result of pores being blocked by oil and dead skin cells, which leads to inflammation.
Acne commonly affects the face during puberty, but it can affect other parts of the body and happens to people of all ages. It may impact mood and self-esteem, but fortunately, there are many ways to prevent or manage breakouts.
Read on to learn more about the different types of acne and how to deal with breakouts and acne scars.
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Types of Acne
Acne can be classified by its causes (fungal, bacterial, hormonal), severity (mild to severe), or blemish type. The following is a list of the types of blemishes in acne:
- Blackheads, open comedones (skin pores)
- Whiteheads, closed comedones
- Pimples, also known as papules, which are small red, inflamed bumps
- Pustule, pus-filled pimples
- Nodules and cysts, known as nodulocystic acne, blemishes that may affect deeper layers of skin and can leave scars
What Are the Symptoms of an Acne Breakout?
Acne breakouts can be recognized by the appearance of blemishes on the skin. These blemishes are small spots that have differences in coloration and texture, and may be painful.
Comedones are small and can be either darker (blackhead) or lighter (whitehead) than your skin. Pimples, nodules, and cysts, on the other hand, tend to be larger and may appear pink, purple, or brown depending on your underlying skin tone. You may be able to notice a white or yellow area within the pimple when it's filled with pus.
When inflammation is present, acne blemishes can be tender. Pustules can open up and cause crusted areas on the skin's surface. Even after they heal, acne breakouts can cause a darkening of the skin, known as post-inflammatory hyperpigmentation, especially in people with darker skin tones. Scarring can also occur, particularly with nodulocystic acne.
What Causes Acne?
Acne is caused by a blockage of a hair follicle or pore by sebum, an oil produced by your sebaceous glands. When there is too much sebum on your skin it can make you more prone to acne. Bacteria like Propionibacterium acnes, (which lives naturally on your skin but may overgrow) and/or dead skin cells can also clog your pores.
The following may contribute to acne breakouts:
Hormonal Changes
Hormonal changes, such as during puberty, menses, and pregnancy lead to changes in skin oil production.
While acne is common during puberty, it can happen at any age. In fact, 1 in 5 babies frequently develop acne shortly after birth related to hormone shifts.
Fungal Infections
The fungus Malassezia folliculitis (also called Pityrosporum folliculitis) causes a type of acne called Malassezia folliculitis or fungal acne.This condition causes inflamed pimples to appear on the upper torso.
Medications
Several medications can worsen acne breakouts. These include:
- Corticosteroids
- Testosterone and androgen steroids
- B vitamins (vitamin B6, B12)
- Medications for mood disorders (lithium)
- Tuberculosis medications, such as Trecator (ethionamide), Hydra (isoniazid), and Rifandin)rifampin)
- Seizure medications, like Curatil (carbamazepine), Dilantin (phenytoin), and Solfoton (phenobarbital)
- Immunosuppressant medications like Neoral (cyclosporine )and Imuran (azathioprine)
- Contraceptives, including oral contraceptive pills, medroxyprogesterone injection (Depo-Provera), progesterone implanted devices (including rods implanted under the skin and intrauterine devices), although birth control can also help with acne
Diet
Research has found that certain foods may promote acne or make symptoms worse. Some of these include:
- Carbohydrates. Simple carbohydrates with a high glycemic index have been found to contribute to the development and severity of acne.
- Dairy products. Foods that contain milk proteins including casein and whey may contribute to the severity of acne.
- Sugar. Like carbohydrates, foods and beverages with added sugar have a high glycemic index, which is associated with acne.
- Fatty foods. Eating foods high in fat may contribute to breakouts in some people.
Medical Conditions
Medical conditions like polycystic ovary syndrome (PCOS), Cushing's syndrome, and acromegaly can contribute to acne.
While stress is commonly blamed for acne, it is not thought to cause acne. However, it might lead to the worsening of existing acne.
Myths About Acne Triggers
Acne is sometimes blamed on certain foods like fried foods and chocolate, but the evidence for this association is mixed. There may be a relationship between these foods and acne, but it is likely because of the way your body processes these foods rather than because of the foods themselves.
There is also a myth that acne is caused by poor hygiene. This is not true; in fact, over-washing your skin may actually contribute to acne instead of improving it.
Cosmetics
Certain cosmetics and skin care products can contribute to acne breakouts, especially liquid foundations and concealers, which may contain oils and other ingredients that can clog pores.
Family History
There is also evidence that genetics may play a role in the development of acne, though the connection is complex and likely influenced by other factors. More research is needed before scientists will understand how family history contributes to the risk of developing acne.
Manage and Prevent Acne at Home
Taking simple measures at home can help you manage acne and prevent recurring breakouts.
- Cleanse skin regularly with a nonabrasive cleanser and avoid scrubbing
- Avoid irritating products like astringents, toners, and exfoliating agents
- Use skin products that are labeled as noncomedogenic, oil-free, and alcohol-free
- Avoid touching your face or picking at blemishes
- Protect skin by avoid ultraviolet (UV) rays from sunlight or tanning beds
Should You Pop Zits or Leave Them Alone?
It's best to leave pimples and blemishes alone and resist the urge to pick at or pop them. Manipulating them can make the outbreak worse and may even cause infection and scarring. Instead, consider making an appointment with a dermatologist who can safely extract blackheads, whiteheads, and pimples using appropriate sterile tools.
Topical Medications
Some topical medications for acne can be purchased without a prescription, while stronger versions and others may require a prescription. Be sure to read labels and follow instructions for application.
Topical OTC acne products include:
- Benzoyl peroxide
- Retinoids
- Salicylic acid
Prescription topical agents include:
- Topical retinoids at stronger strengths
- Topical antibiotics, like Cleocin (clindamycin) and erythromycin
- Finacea or Azelex (azelaic acid)
- Combination products like Cabtreo (clindamycin phosphate, adapalene, and benzoyl peroxide)
Diet and Acne
There is conflicting evidence about diet and acne. However, some specific diets have been linked to an improvement of acne in studies, including:
- A low-glycemic diet can decrease blood sugar spikes and, in turn, lessen inflammation.
- A reduced-dairy diet can eliminate acne triggers such as milk and whey products.
- A diet high in omega-3 fatty acids can decrease inflammation.
How to Manage Severe Acne
Acne may be considered severe when it is persistent, involves an extensive area, or includes nodules and cysts, which can cause scarring. Severe acne can benefit from evaluation by a dermatologist.
Dermatologists can help uncover the potential causes of acne, including any other condition that may be worsening acne. They can also recommend specific over-the-counter medications in combination or prescribe more potent acne products.
Prescription acne medications for severe acne include:
- Oral antibiotics, like tetracycline, doxycycline, and Solodyn (minocycline)
- Iisotretinoin
- Aldactone (spironolactone), particularly for hormonal acne in women
Acne in Transgender Individuals
Acne can worsen in people taking masculinizing hormones, like testosterone. In fact, one study showed that up to 94% of those on masculinizing hormones experience acne, particularly early on in therapy. For people in this situation, acne is managed the same as it is for others with one exception: Spironolactone may be avoided as it has feminizing effects such as breast enlargement.
How to Get Rid of Acne Scars
Acne can cause scarring, particularly when it is picked at or when it affects deeper skin layers, such as in nodulocystic acne (a severe type of inflammatory acne). Scarring may become more noticeable with age as the skin's collagen, which provides structure and support, decreases.
Dermatologists can offer several options for scarring, including:
- Chemical peels
- Laser therapy
- Fillers
Tips for Preventing Future Acne Breakouts
In addition to the at-home measures discussed above, some other tips to prevent acne breakouts in those prone to acne include:
- Wash skin regularly (twice a day and when sweaty) with a nonabrasive cleanser.
- Avoid comedogenic cosmetics and skin products that contain alcohol and oils.
- Avoid scrubbing skin and picking at blemishes.
- Consider dietary changes like decreased milk intake, low-glycemic diet, and increased omega-3 fatty acids.
- Manage stress levels.
Summary
Acne is a very common condition that can affect people at any age. Severe cases can lead to permanent scarring. There are many options you can choose from to help you manage acne, from self-care measures to topical therapies to oral medications.
