Acne Causes, Diagnosis and Treatment

Acne Types

Numerous varieties of acne can appear, and each is brought on by a unique set of causes. Acne's primary forms include:

• Blackheads: Dark areas that resemble dirt that are caused by open pores that are overflowing with oil and dead skin.
• Whiteheads: These are closed pores that store dead skin and oil.
• Papules: These are tiny, pink or red pimples.
• Pustules: Tiny pimples surrounded by red rings and filled with pus. If punctured, they are likely to leave scars.
• Cysts: Big, pus-filled zits that frequently leave scars.
• Nodules: Big, uncomfortable, firm pimples that are located deep under the skin.
• Fungal acne: Also referred to as pityrosporum folliculitis, this irritating kind of acne is caused by a yeast (fungus) accumulation inside the hair follicles.

Understanding the different types of acne is essential for setting effective skincare objectives. Familiarity with these terms helps select the right products and develop a targeted treatment plan. Also, knowing the distinctions between pustules and papules, for example, allows for better communication when discussing treatment options.

Symptoms

Acne can develop anywhere on the body, like the shoulders, back, and chest, though it most frequently affects the face. While acne is common among teenagers, it can also appear in individuals in their 40s and 50s.

Acne vulgaris, the typical teenage form of acne, is marked by 3 types of lesions, including:

• The blackhead or comedo
• The inflammatory papule
• The pustule or pimple

Acne manifests on the skin in the following forms:

• Blocked pores (“comedones”), which are either blackheads or whiteheads
• Painful, red bumps, commonly known as pimples or zits
• Pustules, which are bumps filled with pus
• Cysts, the deeper pimples and boils associated with cystic acne

Causes

Acne is caused by blocked hair follicles or pores. Hair follicles are tiny tubes that house hair strands and are connected to various glands. When these follicles become overloaded with material, they become clogged. Substances that can clog the pores are:

• Sebum: This is an oily substance that helps protect the skin.
• Bacteria: Naturally, a small number of bacteria live on your skin, but an excess can block pores.
• Dead skin cells: As your skin sheds old cells to create space for new ones, these dead cells can get trapped in hair follicles.

When pores become blocked, substances accumulate in the follicle, forming a pimple. This blockage prompts inflammation, resulting in pain, swelling, and visible skin discolouration, such as redness near the pimple.

Acne triggers:

Certain environmental factors can lead to acne or make breakouts worse. These include:

• Tight clothing and headgear, such as hats or sports helmets
• Air pollution and weather conditions, particularly high humidity
• Oily or greasy skin care products, including heavy lotions or creams, or exposure to grease (e.g., handling frying oil when working in a restaurant)
• Stress, which raises cortisol hormone levels
• Picking at acne
• Side effects of certain medications

Foods causing acne:

Some research suggests that certain foods and diets may be connected to acne outbreaks, such as:

• Whey protein
• Skimmed milk
• Diets full of sugar

Although high-sugar diets may trigger breakouts, chocolate does not have a direct connection to acne.

To minimise the risk of acne, it’s important to follow a balanced diet rich in fresh fruits and vegetables, particularly those high in vitamin C and beta-carotene. These help ease inflammation.

Diagnosis

Doctors can identify acne through a skin examination. During this process, they carefully assess your skin to understand your symptoms and may ask questions about potential risk factors, such as:

• Are you experiencing stress?
• Does acne run in your family?
• Do you experience breakouts around your menstrual cycle?
• What medications are you currently taking?

There are no specific diagnostic tests required for acne. However, a provider may conduct additional tests to check for any underlying conditions if you develop sudden or severe breakouts, particularly as an adult.

Understanding Acne Grades

Recognising the severity of acne can help individuals determine the most effective treatment. This will also enable them to select appropriate skin care products and decide whether to manage their condition at home or seek professional help.

Dermatologists classify acne into four grades based on its severity:

• Grade 1 (mild): Primarily blackheads and whiteheads, plus a few papules and pustules.
• Grade 2 (moderate/pustular acne): Several papules and pustules, mainly appearing on the face.
• Grade 3 (moderately severe/nodulocystic acne): Many papules and pustules, sometimes accompanied by inflamed nodules. Acne may also develop on the chest and back.
• Grade 4 (severe nodulocystic acne): Large, painful, inflamed pustules and nodules in significant numbers.

Treatment Options

Acne treatment can vary depending on factors such as age, acne type, and severity. The GP may recommend oral medications, topical treatments, or other therapies to manage breakouts. The primary goal of treatment is to prevent new pimples from developing and address existing skin blemishes.

Topical acne treatments:

Topical medications are applied directly to the skin, similar to lotions or moisturisers. Common ingredients in these topical treatments include:

• Benzoyl peroxide: Found as an over-the-counter wash or gel product like Acnecide® and PanOxyl®, this ingredient targets surface bacteria that contribute to acne appearance. Lower concentrations and wash formulations are gentler on the skin.
• Salicylic acid: Available over-the-counter in cleansers and lotions, salicylic acid helps remove damaged top layer skin cells and prevents clogging of the follicles.
• Azelaic acid: A naturally occurring acid from grains like barley, rye, and wheat that helps reduce swelling and eliminates bacteria.
• Retinoids (vitamin A derivatives): Products like Tazorac®, Retin-A®, and Differin® (available over the counter) help clear blackheads and whiteheads and inhibit blocked pores. These must be applied to the entire affected area and not just individual pimples to prevent new pimples formation. It may take several months for the results to show.
• Antibiotics: Topical antibiotics such as clindamycin and erythromycin reduce surface bacteria that trigger and worsen acne. These are more effective when used together with benzoyl peroxide.
• Dapsone cream: A topical treatment with antibacterial properties that helps address inflamed acne.

Oral acne medications:

Oral medications are taken by mouth to help get rid of acne. Options may include:

• Antibiotics: Medications like minocycline, tetracycline, and doxycycline target acne-causing bacteria and are ideal for moderate to severe cases
• Isotretinoin (Roaccutane®): An oral retinoid that reduces oil gland size contributing to acne appearance.
• Contraceptives: Certain birth control pills (e.g., Dianette®, Lucette®, Yasmin®) contain oestrogen and progesterone, which can help manage acne in some women.
• Hormone therapy: This treatment is useful for individuals with acne related to hormonal imbalances. It includes low-dose birth control pills or spironolactone, which blocks hormones that trigger excess oil production.

Additional acne therapies:

If topical and oral treatments aren’t effective or if acne scars develop, a healthcare provider may recommend:

• Steroid injections: Involves injecting steroids into big nodules to ease inflammation and address severe acne.
• Laser and light therapy: These treatments target acne scars by delivering heat to stimulate collagen production and promote new skin growth.
• Chemical peels: This utilises special chemical treatments to eliminate the old skin’s top layer, encouraging smoother and healthier skin growth. It can also help reduce acne scars.

Conclusion

Acne is generally a common skin issue. Usually, if home skincare treatments aren’t effective, medication may be necessary to clear stubborn acne. Consulting a doctor or dermatologist can help you find the right treatment for your skin. Although it might be tempting, avoid picking at acne or popping pimples to prevent scarring. Keep in mind that acne is short-term and can be managed with the proper measures.

For more information or to address any concerns, book an appointment with us today.