Understanding acne: Causes, prevention and treatment | 7 min read

Acne, is a skin condition that involves the oil glands at the base of hair follicles. It commonly occurs during puberty when the sebaceous (oil) glands come to life – the glands are stimulated by hormones produced by the adrenal glands of both males and females. Boys are more commonly affected than girls.

What is acne?

The word acne comes from the word acme meaning “the highest point,” which comes from the Greek akme meaning “point” or “spot” – it was originally misspelt, with an ‘n’ rather than an ‘m’ in 1835.

Acne, the common type is medically known as Acne Vulgaris. Acne is a skin condition that involves the oil (sebaceous) glands at the base of hair follicles. In humans, pimples tend to appear on the face, back, chest, shoulders and neck which are oil rich areas.

Human skin has pores (tiny holes) which connect to oil glands located under the skin. The glands are connected to the pores via follicles – small canals. These glands produce sebum, an oily liquid. The sebum carries dead skin cells through the follicles to the surface of the skin. Some pores become blocked (plugged).

Simply put – skin cells, sebum and hair can clump together into a plug, this plug gets infected with bacteria, resulting in a swelling. A pimple starts to develop when the plug begins to break down.

Propionibacterium acnes (P. acnes) a bacterium commonly found on the skin, which will multiply rapidly in blocked follicles.

The types of pimples

  • Whiteheads – remain under the skin and are very small
  • Blackheads – clearly visible, they are black and appear on the surface of the skin. Remember that a blackhead is not caused by dirt. Scrubbing your face vigorously when you see blackheads will not help
  • Papules – visible on the surface of the skin. They are small bumps, usually pink
  • Pustules – clearly visible on the surface of the skin. They are red at their base and have pus at the top
  • Nodules – clearly visible on the surface of the skin. They are large, solid pimples. They are painful and are embedded deep in the skin
  • Cysts – clearly visible on the surface of the skin. They are painful, and are filled with pus. Cysts can easily cause scars

How common is acne?

Dermatologists say that approximately three-quarters of 11 to 30 year-olds will get acne at some time. Acne can affect people of all races and all ages. It most commonly affects adolescents and young adults, although there are people in their fifties who still get acne.

Although acne affects both men and women, young men suffer from acne for longer – probably because testosterone, which is present in higher quantities in young men, can make acne worse.

What causes acne?

Nobody is completely sure what causes acne. Experts believe the primary cause is a rise in androgen levels – androgen is a type of hormone. Androgen levels rise when a human becomes an adolescent. Rising androgen levels make the oil glands under your skin grow; the enlarged gland produces more oil. Excessive sebum can break down cellular walls in your pores, causing bacteria to grow. Some studies indicate that a susceptibility to acne could also be genetic. Some medications that contain androgen and lithium may cause acne. Greasy cosmetics may cause acne in some susceptible people. Hormone changes during pregnancy may cause acne either to develop for the first time, or to recur some women’s skin can clear.

Treatment of acne

Acne is common and is usually treatable. You may need treatment for several months to clear spots. Inflamed acne needs to be treated early to prevent scarring. Once the spots are gone, you may need maintenance treatment for several years to keep the spots away.

How your acne is treated may depend on how severe and persistent it is.

  • Treating mild acne – The majority of people who get acne will develop mild acne. This can usually be treated with OTC (over-the-counter) medications. OTC medications can be bought at a pharmacy without a doctor’s prescription. They are usually applied to the skin (topical medicines).
  • Treating moderate acne – You may be prescribed an oral or topical antibiotic. Antibiotics can combat the growth of bacteria ( acnes) and reduce inflammation. Most commonly Erythromycin and Tetracycline are prescribed as antibiotics for the treatment of acne.
  • Treating more severe cases of acne – If your acne is more severe, you should consider seeing a dermatologist. The specialist may prescribe a treatment that will be suitable to treat your type of acne. Prescription medications for acne are presented in many forms, such as creams, lotions, oral etc. Your dermatologist will decide what is best for you.
  • Treating cystic acne – If an acne cyst becomes severely inflamed, there is a high risk of rupturing. A rupturing acne cyst can often result in scarring. The specialist may inject a diluted corticosteroid to treat the inflamed cyst and to prevent scarring. A cyst is injected with intralesional corticosteroid directly. The injection will lower the inflammation and speed up healing. The cyst will “melt” within a few days.
  • Oral contraceptives – The majority of women with acne find that taking certain oral contraceptives clears it up. Oral contraceptives suppress the overactive gland and are commonly used as long-term treatments for acne in women. If a woman has a blood-clotting disorder, smokes, has a history of migraines, or is over 35, she should not take this medication without checking with a gynaecologist first.

How to look after your skin if you have acne (or are prone to acne)

  • Wash your face about twice each day. Do not wash it more often. Use a mild soap made especially for people with acne, and warm water. Do not scrub the skin.
  • Don’t try to burst the pimples. Popping pimples makes scarring.
  • If you have to get rid of a pimple for some event, such as a wedding, or public speaking occasions, ask a dermatologist to treat it for you.
  • Try to refrain from touching your face with your hands.
  • Always wash your hands before touching your face. This includes before applying lotions, creams or makeup
  • You skin needs to breathe. If your acne is on your back, shoulders or chest try wearing loose clothing. Tight garments, such as headbands, caps and scarves should be avoided – if you have to wear them make sure they are cleaned regularly.
  • Don’t go to sleep with makeup on. Only use makeup that is non-comedogenic or non-acnegenic – you should be able to read this on the label. If you cannot find it, ask the pharmacist. You should use makeup which does not have oil and does not clog up the pores.
  • Hair collects sebum and skin residue. Keep your hair clean and away from your face.
  • Too much sun can cause your skin to produce more sebum. Several acne medications make you more sun sensitive. Always apply a noncomedogenic sunscreen to protect yourself from being sunburn.
  • If you shave your face, do it carefully. Use either an electric shaver or safety razors. If you use a safety razor make sure the blade is sharp. Soften your skin and beard with warm soapy water before applying the shaving cream.

How to prevent making acne worse

  • Menstrual cycle – girls and women with acne tend to get it worse one or two weeks before their menstrual period arrives. This is probably due to hormonal changes that take place. Some people say they eat more chocolate during this time and wonder whether there may be a connection. However, experts believe the worsening acne is not due to chocolate, but rather to hormonal changes.
  • Anxiety and stress – mental stress can affect your levels of some hormones, such as cortisol and adrenaline, which in turn can make acne worse. Again, stress can make some people binge-eat. Experts believe the culprits are most likely the hormone levels, rather than the binge-eating.
  • Hot and humid climates – when it is hot and humid we sweat more. This can make the acne worse.
  • Oil based makeups – moisturizing creams, lubricating lotions, and all makeup that contain oil can speed up the blocking of your pores.
  • Greasy hair – some hair products are very greasy and might have the same effect as oil based makeup. Hair products with cocoa butter or coconut butter are examples.
  • Squeezing the pimples – if you try to squeeze pimples, your acne is more likely to get worse, plus you risk scarring.

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