Acne symptoms, causes and treatment

Acne or acne vulgaris is a disease involving the hair follicles of the face, back and chest affecting almost every teenager during puberty, with the only exception being members of a few primitive Neolithic tribes that live in isolation. Acne is not caused by bacteria, although bacteria have an important role in its development. Some women develop acne in their mid- to late-20s.

Table of Medications

  • Doxycycline
  • spironolactone
  • Minocycline
  • Aldactone
  • Clindamycin
  • Tretinoin
  • Bactrim
  • Isotretinoin
  • Retin-A
  • Aczone
  • Epiduo
  • Differin


Acne commonly occurs during puberty when the sebaceous glands activate. But, acne may occur at any age. While there is no danger in having acne, you may skin scars after.

The sebaceous glands produce oil. They get stimulated by the male hormones from the adrenal glands in both females and males.

Acne vulgaris is a typical teenage problem which is characterized by three types of lesions:

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

Acne may appear in the skin as:

  • occluded pores or comedones, known also as whiteheads or blackheads
  • tender red bumps are known also as pimples or zits
  • pustules or bumps that contain pus, 
  • cysts, the deep pimples and boils of cystic acne

Many people treat their acne using products sold at drugstores or cosmetic counters without having to get a prescription from a doctor. However, tougher cases of acne require the person to consult a physician for treatment options.

Symptoms of Acne

Acne signs and symptoms vary depending on the severity of the condition:

  • whiteheads, which are closed plugged pores 
  • blackheads, which are plugged open pores
  • tender, small red bumps or papules
  • pimples or pustules, which are papules with pus at the tips
  • painful, solid, large lumps beneath the skin’s surface 
  • pus-filled and painful lumps beneath the skin’s surface or cystic lesions

Causes of Acne

Acne is not caused by a single factor. It appears when sebaceous glands in the hair follicles get stimulated during puberty or when there are other changes in hormones. Sebum is a natural substance that lubricates and protects the skin. Together with an increase in the production of oil is a change in the way in which the skin cells mature, making them prone to plugging the follicular pore nasal polyps. The plug may appear as a whitehead if it is covered by a thin layer of the skin, or if exposed to the air, the darker exposed portion of the plug is called a blackhead. The plugged hair follicle enlarges gradually to produce a bump. As the follicle enlarges, the wall may rupture to allow irritating substances and normal skin bacteria access into the skin’s deeper layer, ultimately producing inflammation. Inflammation near the surface of the skin produces a pustule; deeper inflammation often results in a papule or pimple. If the inflammation is still deeper, it forms a cyst.

The following are factors that do not usually play a role in acne:

  • Food – People often tell teens to avoid fried and greasy food, as well as junk food. These foods may not be good for overall health, but they do not play a causal role in acne. Some recent studies have linked high-carbohydrate diet, milk, and pure chocolate in making acne worse, the findings are not yet established.
  • Dirt – Blackheads are oxidized oil, not dirt. Perspiration does not cause acne as it is produced entirely by a different gland in the skin. Excessive washing may dry and irritate the skin.
  • Stress – Some individuals become so upset with their pimples that they pick on them, which makes them last longer. Stress does not play much of a direct role in causing acne.

In some individuals, the following may be contributory factors to developing acne:

  • Heredity – If one of your parents had severe acne, it is very likely that your acne will be difficult to control.
  • Pressure – In some individuals, pressure on the skin form chin straps, helmets, collars, suspenders, and the like can make acne worse.
  • Drugs – Some medications may cause or worsen acne such as medications that contain iodides, bromides, oral or injectable steroids. Other drugs that may cause or aggravate acne include anticonvulsant medications and lithium. Most cases of acne are not caused by drugs.
  • Occupation – Some jobs are exposed to products such as oil that may cause acne.
  • Cosmetics – Some skincare products can clog the pores. There are various brands of skincare products, which makes it important to read the list of ingredients and choose those with water listed ingredients. Water-based products are usually best for people with acne.

Diagnosis and Treatment


Acne is diagnosed by your doctor using a simple visual examination. The diagnosis of acne usually does not involve any test. Sometimes, a doctor may scrape or take a swab of a pustule or lesion for microbiological examination or culture to make sure that there are no other sources of infection.


If you have used over-the-counter acne products for many weeks and they have not worked, your doctor can prescribe stronger medications. Typically, your doctor will refer you to a dermatologist who can help you:

  • Control your acne
  • Make scars less visible
  • Avoid scarring and other damage to the skin

Acne medications help reduce the production of oil, speed up the turnover of skin cells, reduce inflammation or fight the bacterial infection. Most prescription drugs for acne begin to work after four or eight weeks. You will notice that your skin might get worse before it gets better. It could take months or years before your acne is cleared completely. 

The treatment that your doctor will recommend will be based on your age, the type of acne you have, and their severity. You may be required to wash the affected skin and apply medications twice daily for many weeks. You may also be required to take oral medications.  If you are pregnant, your doctor cannot prescribe medications for your acne.

Topical medications for acne

The most common medications for topical administration for acne include:

  • Retinoids and similar drugs – They come as gels, creams, or lotions. Retinoid is derived from vitamin A. It includes tretinoin and tazarotene. It prevents the plugging of the hair follicles.
  • Antibiotic – Antibiotics kill excess bacteria in the skin and also reduce redness.
  • Salicylic acid and azelaic acid – Azelaic acid is found in whole-grain cereal and animal products. It has antibacterial properties. Salicylic acid prevents the plugging of the hair follicles.
  • Dapsone – It is used for the treatment of inflammatory acne of adult females.

Oral medications for acne

  • Antibiotics – Oral antibiotics are needed to fight inflammation and reduce bacteria in moderate to severe acne.
  • Combined oral contraceptives – The FDA has approved the use of a combination of four oral contraceptives for acne therapy in women who also use contraceptives.
  • Anti-androgen agents – This type of drug is recommended for adolescent girls and women who used antibiotics but failed to solve the problem.
  • Isotretinoin – This powerful drug is typically recommended for people whose acne does not respond to other treatments.


Therapies are recommended in select cases:

    • Lasers and photodynamic therapy – It is a light-based therapy.
    • Chemical peel – It involves repeated use of a chemical solution to treat acne.
    • Extraction of whiteheads and blackheads – Your doctor will employ special tools for the removal of whiteheads and blackheads.
  • Steroid injection – This procedure involves the injection of a steroid drug into cystic and nodular lesions.

What are the normal conditions

Normal skin is widely used to refer to well-balanced skin. The scientific term for healthy skin is eudermic. The T-zone of the face – the forehead, nose, and chin- could be a little bit oily, but when the overall sebum and moisture are balanced and the skin is neither too oily or too dry, the skin is healthy. 

Normal skin has:

  • fine pores
  • good blood circulation
  • fresh, rosy color with uniform transparency
  • a velvety, soft and smooth texture
  • no blemishes

The normal skin becomes dryer as the person gets old. 

Risk of Having Acne

Risk factors of acne include genetics, anxiety and stress, the menstrual cycle, hot and humid climates, the use of oil-based makeup, and squeezing of the pimples.

Other risk factors of acne include:

  • Age – People of all ages can get acne, but it is most common in teenagers.
  • Hormonal changes – Hormonal changes are common in teenagers, girls and women, and people who use certain medications, such as those that contain androgens, corticosteroids, and lithium.
  • Family history – Genetics plays a role in acne. You are likely to develop acne if both of your parents had acne.
  • Greasy or oily substances – You are likely to develop acne where your skin comes into contact with oily creams and lotions or with grease in a work area, such as in a kitchen.
  • Stress – Stress does not cause acne, but if you already have acne, stress may make it worse.
  • Friction or pressure on your skin – This may be caused by items such as cellphones, tight collars, helmets, or backpacks.

When to Seek Medical Attention

If self-treatment does not clear the acne, you should see your doctor. Your doctor may prescribe the use of stronger medications. If acne persists or worsens, you may seek medical treatment from a skin specialist – a dermatologist.

For many women, acne may persist for many years, with flares commonly appearing a week before menstruation. This type of acne will clear up without treatment in women who are using contraceptives.

In the elderly, a sudden appearance of severe acne could be a sign of an underlying disease that requires medical attention. 

The Food and Drug Administration has issued a warning that some nonprescription acne lotions, cleansers, and other skin products could cause a serious reaction. The type of reaction is rare that should not be confused with the irritation, redness, or itchiness where you have application medications or products.

Seek emergency medical help if after using the skin product you experience:

  • Difficulty breathing
  • Faintness
  • Swelling of the face, eyes, face,  tongue, or lips
  • The tightness of the throat