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Acne

Last updated March 23, 2018

Approved by: Maulik P. Purohit MD MPH

Check out this great video DoveMed found discussing how dead skin cells and hair cause the blockage of pores that eventually end up as acne. Is it that blockage alone that creates acne? Click on the video to find out. 


What are the other Names for this Condition? (Also known as/Synonyms)

  • Acne Vulgaris
  • Pimples
  • Zits

What is Acne? (Definition/Background Information)

  • Acne, also known as pimples or zits, is a common skin condition, when inflamed red spots or lesions appear on the face, neck, shoulders, and other regions
  • This condition occurs, when the tiny hair follicles become clogged with dead cells and oil. Acne manifests itself as pinheads, whiteheads, blackheads, nodules, and so on. Sometimes, they may be of a non-inflammatory type too
  • Acne is frequently observed in adolescents and is caused due to the growth hormonal changes that take place during that period
  • Depending on the severity of the condition, Acne may be treated with both passive and active measures. These include the use of creams and gels, medications, dermabrasion, skin surgery, and even laser therapy
  • Acne skin condition may not be preventable, but the contributing factors, like cosmetics, certain food types, which aggravate the condition may be controlled

Who gets Acne? (Age and Sex Distribution)

  • Acne is commonly seen during adolescence. However, younger children and adults, can also be affected; though, this occurrence is quite infrequent
  • The skin condition affects both teenage boys and girls equally
  • There is no racial or ethnic predilection

What are the Risk Factors for Acne? (Predisposing Factors)

Following are the risk factors of Acne:

  • Increase in the hormone testosterone that takes place during puberty, puts adolescents at a high risk for Acne
  • The condition can run in families and hence, those with parents/siblings having a positive medical history, may develop Acne
  • Acne is sometimes associated with conditions, such as menstrual periods, pregnancy, menopause, or even disorders, like polycystic ovary syndrome (PCOS)
  • Medications containing corticosteroids and androgens can trigger this skin condition
  • Applying oily or greasy substances on skin, like certain cosmetics
  • Tight clothes and innerwear, helmets, bags, and even the frequent use of mobile phones, which put constant pressure or cause friction on the skin are risk factors

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acne? (Etiology)

  • The roots of the hair (called follicles) are attached to sebaceous glands. These glands secrete oil (sebum) to lubricate the hair shaft and skin surface skin around it. When excess oil mixes with dead skin cells to plug the hair follicles, it leads to the formation of Acne
  • The blocked hair follicles appear as a surface lump (white, black or red, inflamed) or a bulge, in which bacteria thrive. If these are below the skin surface, then they are termed as boils or cysts
  • The following factors may trigger Acne by increasing the sebum production, or have a worsening effect on an individual already with Acne:
    • Hormonal changes during puberty
    • Food habits that include chips, bread, sugar-rich products, dairy items, and a high-glycemic diet
    • Certain drugs that contain androgens and corticosteroids
    • Stress

What are the Signs and Symptoms of Acne?

The signs and symptoms of Acne are as follows:

  • The face, neck, chest, back, and shoulders, are usual sites of Acne skin lesions. However, almost all individuals are affected by pimples on the face

The skin lesions are categorized as inflammatory and non-inflammatory:

  • Inflammatory lesions are of the following type:
    • Lumps formed deep inside the skin, known as cysts
    • Lumps formed on the surface of the skin, known as nodules
    • Small raised projections, called papules
    • Pustules or pimples, which are pus-filled tiny tender bumps
  • Non-inflammatory lesions are of the following type:
    • Whiteheads and blackheads (collectively called comedones) that form, when hair follicle openings are clogged with oil, dead cells, and bacteria

Nodules and skin cysts that are deep into the skin may cause scarring of the skin, which may be permanent.

How is Acne Diagnosed?

  • Acne is diagnosed through a simple physical examination, by the physician or dermatologist
  • The healthcare provider may also ask many questions related to the individual’s age, family medical history, current medications, cosmetics, body lotions used, other medical conditions, infections, etc.

Other tests and analysis for Acne may include:

  • If secondary infections develop, then a culture test may be done
  • In non-adolescent individuals, further medical investigations are often needed to determine the cause of increased testosterone in the body. For example - if Acne is caused by PCOS, then an ultrasound of abdomen may be performed and hormonal blood levels analyzed
  • Invasive methods, such as a skin biopsy is typically not required; Acne diagnosis can be made through a physical examination itself

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acne?

Some of the complications of Acne include:

  • Increased psychological stress, which affects one’s performance at school and college
  • Permanent pitting and scarring of the skin on one’s face and neck - cosmetic surgery may be required to remove such scars and marks in some cases
  • Side effects of the local/topical (antiseptic, anti-inflammatory) applications

How is Acne Treated?

Acne skin condition has several passive and active treatment measures available. All these measures work in different ways to treat any or all of the causative factors, such as:

  • By regulating the excess oil production
  • Through dead skin cell management
  • Destroying infectious bacteria, thereby controlling the inflammations

Treatment measures prescribed are dependent upon the severity of the skin condition. These measures are outlined below:

  • Use of antiseptic, antibiotic topical applications, anti-inflammatory gels, lotions and creams. Benzoyl peroxide is the most common ointment for milder forms of Acne and topical retinoids are used for regulating the hair follicles. Topical retinoids help treat Acne by removing the dead skin, from the affected region
  • Medications, such as antibiotics, oral retinoids, and hormones (like oral contraceptives for women), are used for more moderate cases
  • In case of severe Acne, isotretinoin is prescribed (though, NOT for pregnant women). However, there may be some adverse side effects for this drug and therefore, the patient needs to be closely monitored

Note: Isotretinoin should NOT be used on pregnant women, or on women who are planning to become pregnant. This is very important because isotretinoin can cause fetal abnormalities and malformations, during the growth of the fetus in the mother’s womb, termed teratogenic defects of isotretinoin. Hence, a pregnancy test is usually performed in women of child-bearing age, before starting treatment with isotretinoin.

  • Under local anesthesia, a cosmetic procedure called dermabrasion is performed. In this procedure, the raised lumpy acne scars and skin dark spots are abraded (rubbed-off)
  • There are other cosmetic procedures like, chemical peeling, minor skin surgery (punch excision), and microdermabrasion, which may be used
  • Phototherapy: A controlled exposure to light for a certain time duration; but, this method is not very effective for long-lasting Acne
  • Surgical procedures using laser, to even prevent occurrence of the pimples
  • Several alternative medicines and herbal topical ointments exist. But, these may not have medical acceptance, due to a lack of reliable, verifiable, and/or tested information
  • During the period an individual has Acne, it would be preferable to bring about certain dietary changes, like avoiding foods (like dairy products, sugar-rich foods, chips) that worsens or exacerbates the condition

Taking care of oneself, being clean and hygienic (especially face and hands), avoiding the urge to touch/break the blisters, avoiding oily make-ups and creams, drinking lots of water, etc. are all simple practices that can ensure a faster recovery from Acne.

How can Acne be Prevented?

  • Acne occurs due to various medical factors and conditions that come together; it cannot be prevented
  • There are factors that either contribute to Acne formation, or aggravate the severity of its state/condition - those factors that can be controlled have to be recognized, in order to achieve an early recovery from Acne
  • Bringing about slight changes to the diet, refraining from certain kinds of foods/cosmetic products, and maintaining proper self-care are also beneficial to an early recovery
  • Avoid a high glycemic diet

The glycemic index measures the rate of increase in blood glucose levels, following a meal. Foods with a high glycemic index include white rice, potato, white bread, corn flakes, bagels, etc. Vegetables, nuts, beans, whole grains, many fruits, etc. have a low glycemic index.

What is the Prognosis of Acne? (Outcomes/Resolutions)

Normally, Acne disappears after a period of time - once the adolescence-teenage years pass. In some cases, they are known to be present, well into adulthood (even up to the mid-thirties).

  • Depending on the severity of the condition, Acne clears within 6-8 weeks of suitable and early treatment, leaving no scars in most cases
  • Very severe cases of Acne may cause permanent facial marks, deep pits, pigmented scars, etc., if proper treatment is not administered
  • Due to its physical appearance, Acne could impose a psychological trauma on the individuals, especially on teenagers, causing depression and reduced self-esteem

Additional and Relevant Useful Information for Acne:

  • There is no evidence to prove that oily foods and chocolate-based products have an influence on Acne
  • Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition
  • The presence of dirt on the body is not a causative factor for Acne; but, it helps to be clean and hygienic

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 12, 2014
Last updated: March 23, 2018