Acne: Symptoms, Causes, Treatment, Prevention and management tips

Acne is a chronic, inflammatory skin condition with an increase in sebum secretion that causes pimples and spots,especially on the face, shoulders, back, neck, chest, and upper arms.

Updated: June 16, 2022

Acne is a chronic, inflammatory skin condition with an increase in sebum secretion that causes pimples and spots,especially on the face, shoulders, back, neck, chest, and upper arms. When your hair follicles become plugged with oil and dead skin cells, acne can occur. It is most common among teenagers when the sebaceous glands activate, though it affects people of all ages.The glands produce oil and are stimulated by male hormones produced by the adrenal glands in both males and females.
It is not dangerous, but it can be persistent as well as can leave skin scars. Acne can cause emotional distress depending on its severity. Effective treatments are available and its always better to start the treatment as early as possible to lower your risk of such problems.

Symptoms of Acne:

Signs and symptoms varies depending on the severity of your condition. It could be

  • Whiteheads or closed plugged pores
  • Blackheads or open plugged pores
  • Small red, tender bumps  or papules
  • Pimples or pustules, which are papules with pus at their tips
  • Large, solid, painful lumps beneath the surface of the skin called nodules
  • Painful, pus-filled lumps beneath the surface of the skin called cystic lesions

You should consult a doctor if self-care remedies don't clear your acne. If acne persists or is severe, you should visit a dermatologist who specializes in the skin.
Acne can persist for decades for many women. The flares are common a week before menstruation. This type of acne tends to clear up without treatment in women who use contraceptives. A sudden onset of severe acne in older adults may signal an underlying disease which require medical attention.
If you experience faintness, difficulty breathing, swelling of the eyes, face, lips or tongue or tightness of the throat after using nonprescription acne lotions, cleansers and other skin products, you need emergency medical help.

Causes of Acne:

The main factors which cause acne are:

  • Excess oil production
  • Hair follicles clogged by oil and dead skin cells
  • Bacteria
  • Excess activity of androgens hormone

Acne typically appears on your face, forehead, chest, upper back and shoulders because these areas of skin have the most oil glands called sebaceous gland. Hair follicles are connected to oil glands. Whitehead are produced when the follicle wall bulge. The plug may be open to the surface and darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it is exposed to the air.
When blocked hair follicles become inflamed or infected with bacteria, pimples are raised that are red spots with a white center.Blockages and inflammation that develop deep inside hair follicles produce cyst like lumps beneath the surface of your skin.

Factors that may worsen acne:

The following factors can trigger or aggravate acne:


Rise in androgen levels is a main factor that can trigger acne. Androgens are the hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Excessive sebum can break down cellular walls in the pores, causing bacteria to grow. In women, endrogen gets converted into estrogen.
Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. Low amounts of androgens circulate in the blood of women and can worsen acne.

Certain medications:

Drugs containing corticosteroids, testosterone or lithium can worsen acne.


Certain dietary factors, including skim milk and carbohydrate-rich foods such as bread, bagels and chips may worsen acne. Eating chocolate can help making acne worse.


Stress can make acne worse.
Other causes include greasy cosmetics, hormonal changes and menstruation.

Treatment of Acne:

Treatment depends on how severe and persistent the acne is.

Mild acne:

Mild acne can be treated with over-the-counter (OTC) medications, such as gels, soaps, pads, creams, and lotions, that can be applied to the skin.
Creams and lotions are best for sensitive skin. As alcohol-based gels dry the skin these are better for oily skin.
OTC acne remedies may contain the following active ingredients:

  • Resorcinol that helps break down blackheads and whiteheads
  • Benzoyl peroxide that kills bacteria, accelerates the replacement of skin, and slows the production of sebum
  • Salicylic acid that assists the breakdown of blackheads and whiteheads and helps reduce inflammation and swelling
  • Sulfur
  • Retin-A which helps unblock pores through cell turnover
  • Azelaic acid which strengthens cells that line the follicles, stops sebum eruptions, and reduces bacterial growth.

As some of the OTC product can cause skin irritation, redness, or burning on first use, it is advisable to start with the lowest strengths. These side effects normally subside after continued use.

Moderate to Severe acne:

If you have tried over-the-counter or nonprescription acne products for several weeks and still your acne persist, you should visit a doctor who can prescribe stronger medications. A dermatologist can help you control your acne, avoid scarring or other damage to your skin and make scars less noticeable. Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation which helps prevent scarring. There is a possibility that your skin may get worse before it gets better after using these medication. However most prescription acne drugs can take many months or years for your acne to clear up completely.
Depending on your age, the type and severity of your acne, and what you are willing to commit to, your doctor will recommend a treatment plan. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks.
Most often oral medication and topical medications are used in combination. But pregnant women will not be able to use oral prescription medications for acne.

Topical medications:

The most common topical prescription medications for acne include:


Retinoid drugs are derived from vitamin A and include tretinoin, adapalene and tazarotene. As these come as creams, gels and lotions, you can apply this medication in the affected areas. Initially you should begin with three times a week in the evening, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.


These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic. Antibiotic you can applly in the morning and the retinoid in the evening. The use of topical antibiotics alone are not recommended. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide and erythromycin with benzoyl peroxide.

Azelaic acid:

The natural source of azelaic acidis found in whole-grain cereals and animal products which has antibacterial properties. Azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It is even more effective when used in combination with erythromycin. Prescription azelaic acid is an option during pregnancy and while breast-feeding. Side effects include skin discoloration and minor skin irritation.

Salicylic acid :

This may help prevent plugged hair follicles.


5 percent gel of Dapsone twice daily is recommended for inflammatory acne, especially in adult females with acne. Side effects include redness and dryness.

Oral medications:


You may need oral antibiotics to reduce bacteria and fight inflammation for moderate to severe acne. Tetracycline or macrolide can be used for the treatment but should be used for a limited time period to prevent antibiotic resistance. As topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance, the combination is always preferred along with retinoids.The side effects include upset stomach, dizziness and increased skin's sun sensitivity.

Combined oral contraceptives:

A combination of estrogen and progestin can be used for acne therapy in women who also wish to use them for contraception. It might take more time to show its effectiveness. So using other acne medications with in the first few weeks may help.
The most common side effects of these drugs are weight gain, breast tenderness and nausea. A serious potential complication is a slightly increased risk of blood clots.
These may not be suitable for women who have a blood-clotting disorder, smoke, have a history of migraines and are over 35 years old.

Anti-androgen agents:

If oral antibiotics aren't helping, the drug spironolactone may be considered for women and adolescent girls. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness and painful periods.


Oral isotretinoin is very effective for severe acne. Potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects if used during pregnancy, and mood swings. Therefore people who are using this drug as treatment should be closely monitored by their doctor.


Therapies can only be be considered either alone or in combination with medications in special cases. When the acne doesn't respond to any of the medication then it can be considered.

Chemical peel:

This procedure uses repeated applications of a chemical solution, such as salicylic acid, glycolic acid or retinoic acid. Usually repeat treatments are needed as any improvement in acne is not long lasting.

Extraction of whiteheads and blackheads:

Whiteheads and blackheads (comedos) that are not cleared up with topical medications can be gently removed using special tools. This technique may cause scarring.

Steroid injection:

If an acne cyst becomes severely inflamed, it may rupture. This can lead to scarring.
Injecting a steroid drug directly into a nodular and cystic lesions will have rapid improvement and decreased pain. This can also help prevent scarring, reduce inflammation, and speed up healing. The cyst will break down within a few days.
Side effects may include thinning in the treated area.

Lasers and photodynamic therapy:

A variety of light-based therapies can be tried to clear up acne.

Treating children:

When it comes to treat acne in children you should always keep in mind to avoid certain drugs in children, the appropriate doses, drug interactions, side effects, and how treatment may affect a child's growth and development.   

Prevention and management tips:

Following the below tips can help prevent acne for people whose skin is prone to it and look after the skin with acne.

  • Wash your face no more than twice each day with warm water and mild soap made especially for acne.
  • Do not scrub the skin or burst the pimples, as this may push the infection further down, causing more blocking, swelling, and redness.
  • Avoid popping pimples, as this can make scarring.
  • Avoid touching the face.
  • Wash hands frequently, especially before applying lotions, creams, or makeup.
  • Choose makeup for sensitive skin if necessary and avoid oil-based products. Remove makeup before sleeping.
  • Clean spectacles regularly as they collect sebum and skin residue.
  • If acne is on the back, shoulders, or chest, try wearing loose clothing to let the skin breathe. Avoid tight garments, such as headbands, caps, and scarves, or wash them regularly if used.
  • Try to keep cool and dry in hot and humid climates, to prevent sweating.
  • Use an electric shaver or sharp safety razors when shaving. Soften the skin and beard with warm soapy water before applying shaving cream.
  • Hold the telephone away from the face when talking, as it is likely to contain sebum and skin residue.
  • Keep hair clean, as it collects sebum and skin residue. Avoid greasy hair products, such as those containing cocoa butter.
  • Avoid excessive sun exposure, as it can cause the skin to produce more sebum. Several acne medications increase the risk of sunburn.
  • Avoid anxiety and stress, as it can increase production of cortisol and adrenaline, which can trigger acne.

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