Acne: Symptoms, Causes, and Treatment

Acne is a skin condition where hair follicles become blocked with oil and dead skin cells, leading to pimples, blackheads, or cysts. It's most common in teenagers but affects people of all ages. While not usually serious, acne can cause distress and sometimes scars. Treatments range from over-the-counter products to prescription medications.

In plain words

Acne is a common skin problem where hair follicles get blocked with oil and dead skin cells. This causes pimples, blackheads, or painful lumps. It often appears on the face, chest, and back. While most common in teens, adults can get acne too. Mild cases can be treated with store-bought products, but severe acne may need doctor-prescribed medicine. Acne is not caused by dirty skin or eating certain foods. It happens when oil glands make too much oil, pores get clogged, and bacteria grow. Hormone changes, family history, and some medicines can make acne worse. A doctor can look at your skin to diagnose acne. No special tests are needed. Treatments help control acne but don't cure it forever. Good skin care and not picking at pimples can help prevent scars.

What is Acne: Symptoms, Causes, and Treatment?

Symptoms

Early symptoms

Whiteheads: Small, clogged pores that remain closed at the surface (closed comedones). These flesh-colored bumps don't change color when squeezed. (1) (2) (4)
Blackheads: Open clogged pores where the trapped oil and dead skin darken with exposure to air (open comedones). They're not caused by dirt. (1) (2) (4)
Papules: Small red, tender bumps without a visible white center. These occur when hair follicles become inflamed. (2) (4)
Pustules: Red pimples with white or yellow pus-filled centers. These form when clogged pores become infected with bacteria. (1) (2)
Nodules: Large, solid, painful lumps beneath the skin's surface. These deep clogged pores can lead to scarring. (4)
Cysts: Painful, pus-filled lumps deep under the skin. These severe acne lesions are most likely to cause permanent scarring. (4)

Serious or emergency symptoms

Severe nodules or cysts: Deep, inflamed, painful acne lesions that may indicate nodulocystic acne, which can lead to permanent scars without proper treatment. See a dermatologist promptly to discuss treatment options. (4)
Signs of infection spreading: Increasing redness, warmth, swelling, or pain around acne lesions, possibly with fever — this may indicate a spreading skin infection. Seek medical attention immediately as this may require antibiotics. (1)

Causes

Primary causes

Excess oil production: Overactive sebaceous glands produce too much oil (sebum), which can clog hair follicles and create an environment for acne-causing bacteria to thrive. (1) (3) (4)
Clogged hair follicles: Dead skin cells that normally shed can stick together and plug follicle openings when mixed with excess oil, leading to different types of acne. (1) (3) (4)
Bacteria: Propionibacterium acnes bacteria that normally live on the skin can multiply in clogged follicles, leading to inflammation and pus-filled pimples. (3) (4)
Hormonal changes: Androgen hormones increase during puberty, causing oil glands to enlarge and produce more sebum. Hormone swings during menstruation, pregnancy, or with certain medications can also trigger acne. (4)

Risk factors

Age

Acne is most common in teenagers due to hormonal changes, but it can occur at any age, especially in women with hormonal fluctuations. (4)

Family history

If one or both parents had acne, you're more likely to develop it too, suggesting a genetic component to sebum production and inflammation responses. (4)

Certain medications

Drugs containing corticosteroids, testosterone, lithium, or certain birth control methods can trigger or worsen acne in some people. (4)

Friction or pressure on skin

Tight collars, helmets, backpacks, or cell phones pressed against skin can worsen acne in those areas. (4)

Diagnosis

A doctor can diagnose acne by examining your skin. They'll note what types of spots you have, where they appear, and how severe they are. No special tests are usually needed unless there might be an underlying condition causing unusual acne. The clinician will consider your medical history and may ask about stress levels, menstrual cycles, medications, and family history of acne.

Visual examination

A healthcare provider will look at your skin to determine the types of acne lesions (blackheads, whiteheads, pimples, nodules) and their distribution. (5) (7)

Medical history review

Your doctor may ask about your family history of acne, current medications, menstrual cycle patterns, and previous treatments to understand contributing factors. (5)

Treatment

Medication options

Topical retinoids

These vitamin A derivatives help prevent clogged pores by speeding up skin cell turnover. They can improve existing acne and prevent new pimples from forming. (6) (7)

Benzoyl peroxide

Kills acne-causing bacteria, reduces inflammation, and helps clear clogged pores. Available in different strengths for mild to moderate acne. (6) (3)

Topical antibiotics

Reduce bacteria and inflammation when applied to the skin. Often combined with benzoyl peroxide to prevent antibiotic resistance. (6) (7)

Oral antibiotics

For moderate to severe inflammatory acne, these reduce bacteria and inflammation throughout the body when topical treatments aren't enough. (6) (7)

Lifestyle and self-care

Gentle skin care: Wash affected areas twice daily with mild, non-abrasive cleanser and lukewarm water. Avoid harsh scrubbing that can irritate skin and worsen acne. Use hands rather than washcloths. (2) (6)
Avoid picking or squeezing: Resist the urge to pop pimples, as this pushes bacteria deeper, increases inflammation, and raises the risk of scarring and longer healing times. (2) (6)
Choose non-comedogenic products: Use makeup, sunscreen, and hair products labeled 'oil-free,' 'non-comedogenic,' or 'won't clog pores' to avoid making acne worse. (6)
Manage stress: Stress doesn't cause acne but may make it worse. Try stress-reduction techniques like exercise, sufficient sleep, or meditation as part of your overall treatment plan. (6)

Always discuss dosing and treatment changes with your own prescriber.

Possible complications

Scars: Deep acne lesions can leave permanent pits or raised scars (keloids) after healing, especially when squeezed or picked at. Early treatment helps minimize scarring. (4)
Skin discoloration: Dark spots or redness (post-inflammatory hyperpigmentation) may remain for months after acne clears, particularly in people with darker skin tones. (4)
Emotional distress: Persistent or severe acne can affect self-esteem and lead to anxiety or depression, especially in teenagers and young adults. (4)

When to see a doctor

Routine follow-up

If over-the-counter products haven't improved your acne after several weeks of consistent use. (5)
If your acne makes you feel very upset or affects your social life or self-esteem. (7)

Seek emergency care

Get urgent care if you develop signs of a severe allergic reaction to acne medication, such as difficulty breathing, swelling of the face or throat, or hives. (4)
Seek immediate medical attention if you experience severe skin irritation, pain, or signs of infection (pus, increasing redness, warmth, or fever) after trying a new acne treatment. (1)

Frequently asked questions

What is acne?

Acne is a skin condition where hair follicles become blocked with oil and dead skin cells, causing pimples, blackheads, or cysts. It most often appears on the face, forehead, chest, upper back, and shoulders because these areas have the most oil glands. (1) (2) (3)

What causes acne?

Acne develops when your hair follicles become plugged with oil and dead skin cells. Contributing factors include excess oil production, clogged pores, bacteria, inflammation, and hormonal changes that increase oil production. (1) (3) (4)

How is acne treated?

Treatment depends on your acne's severity. Mild cases may improve with over-the-counter products containing benzoyl peroxide or salicylic acid. More stubborn acne may need prescription topical or oral medications like retinoids, antibiotics, or hormonal treatments prescribed by your doctor. (6) (7)

Can acne be cured?

While acne often improves over time, there isn't a permanent cure. However, effective treatments can control acne and prevent new breakouts. With proper care, most people see significant improvement, though some may need ongoing treatment to keep their skin clear. (6)

Does diet affect acne?

Research isn't conclusive, but some studies suggest that high-glycemic foods and dairy might worsen acne in some people. If you suspect certain foods trigger your breakouts, talk with your doctor about trying dietary changes alongside medical treatment. (4)

How should I prepare for my appointment about acne?

Before you see your doctor or a dermatologist, write down how long you have had acne and what makes it better or worse. List every skin product, cleanser and cosmetic you use, plus any medicines and supplements you take. Note any acne treatments you have already tried and how well they worked. People who menstruate may find it useful to note whether breakouts change around their period. It can also help to bring a short list of questions, such as which treatment suits your skin, how long it will take to work, and what side effects to watch for. (7)

References

CDC — Skin Conditions - Acne source 1
NHS — Acne - Overview source 2
MedlinePlus — Acne source 3
Mayo Clinic — Acne - Symptoms and Causes source 4
Cleveland Clinic — Acne source 5
NHS — Acne - Treatment source 6
Mayo Clinic — Acne - Diagnosis and Treatment source 7