How To Treat Acne – An Overview

Acne is a term that includes clogged pores, pimples and lumps or cysts that occur on the face, neck, chest, back, shoulders, and upper arms. It occurs mostly in teenagers between the ages of 12 and 17, but can occur at any age. This condition has many variations and is non life threatening, but the more severe cases of acne can be disfiguring, leaving permanent scars on the affected areas.

The lesions which acne causes are described in five ways: comedos, papule, pustule, nodule and cyst. These terms denote the range or severity. Comedo, also known as blackheads and whiteheads, are at one end of the scale and nodules or cysts at the other.

Usually, the mild cases are cleared up with over-the-counter treatments. Although acne affects girls and boys equally, there are some distinctions. Young men are more likely to have severe, long-term acne while women can have reoccurring or intermittent acne well into adulthood, due to hormonal changes and cosmetics.

Despite the amount of information available about acne, there are many myths that confuse those who suffer from the condition. Rather than finding solutions and treatments to alleviate the symptoms, problems are often compounded by ill-advised treatments based on these myths. Some treatments based on these myths actually do more harm than good.

Let’s begin by taking a look at the myths.

Myth #1: Acne is caused by poor hygiene

Truth: It doesn’t matter how often you scrub your face or other areas affected by acne. In fact, a rigorous regimen of washing and scrubbing can actually irritate the skin and make the acne worse, not better.

Acne is not caused by poor hygiene. It doesn’t mean that hygiene isn’t important, but it’s not the cause. Good hygiene in conjunction with acne treatment products can help. Rather than frequent, harsh washing, it is generally recommended that you wash your face twice to three times a day with mild soap and then pat it dry – don’t scrub dry.
Myth #2: Acne is caused by diet

Extensive scientific research has determined that there is no link between food and acne. However, each of us is individual, so if you find that you break out after eating a particular food, cut back on that food.
Myth #3: Acne is caused by stress

Stress is not a direct cause of acne, but it is true that some types of stress can cause the body to produce a hormone called cortisol, which can irritate existing acne. Indirectly, some medication that we take to alleviate or control extreme stress or emotional problems like depression can be factors in the production of acne. In fact, some medicines have acne listed as a possible side effect.

Myth #4: Acne will go away on its own

This is generally not true. Acne needs treatment to be cured. There is a huge selection of acne treatment products available today, so try some and find what works for you. In some cases, a dermatologist should be consulted and other forms of treatment can be pursued.

Myth #5: Tanning clears up skin

Tanning has the reverse effect. It may have masked the acne, but in reality, the sun can make the skin dry and irritated, which can lead to more breakouts. If you do tan, make sure you are using a sunscreen that doesn’t contain oils and other chemicals that might clog up your pores and cause acne to get worse. Look for noncomedogenic or nonacnegenic sunscreen.

Myth #6: Popping Zits Will Make Them Go Away Faster

Instead of speeding up the process of healing, this action actually prolongs the situation as popping the whitehead caused the bacteria inside to be pushed deeper into the skin, which allows more infection to grow, and ultimately leads to scarring.

Myth #7: Only Teenagers get acne.

The truth is, about 25% – 30% of all people between the ages of 25- 44 have active acne.

For the Parents of Teens with Acne

Acne has affected all of us at one time or another. It can affect your child’s self image as well as their overall social life, and in severe cases can lead to depression and withdrawal.

Let your teenager know that you are available and that you are willing to help him or her with their acne. Talking about your own experiences may help them relate and quite possibly, give them a broader perspective on the condition. Even if they don’t want to talk about it, dealing with acne is one of their major concerns. Consequently, your teenager is trying everything he or she can to control it.

Talking with your teenager about acne can be difficult because they might be embarrassed by their appearance and would rather pretend it wasn’t an issue. The key is to be supportive and understanding. Provide information and advice about how to treat their acne.

One of the most effective ways is to learn as much as possible about the various types of acne and how it can be treated. Simply doing this can go a long way in providing more effective guidance for your children when confronted with decisions related to their treatment. You will be able to help them in the selection of acne medications and perhaps determine whether or not it is an appropriate time to consult with a dermatologist.
What Really Causes Acne?

Doctors and researchers have come to some conclusions about the risk factors that ultimately contribute to the development of acne. According to some researchers, the primary causes are hormones and genetics, but this cannot account for every case.

In some instances, factors like medication, types of cosmetics, and certain aspects of personal hygiene (i.e. methods of cleansing the skin) are more likely to create the conditions for acne’s formation. Environment, can also be a catalyst. Those working with chemicals or who are exposed to oils and greases, have a greater chance of getting acne because the materials themselves can clog the pores.


With the onset of puberty, the human body starts to produce hormones called androgens. These cause the enlargement and over stimulation of the sebaceous glands which are found in the hair follicles or pores of the skin. The extra sebum or oil that the sebaceous glands produce mixes with dead skin cells and bacteria on the skin’s surface and this blocks pores. Within the blocked pore, the bacteria multiply and cause inflammation. All of this leads to the lesions that are associated with acne.
Teenagers are the most common sufferers of acne, purely because of the hormonal shifts that are associated with puberty. Current figures indicate that nearly 85% of people will develop acne at some point between the ages of 12 and 25.
It is also important to note that the hormonal changes associated with both the menstrual cycle, pregnancy, and even menopause have been shown to be culprits in the creation of acne. Also, when women are either beginning or ending their usage of birth control, the hormonal fluctuations can cause acne.
Furthermore, fluctuations in the hormones of men and women, can cause spikes in the production of sebum in the sebaceous glands.


Another factor is genetics. Many researchers believe that the tendency to develop acne can be inherited from parents. In studies conducted by a number of scientists, links have been found between those presently suffering from acne and the presence of acne in their family history.
Other Factors


The side effects of certain drugs can cause acne. Examples can include: barbiturates, anti-depressants, anti-anxiety medication, lithium and certain forms of steroids.

Heavy or oily cosmetics
In the case of certain cosmetics, their ingredients can affect the structure of hair follicles and lead to over-production of sebum, which in turn clogs the pores.

Over-abrasive cleansing

Astringent facial products can dry the skin out and cause the body to overproduce sebum to compensate. The use of harsh exfoliators can damage existing spots and spread infection.

Flare Up Factors

Pressure from helmets or hats, backpacks, and tight clothing
If there is pressure against the skin, the potential for irritation and acne breakouts is much greater. Friction from tight clothing, or pressure from a hat or helmet can affect the pores and cause acne to flare up.

Environmental irritants

If a person works in a garage or a factory, certain chemicals present in such environments can actually cause acne flare-ups.
Pollution can have much the same effect upon the skin, clogging pores and creating infections.
Heavy scrubbing of skin
Picking or squeezing blackheads or whiteheads can cause the infection to move deeper into the skin, which will lead to scarring.

Types of Acne

Acne Vulgaris

acne Cosmetica

Acne vulgaris is another name for common acne. This is the type of acne that mainly affects adolescents, but may persist and become more severe as one reaches adulthood.

Mild to Moderate acne vulgaris is characterized by the following lesions:


Whiteheads result when a pore is completely blocked, trapping sebum, bacteria, and dead skin cells, causing a white appearance on the surface. Whiteheads have a shorter life span than blackheads.


Blackheads result when a pore is only partially blocked, allowing some of the trapped sebum, bacteria, and dead skin cells to slowly drain to the surface. The dark color associated with its appearance is not caused by dirt. It is a reaction of the skin’s own pigment, melanin, reacting with the oxygen in the air. As a whitehead has a short life cycle, a blackhead is a firmer structure, and can often take a long time to clear.


Papules are inflamed, red, tender bumps with no head.

acne papules


A pustule is similar to a whitehead, but is inflamed, and appears as a red circle with a white or yellow center. This is what is commonly called a “zit.”
Severe acne vulgaris can be distinguished by the presence of nodules and cysts:

Acne Nodules


As opposed to the lesions mentioned above, nodular acne consists of acne spots which are much larger, can be quite painful and can sometimes last for months. Nodules are large, hard bumps under the skin’s surface. Scarring is common. Absolutely do not attempt to squeeze such a lesion. You may cause severe trauma to the skin and the lesion may last for months longer than it normally would if you don’t touch it.


An acne cyst is often similar in appearance to a nodule, but it is pus-filled, and has been described as having a diameter of 2 inches or more across and is often very painful. Again, scarring is common with cystic acne. Squeezing an acne cyst may cause a deeper infection and more painful inflammation which will last much longer than if you had left it alone.

Adult Acne

Adult acne is a form of acne vulgaris that affects adults over 30 years of age. Because acne is normally associated with the hormonal fluctuations that occur during puberty, its appearance in an adult should be investigated to determine the underlying causes, especially if it appears for the first time in adulthood.

Some adult acne is caused by:

Medication Some medications can induce acne. Anabolic steroids, anti-epileptic medications, anti-tuberculosis drugs rifampin and isoniazid, lithium and medications that contain iodine.

Chronic physical pressure on the skin Whether chaffing from wearing a helmet or carrying a backpack, such pressure against the skin can lead breakouts

Chlorinated industrial chemicals Working in certain types of industrial environments can cause acne-like symptoms or even chloracne, an occupational skin disorder caused by prolonged exposure to chemicals like chlorinated dioxins.

Metabolic changes Changes in the body’s hormonal balance, such as those present during pregnancy or menstruation can produce acne in adults.


Rosacea is often misdiagnosed as acne. Rosacea affects thousands of people in the U.S. alone, mostly those over the age of 30. It generally appears as a red rash confined to the cheeks, nose, forehead and chin. This redness is often accompanied by bumps, pimples, and skin blemishes–the reason it is so commonly mistaken for acne. Further, this redness is also linked to the fact that blood vessels may become more visible on the skin.

Rosacea has been shown to be more prevalent in women than in men, but often if found in men it tends to be more severe. If you are seeking treatment and you think it may actually be Rosacea, you need to be aware that the treatments differ quite a bit from those used in the care of acne vulgaris.

Acne Mechanica

acne mechanica

This form of acne is caused by external mechanical forces like constant pressure, constant and repeated friction, covered skin, and heat. For those involved in sports, in the military or in high-activity jobs, this is nothing new, as the condition is common with many athletes and in professions where factors like tight-fitting, or restrictive clothing is worn for extended periods of time. These sorts of jobs may include certain kinds of factory work where an employee may be busy with repetitive tasks that may irritate the skin and lead to break outs.

Further examples of possible causes may include:

Wearing head bands that rub the forehead and irritate the skin

The kind of friction caused by physical contact with musical instruments for extended periods of time
Wearing tight clothing like blue jeans or undergarments made with synthetic materials

Bra straps

Acne Cosmetica

Women who wear make-up or cosmetics may find they experience breakouts on their foreheads or cheeks. This form of acne is generally caused by the type of cosmetics a person is using.

Pomade Acne

When hairstyles change, it is not uncommon for teenagers and young adults to adopt new styles. But, sometimes a new style requires the use of a thick, oily hair cosmetic called pomade. Pomade is generally used when a hairstyle requires that curly hair be straightened or hair be molded into various shapes.

One of the undesired effects may be pomade acne. Pomade acne occurs on the scalp, forehead, and temples where pomade comes into contact with the skin.

Most pomades fall into the category of comedogenic – or pore clogging cosmetics. The heavy oils used in pomades can clog pores, setting the stage for the formation of comedones. In addition, some of the other chemicals in pomades may irritate the skin, contributing to inflammation.

Excoriated Acne

The term excoriated means to scratch or abrade the skin. Excoriated acne is defined by the behavior of the person suffering from it. When the person obsessively picks and scrapes at every pimple and blemish on their skin, they are said to have excoriated acne. Because of the excessive nature of the attention given to the sufferer’s skin, deep irritation can result as well as scarring.

Though it may appear to others as a mild form of acne, without pustules or nodules, to the person dealing with it, this condition may be intolerable. This almost psychological urge to get rid of one’s skin lesions or blemish can become very damaging. It is recommended that a dermatologist be sought for treatment.


Baby Acne

This form of acne occurs in newborns and is concentrated on the nose and cheeks. It is caused by the hormonal changes that occurred while the fetus was developing in the womb. Typically, the acne clears up in matter of weeks without treatment.


However, infantile acne has a serious aspect that must be considered. If simple cleansing with mild soap and water will not clear up the acne, then a mild topical agent like a prescription form of benzoyl peroxide for infants can help the current situation and prevent scarring. If this does not help, then a dermatologist may need to be consulted.

Things to note:

Family History. Genetics might be a factor in the development of acne in the infant. Do the child’s parents or siblings have acne or did they have it in the past?

Early hormone production. Some infants have a condition that causes early production of sex hormones, like androgen, which is linked to acne. If this is the case, medical help should be sought to avoid problems with the child’s development.

Growth and developmental abnormalities. Acne at such an early stage in the child’s life could indicate developmental problems that might not show up until later. A pediatrician should be consulted to see if this might be a possibility.

Drug-induced acne or acneiform eruption. If your child has been exposed to medications that include corticosteroids or iodine, they could develop acneiform lesions.

Severe Acne

There are four types of severe acne that are categorized by the type of lesions that it produces and long term effects it can have for the sufferer. This extreme acne affects more than just the body, it can affect every aspect of a person’s life. The emotional and psychological aspects can lower the quality of life and permanently destroy self-esteem.

Acne Conglobata


Acne Conglobata is the most severe form of acne vulgaris. This form of extreme acne is characterized by large, interconnected nodules and widespread blackheads. Because theses lesions can become ulcerated, they can cause severe, permanent damage. Acne conglobata is commonly found on the face, chest, back, buttocks, upper arms, and thighs.

Acne conglobata affects adults between 18 and 30 and is more prevalent in men than women. It should also be noted that acne conglobata can stay active for many years, lying dormant until something causes it to resurface. As with all types of acne, the cause of acne conglobata is not known.


This type of severe acne is actually an abrupt onset of acne conglobata that typically afflicts young men. The symptoms of the severe nodulocystic, often ulcerating acne, are readily apparent. As with normal cases of acne conglobata the lesions cover large portions of the extremities including the facial region. Acne fulminans is unique because it also includes fever symptoms, aching of the joints, particularly the knees and hips, and varying degrees of weight loss.

Gram-negative folliculitis

Gram-negative folliculitis is a form of extreme acne caused by an inflammation of the follicles. It’s caused by a bacterial infection and is characterized by pustules and cysts. In some cases, its development is caused by a complication resulting from long-term antibiotic treatment of acne vulgaris.

Pyoderma Faciale

This type of severe acne only affects women between the ages of 20 to 40. It is characterized by large painful nodules, pustules and sores that may leave scarring. Forming abruptly, pyoderma faciale may occur in women who have never had acne before. Generally, this type of extreme acne is confined to the face, and though it usually does not last longer than a year, it can cause a great deal of damage in a very short time.
Natural Acne Remedies

Hot/Cold Compresses
Soak a clean hand towel in hot water and wring it out so it’s damp, but not soaking wet. Place the towel over the infected area so it opens the pores. When the towel feels warm, gently dab the infected area, cleaning away any residue. Take another hand towel and repeat the process.

Then take a third hand towel and soak it in cold water. Wring it out so it’s damp, but not soaking and place it over the infected area. This closes the pores.

NOTE: Use white hand towels. Many people with skin irritations react to the dyes in colored textiles.

Drink Water
This natural remedy for acne is simple. If you drink a sufficient amount of water per day, typically 7-8 glasses, your body eliminates toxic elements that can contribute to the development and spread of acne. You may also try boiling water and adding fenugreek seeds and corn.

Oils and Juices
Though it can seem odd, the benefits of using natural substances like almond oil can actually help with the removal of acne scars. Apricot juice also helps to alleviate the presence of cysts.

Blend a mixture of cucumber juice, carrot juice, alfalfa or lettuce and apply to the infected area. Apply lemon juice to the affected area. Let it dry for 10 minutes and rinse off with cool water.

Fenugreek leaves
This remedy prevents breakouts. Crush the Fenugreek leaves into a paste and apply it to infected areas every night, then wash it away the following morning with warm water.

Honey Mask
Because honey has naturally occurring anti-bacterial qualities it is often applied to the face as a mask, killing surface bacteria. Typically, the mask should be applied once or twice weekly depending upon the results.

Distilled white vinegar
Apply the vinegar as a topical solution, letting it sit on the infected area for at least 5-10 minutes. Then rinse it thoroughly with cool water. Often the vinegar can be a little too strong, so it is recommended that you dilute it, though not too much.

Make-up or Cosmetic Usage
Avoid using cosmetics because they contain chemicals and oils that clog the pores, and lead to breakouts.

More Remedies

In addition to the natural remedies for acne, there are other options available too.

Diet and vitamin supplements
Most of the fruits and vegetables we eat have been sprayed with pesticides, grown in fertilizer enhanced dirt and further manipulated with chemical preservatives, so it’s not surprising that some acne may be caused by allergies to chemicals.

To combat this, eat a balanced diet and take a hearty multi-vitamin. It can help reduce the chances of some bio-chemical conditions which provide fertile ground for acne.

Echinacea and Oregon grape
These herbs are both useful for boosting the body’s immune system and also combating many forms of acne-causing bacteria.

Vitamin A
Large quantities of Vitamin A have been used to successfully treat some severe forms of acne. If you plan to use vitamin A as a possible remedy, consult a physician first. Large enough doses can be toxic.

Zinc can aid in the healing of acne lesions and help in the prevention of scarring.
Over-the-Counter Acne Remedies

Before starting a regime of over the counter treatments, consult a physician. Even though acne is generally a benign condition, a doctor or dermatologist can advise you on the best treatment as well as provide further suggestions based on the particular kind of acne you may be suffering from.

You should not rely strictly on the advice of friends or family, because what may work for one person may not work for another. You should also have some background knowledge about the active ingredients in various acne medications, so you can make a better-informed choice.

One of the most popular ingredients in acne medications is benzoyl peroxide. Found in gels and ointments, it helps by combating the bacteria that cause acne. It is also useful for removing dead skin cells that accumulate on the surface of the skin and create blackheads and whiteheads.

Benzoyl peroxide has been proven to be safe and effective in combating lesions. It can also be used as a means of acne prevention by keeping the skin free from acne causing bacteria. The only side effect associated with this ingredient is dry skin. This can be avoided by decreasing the frequency of use.

Another ingredient commonly found in a majority of acne medications is salicylic acid. This prevents acne by clearing up dead skin cells that are accumulating too quickly and clogging the pores. If the medication you are using contains salicylic acid you should continue to use it after the skin has cleared up to prevent future outbreaks. The only side effects associated with salicylic acid are dry, irritated skin.
Other ingredients

Besides the more common ones, there are other ingredients you may see in acne medication such as resorcinol and sulphur. Resorcinol causes the top layer of skin to peel and removes the dead skin cells that clog the pores. Resorcinol is often combined with sulphur, which seems to increase the effectiveness of the substance.

Of all the ingredients that have been listed which are effective in fighting acne or preventing its outbreak, benzoyl peroxide is probably the most versatile. It can be used in cleansing liquids or bars, as well as lotion, cream, and gels. The cleansing products are used once or twice a day, while the creams and lotions can be used as needed. They should be applied on the skin around the acne as well as the pimples themselves for overall effectiveness. You should try to avoid getting benzoyl peroxide in your eyes, mouth or nose, as it will cause irritation or inflammation.


Generally, mild and moderate forms of acne can be treated with over-the-counter medications, but with severe cases you may need to seek treatment from a dermatologist. In many cases, the doctor will recommend an oral or topical prescription medicine to deal with the condition.


Commonly used to fight acne, antibiotics can be taken orally or as a lotion. Topical prescription medications may include ingredients such as zinc or retinoids. The most common antibiotic used for treating acne is tetracycline. It is used to kill the bacteria responsible for acne and also reduces inflammation. Treatment may take several weeks or even months to be effective and it’s important to continue using antibiotics even after the acne has cleared up.

A common side effect associated with tetracycline is increased sensitivity to sun light, resulting in bad sunburns if you stay in the sun too long. Further side effects may include dizziness, hives, and upset stomach.

Women who are taking tetracycline may be susceptible to an increase in incidences of vaginal yeast infection.

Ointments and topical solutions

Antibiotic ointments actually have fewer complications than oral antibiotics. If you use these ointments with other topical treatments like benzoyl peroxide, the bacteria may not develop resistance to the antibiotics. This increases the level of prevention.


Retinoids are a form of acne medication that are derived from vitamin A and can be applied directly to the skin. Topical retinoid medications are useful for treating blackheads and whiteheads by helping to open clogged pores.

Oral retinoids are used to treat the more severe forms of acne, because they have a better chance of stopping breakouts and lesions which don’t respond to other treatments. Oral retinoids cause the upper layer of the skin to peel which opens the pores. They also cause the body to produce less sebum, the substance which causes oily skin.

As with many other types of prescription strength medication, a number of serious side effects are associated with oral retinoids. They can cause liver damage and depression, so regular medical attention is needed to make sure the patient is not being adversely affected by retinoid treatment. This medication can also cause birth defects if mothers are taking it when they’re pregnant.

Other medications

Birth control pills are sometimes effective in treating acne in women. They change hormone levels in the body and can reduce the acne causing effects of testosterone.

Surgical Options

If you are considering the possibility of treating acne with laser therapy or surgery, fully evaluate each of the processes, including the number of required treatments, the costs, and the potential side effects of the treatment. It’s also important that you select a process that is designed to deal with reducing the presence of acne without scarring.

Acne Surgery

Acne surgery involves making an incision into the affected area and draining the clogged matter. The process for blackheads and whiteheads doesn’t actually involve surgery, but is often performed by a nurse, esthetician or dermatologist. A small, pointed blade is used to first open the comedone and then gently work the material out using a comedone extractor.

Severe cysts can be drained and removed by excisional surgery. The procedure extracts the cysts in a sterile environment so additional bacteria does not enter the wound and develop serious infection or create scarring.

Forms of Physical Treatment


This treatment involves removing the top layer of skin chemically or with an abrasive. Chemical peels are usually done with salicylic acid or glycolic acid. These work by destroying a microscopic layer of skin cells to unclog pores and remove the build-up of dead skin cells. The same effect can be achieved by using an abrasive cloth or liquid scrub.

Comedo Extraction

In this procedure, an anesthetic cream is applied to the affected area. The comedones (blackheads and white heads) are extracted using a pen-like instrument which opens the top to allow the removal of dead skin cells and sebum from the follicle. The procedure is usually followed by an application of antibiotic cream.


With many forms of severe acne, cysts can form under the skin and become very painful, even disfiguring. Often, the smaller cysts can be treated with cortisone injections which will flatten the lesion in a few days. But for larger cysts the only alternative is to have them drained and then surgically removed. Drainage can help relieve the pain associated with cysts and also reduce the chance of scarring. It is important not to try to drain cysts yourself, because you risk infection, which could lead to permanent scarring.

Laser Treatment

Laser treatments involve the use of varying wavelengths that are aimed directly at the affected area of the skin. These wavelengths pulsate against the skin and destroy overly-large sebaceous glands and acne lesions. Laser treatments remove the damaged outer layers of skin so that new cell growth can be initiated. The laser technician varies the intensity of the laser as necessary to effectively treat the area.

Despite all of the benefits, there is still considerable debate surrounding the effectiveness of laser therapy. It has been shown to be effective in improving the skin’s appearance, but as with most of the other available acne treatments, there are some side effects.

For example, patients can experience red, burned skin after treatment that can last for weeks. Individuals with dark-colored skin can end up with skin discoloration after laser treatments. Finally, the skin’s appearance can be uneven if the laser is applied inconsistently.

Acne Prevention

Here is a final checklist of valuable acne prevention methods:

Find a regimen and stick with it – Pick your medication and treatment method and do not deviate from it unless your condition is worsening.

Don’t use alcohol – Do not use products, like toners, if they contain heavy concentrations of isopropyl alcohol. This can do more damage than good.

Don’t over-wash – Wash a maximum of two times a day. Anymore, and you risk increasing the breakouts you have.

Choose skin products carefully – Don’t get harsh or abrasive scrubs that can tear the skin and further aggravate the acne.

Wash after exercising – Don’t forget to hit shower after you’ve had a workout. The friction and moisture caused by clothing rubbing against the skin can create the perfect conditions for acne production.

Avoid constant touching or picking at your face – This is pretty self-explanatory. These activities can cause bacteria to get into pores and create acne.

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