Acne is one of the most well-known and most common skin conditions. It affects millions of people worldwide and, especially in its more severe form, it can have a significant physical and psychological impact on a patient’s life.

It is typically more common during adolescence, but this does not mean it cannot reappear in adulthood. In fact, some people never had a problem with acne during their teenage years, yet develop it later in life. Acne usually appears on the face, chest, back, and shoulders.

What is acne?

The term acne refers to a chronic inflammatory condition of the pilosebaceous units, characterised by comedones, papules, pustules, nodules, and scarring. It is extraordinarily widespread, with around 85% of people experiencing this condition at some point in their lives. It affects people of every age and gender and is very common in the pre-teen, teenage, and, very often, the adult life of many people.

Its lesions are essentially caused by the obstruction of the follicles by a keratin plug, which is the result of excessive proliferation and abnormal differentiation of keratinocytes.

What are the causes of acne?

Acne can develop in someone’s life for various reasons. Its development is influenced by a combination of factors, including:

  • Excessive sebum production: The sebaceous glands in the skin produce sebum (skin oil). Overproduction of sebum can clog hair follicles and contribute to acne formation.
  • Clogged pores: The build-up of dead skin cells and sebum can block hair follicles, creating an ideal environment for bacterial growth.
  • Bacterial infection: Propionibacterium acnes (P. acnes) is a bacterium that plays a key role in the development of acne, causing inflammation and irritation in the hair follicles.
  • Hormonal changes: Hormonal fluctuations, often observed during puberty, menstruation, and pregnancy, can trigger acne flare-ups. Androgens, the male hormones, stimulate sebum production and can worsen acne.
  • Heredity: A family history can increase the likelihood of developing acne. If parents had acne, the patient may have a genetic predisposition.
  • Lifestyle: Poor dietary choices, stress, and inadequate skincare practices — for instance, using unsuitable cosmetics or failing to remove make-up — can make it worse.

What are the different types of acne?

The type of acne a patient is dealing with depends on the severity of the acne lesions. A first distinction is made between non-inflammatory and inflammatory acne. Inflammatory acne is in turn divided into different grades depending on the type of symptoms.

Acne presents itself in various forms, such as:

  • Seborrhoea: increased secretion of sebum.
  • Blackheads (open comedones): small, dark bumps on the surface of the skin caused by clogged hair follicles.
  • Whiteheads (closed comedones): similar to blackheads, but with a closed appearance and a white or beige colour.
  • Papules: small, red bumps on the surface of the skin.
  • Pustules: red bumps filled with pus that may have a white or yellow centre.
  • Nodules: large, painful, solid lumps beneath the surface of the skin.
  • Cysts: deep, painful, pus-filled lumps that can cause scarring.

The severity of acne can range from mild to severe, with the potential for scarring in more severe cases. Blackheads and whiteheads are usually considered mild acne. Papules and pustules indicate moderate acne. Nodules and cysts are classified as severe acne due to their potential for scarring.

Among the more severe types is acne fulminans, a rare type that mainly affects young men. The acne lesions, which are essentially scars, primarily appear on the face, back, chest, and shoulders. Another form of acne, again most commonly seen in the male population (men aged 18–30), is acne conglobata. This form manifests as purulent cysts and abscesses and may be accompanied by other dermatological or musculoskeletal conditions.

Women after puberty may face pyoderma faciale, which is a severe form of rosacea-related acne and causes scarring of the skin. Finally, there is gram-negative folliculitis, a bacterial infection that causes cysts, pustules, and nodules around the nose and mouth.

It is worth noting that traumatic acne is also included among the types of acne — patients press on acne lesions (e.g., with their fingers) and thus cause injuries to the skin, which in turn lead to scars (superficial or deep) — as well as acne caused by cosmetics or creams that are unsuitable for the patient’s skin and worsen the condition in an organism that is predisposed or has hormonal problems.

What does acne treatment include?

Treatment options for acne are diverse and can be tailored to the specific needs of each patient. They also depend on age and on the severity of the acne. Therapeutic options for managing acne include:

  • Anti-acne products: Creams, gels, special soaps, and lotions designed for acne-prone skin can help with acne symptoms and even significantly reduce them. These products do not require a prescription and can help unclog pores and reduce inflammation. It should be noted, however, that these products are not suitable for severe cases of acne and essentially serve as maintenance aids for healthy skin in people predisposed to the condition.
  • Topical Medication: These are medications applied locally and include topical retinoids (tretinoin, adapalene, tazarotene) and antibiotics (clindamycin, erythromycin). They promote normal exfoliation of the follicular epithelium and have strong anti-inflammatory properties. They are ideal for mild to moderate inflammatory acne.
  • Oral or Subcutaneous Medication: As with topical drugs, the medication includes antibiotics and retinoids — only here, intake is by mouth in tablet form or via injection. The main antibiotics used are doxycycline and minocycline. These agents are indicated for moderate to severe acne, with administration potentially extending up to 8 weeks before the effectiveness of treatment can be assessed.
  • Retinoids: indicated for severe cystic acne but also for milder forms. They are the most reliable therapeutic approach and are administered in doses of 0.5–1 mg/kg divided into 2 doses. Patients should not exceed a total of 120–150 mg/kg over the course of treatment, and caution must be exercised when administered during summer months due to potential phototoxicity.
  • Non-pharmacological treatment: With advances in medicine, there are now many acne treatments, allowing patients to avoid medication if they prefer. Phototherapy is the most reliable method for tackling acne. Dermatological procedures such as chemical peels and dermabrasion are also excellent additions to the arsenal against acne.

What are the advantages and disadvantages of each treatment?

The choice of treatment depends on several factors, including the type and severity of acne, the patient’s age, and other individual factors related to the patient’s life stage and wishes.

Topical medications are usually less invasive but may take longer to show results. Systemic treatment can offer faster relief, but at the same time may produce side effects requiring monitoring.

Finally, non-pharmacological treatments can offer rapid improvement, but require treatment-free intervals and many sessions. A specialised dermatologist can safely guide patients toward the treatment method they need.

How can a dermatologist help with managing acne?

Dermatologists are physicians specialised in the health of the skin. Their role in acne treatment includes:

  • Diagnosis and assessment: Dermatologists can accurately diagnose the type and severity of acne, identifying any underlying factors contributing to the condition.
  • Personalised treatment plans: Dermatologists develop individualised treatment plans tailored to the patient’s unique needs, ensuring the most effective approach.
  • Prescription of medication: Dermatologists can prescribe topical and oral medications, including antibiotics and isotretinoin, and monitor their use as well as manage any side effects.
  • Procedural interventions: When necessary, dermatologists perform procedures to relieve acne symptoms, reduce scarring, and improve the appearance of the skin.
  • Education and prevention: Dermatologists educate patients about proper skincare practices and lifestyle modifications to prevent future acne breakouts.

Why should you seek the specialised help of a dermatologist?

Dermatologists are specialised physicians who are familiar with all the latest developments in skin conditions and new treatments. Their guidance reduces the risk of scarring and complications. Dermatologists can address both the physical and psychological aspects of acne.

How can you better care for acne-prone skin?

Patients suffering from chronic acne can follow some tips to reduce and limit symptoms. These tips, however, mainly concern people with mild or moderate acne.

They include:

  • Use of skincare products specifically designed for acne-prone skin.
  • Washing the face at least twice a day with appropriate products.
  • Care when shaving, especially over areas with lesions.
  • Avoiding facial scrubs and deeply hydrating masks.
  • Using cosmetic products that are water-based or non-comedogenic.
  • Sun protection. For some people, the sun worsens the discoloration that sometimes remains after acne resolves. Some medications also make the skin more sensitive to sunburn. You can regularly use a non-greasy (non-comedogenic) moisturiser that includes sunscreen.
  • Avoid rubbing or pressing on acne-prone skin. Protect skin prone to acne from contact with objects such as phones, helmets, tight collars or straps, and backpacks.
  • Avoid touching acne-prone areas. Doing so can cause more acne or lead to infection or scarring.
  • Shower after strenuous activity. Sweat can lead to flare-ups.

Conclusions

Understanding the causes, types, and treatment options for acne is vital for managing it effectively. The advice of a dermatologist is essential, as they are best placed both to identify the type and severity of acne and to recommend a personalised treatment plan that fully matches each patient’s needs.