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Acne: Everything You Need to Know

One of the best ways to treat acne is a lot of prevention. This article will help explain what causes acne plus how to treat and prevent it.

Acne is an inflammatory skin condition that affects the pores of the skin.

Although a lot of people think that acne only happens to teenagers, that simply isn’t the case. 

Changes in androgenic hormones, or male sex hormones, are one cause of acne. Some people are particularly sensitive to these hormones. Others have high levels of them.

Although the predominant female hormones are estrogen and progesterone, other hormones, including testosterone, are also present in small amounts in the female body. 

When there are changes in these levels, acne can occur. 

Acne is a normal occurrence, but there are some things that can cause it to flare up:

  • Premenstrual changes in hormonal balance
  • Certain hormonal issues during puberty, pregnancy, breastfeeding, or perimenopause 
  • Cosmetics and daily skin care routine

Acne is treatable. Determining what’s causing it is important for treating it.

Many factors can contribute to developing acne:

  • Genetic predisposition
  • Androgenic hormone stimulation, leading to an increase in sebum production
  • Changes in sebum such as a decrease of linoleic acid, which is an essential fatty acid that protects the epithelium (a deep layer under the outer skin)
  • Follicular hyperkeratinization, which is when the cells of the follicle become sticky and don’t shed normally, leading to the formation of microcomedones (a type of pimple) 
  • Microbial colonization with bacteria called Propionibacterium acnes
  • Inflammation caused by immune system reactions

The exact mechanisms are not fully understood, but acne flare-ups can be caused by several other factors. 

Some hormonal causes of acne include:

  • Hormonal changes throughout the menstrual cycle
  • Taking progestin-only oral contraceptives
  • Hormonal imbalance
  • Endocrine system disorders

Non-hormonal causes of acne include:

  • Stress
  • Smoking
  • Excessive skin cleansing
  • Inappropriate skin care products and (comedogenic) makeup
  • Diet (high glycemic and dairy foods) 
  • High environmental humidity
  • Tight synthetic clothing that doesn’t let the skin breathe

Often, acne is caused by a combination of factors.

A health care provider can help determine the cause of acne by reviewing the medical history (genetic predisposition), the age of puberty, menstrual cycle regularity, allergies, etc.

A health care provider might also perform some tests to check blood chemistry and hormone levels or conduct pelvic and thyroid gland ultrasounds.

If acne is caused by a hormonal imbalance or gastrointestinal dysfunction, eliminating the triggers won’t improve the situation. Resolving the cause of the condition is necessary.

Dairy is very common in the Western diet. Reducing the intake of dairy products may help to improve acne for some people.

Experiment by avoiding dairy products for a specific period of time (for instance, a week or two) and assess whether or not it has an effect. Flo can help you log acne symptoms and monitor any changes.

The higher the glycemic index of the product, the faster the carbohydrates in it raise blood sugar levels. Processed foods, especially those with a high glycemic index, have been known to make acne worse. 

Some of the foods that could exacerbate acne include fast food, instant foods, milk, sweetened beverages, white bread, smoked sausages, and potato chips.

Some studies suggest that following a low-glycemic diet may reduce acne because it helps eliminate blood sugar spikes. When blood sugar spikes, it causes inflammation throughout the body, leading it to produce more sebum, an oily substance in the skin. This process can cause acne. Other studies haven’t found a connection between a high-glycemic diet and acne.

Nevertheless, adopting a whole-food diet and reducing intake of dairy products may help reduce acne.

Excessive contact between the hands, hair, and face can make acne worse.

Sebum, dust, and the remains of beauty products accumulate on hair during the day. When these elements come in contact with the skin on the face, they may clog pores, which can cause pimples.

Wearing a ponytail can help. Bangs can also cause pimples on the forehead, especially for those with oily hair.

Styling hair in a way that ensures hair products won’t get on the face, neck, and back can also help. Some hair products contain mineral oils that can clog pores.

For the same reason, washing long hair with the head bent forward can keep water and soap from dripping down the back.

According to research, acne and gastrointestinal problems are related. Acne can be caused by dysbiosis (also referred to as dysbacteriosis), which is when the normal intestinal flora is outnumbered by pathogens. Dysbiosis can be triggered by an unhealthy diet or taking antibiotics.

Bacterial dysbiosis can lead to inflammation that causes acne.

Probiotics can help prevent dysbiosis. They are found in fermented foods and supplements. Make sure to consult a health care provider before taking any supplements or medications or making significant changes to your diet.

Maintain a healthy diet by cutting down on sweets, preservatives, and fatty and spicy foods, if needed.

Demodicosis is a disease caused by Demodex mites. These mites are normal and common and live inside the hair follicles and sebaceous glands of most people.

The mites can inhabit the skin for years without causing any issues, but in certain conditions (e.g., immune function decline, stress, an increase in sebum production), they can start multiplying, causing skin itchiness, redness, and sloughing.

A skin-scraping test can detect demodicosis.

The disease is treated with external remedies that have an anti-demodectic effect. They disinfect the skin, clearing it of sebum and mite waste. The treatment is prescribed by a health care provider.

Pimples can sometimes occur during or after treatment with certain medications, in which case, it’s called drug-induced acne.

Drug-induced acne can be caused by:

  • Antibiotics
  • Hormonal contraceptives
  • Antidepressants
  • Corticosteroids
  • Anti-epileptic drugs
  • Anti-tuberculosis drugs  

Drug-induced acne typically causes lesions that are the same in shape and size, regardless of the drug that causes it. Other types of acne cause lesions that look different.

Drug-induced acne normally clears away after the medication is discontinued. If this doesn’t happen, be sure to see a health care provider.

According to research, sex and acne are indeed connected, but having sex does not necessarily reliably clear acne.

It is just one factor that can reduce the likelihood of developing the condition.

Acne occurs for many reasons, one of them being hormonal imbalance. In particular, acne can be caused by an excess of male hormones called androgens.

After sex, the body produces endorphins that promote epithelial cell growth and accelerate skin regeneration (when old cells are exfoliated and replaced with new ones).

Sex improves blood circulation, which oxygenates the skin. It also enhances the production of collagen, the skin’s building material, which makes it more elastic.

Human skin consists of several layers.

The outer layer (epidermis) has tiny holes (pores) that let the skin breathe.

Thin tubules (follicles) connect the pores with sebaceous glands located in the deeper inner layer (dermis). These glands secrete sebum, a natural oil that protects the skin and makes it elastic.

Due to hormonal changes, genetic predisposition, and other factors, skin may produce more sebum than necessary. As a result, sebum can build up with dead skin cells, dirt, etc. and clog the follicles, which leads to inflammation.

The skin’s surface is normally populated by bacteria, including Propionibacterium acnes. When bacteria multiply, it can lead to inflammation.

Acne lesions are commonly known as pimples. However, different types of acne lesions have specific names, depending on their size, color, and soreness.

  • Comedones are sebum plugs that clog the pores. Open comedones are called blackheads and look like black dots. Closed comedones are called whiteheads. They are painless.
  • Papules are small pinkish bumps that are elevated above the surface of the skin. They turn pale when you apply pressure to them.
  • Pustules are white bumps filled with pus. They can be easily squeezed, but squeezing them can lead to infection.
  • Nodules are dark red solid bumps up to three centimeters in diameter that are embedded deep in the skin. These are painful.
  • Cysts are several nodules located next to each other. They can be connected under the skin.

The type and severity of acne determine the treatment strategy.

Acne can affect not only the face but also other parts of the body, such as the neck, chest, back, stomach, and buttocks, where there are many sebaceous glands.

Facial acne is often caused by bodily malfunctions (hormonal imbalance, gastrointestinal tract problems, etc.).

Body acne is sometimes caused by irritants such as wearing tight synthetic clothing, scarves, tight collars, or a backpack; hair removal; poor hygiene; and allergic reactions to soap and other bath and shower products.

Internal causes, including hormonal issues, can also cause body acne.

If eliminating any irritating factors doesn’t clear up the acne, consult a health care provider to determine what’s causing it and get treatment.

Acne treatment depends on its severity, which a health care provider or dermatologist determines by visually assessing the skin.

Generally, there are four forms of acne:

  • Mild acne is mainly comedones and up to 10 papules and pustules.
  • Moderate acne is when 10–40 papules/pustules and 10–40 comedones are present.
  • Severe acne is when there are 40–100 papules and pustules, 40–100 acne lesions (comedones), and up to five larger and deeply inflamed lesions.
  • Very severe acne is when, in addition to numerous lesions, there are more than five inflamed bumps (nodules) and cysts

Mild acne is usually treated with external remedies and can be treated without a health care provider.

Moderate and severe forms of acne require a combination of locally applied remedies and oral medications, so it’s best to seek help from a health care provider for these conditions.

Hormonal imbalance can cause acne. A blood hormone test can confirm if this is the case.

The most common cause of acne is an excess of male hormones called androgens. Laboratory testing will determine the levels of the main androgen: testosterone.

Excess testosterone makes sebaceous glands more active, which leads to duct blockage and acne formation.

In addition to testosterone, it’s important to check the levels of the luteinizing hormone (LH), follicle stimulating hormone, and estradiol.

This will determine if the endocrine system is functioning properly since disorders of the endocrine system can lead to acne.

Testing for testosterone, LH, and prolactin is most accurate on days 5–7 of the menstrual cycle.

If test results show that hormone levels are abnormal, medication can be prescribed to stabilize them.

Some people believe that face-mapping techniques can indicate the source of acne. However, these techniques have no scientific basis.

The face-mapping theory claims that where acne occurs correlates to issues with specific organs. People who believe this theory claim that by analyzing the location of acne, what’s causing it can be determined much more quickly.

For example, people who believe the face-mapping theory claim:

  • Pimples on the forehead can be the result of problems with the digestive system.
  • If there are a lot of pimples between the eyebrows, it might be that the liver is not functioning properly, and cutting down on sugar and fatty and smoked foods can be helpful.
  • If pimples are located around the eyes and ears, the kidneys may be involved. Perhaps, the body is dehydrated and needs water.
  • Acne spots on the nose are linked to the cardiovascular system, blood pressure, and cholesterol.
  • Pimples located on the cheeks may be a sign of lung problems.
  • Chin pimples can be related to gynecological issues.

It’s important to know that the presence of acne doesn’t diagnose a problem or condition with another area of the body. The face-mapping technique is not supported by science, and each case must be considered individually and under the supervision of a health care professional.

Similarly, there is no scientific evidence for the relationship between acne on other parts of the body and other body conditions. People who believe in the body-mapping technique claim:

  • If acne appears on the neck, it may relate to issues with the reproductive system.
  • Shoulder pimples are a possible sign of a malfunction in the nervous system. In this case, adjustments to daily routines and emotional states would help.
  • If acne is located on the chest, back, and buttocks, digestion may be the cause, and greasy, spicy, and sweet foods should be avoided.
  • If there are multiple spots on the belly, blood sugar may be to blame.

Again, this theory has no basis in science.

Dietary adjustments, including adding a few micronutrients, may help improve acne and the skin’s complexion.

Modern research shows that foods high in sugar will aggravate acne. Eating foods high in zinc, omega-3 fatty acids, selenium, vitamins A, E, and others may help improve skin. 

These can be found in shellfish, beef, poultry, cheese, nuts, and spinach.

Flo can help track acne symptoms and dietary changes throughout the cycle, revealing patterns and foods that work well to reduce acne.

If a breakout is extensive or there are signs of inflammation, consult a specialist.

Acne is treated by a dermatologist, but given its wide range of causes (including hormonal ones), an endocrinologist and/or a gynecologist may also be able to help.

Acne treatment can begin only when the causes of the disease are pinpointed. To do this, the health care provider will perform a range of tests and choose an appropriate treatment.

Treatment methods and duration depend on age, menstrual cycle regularity, skin type, condition severity, and other factors. For that reason, treatment is done on a case-by-case basis.

It’s also why it’s important to not use medication that was prescribed for someone else with a similar condition. Doing so can make the acne worse.

Sometimes acne treatment is long-term. The type of treatment depends on the severity of the condition.

Mild acne (without inflammation signs) can be treated with externally applied remedies that destroy the bacteria that are causing the inflammation, cleanse the pores, reduce sebum production, and dry out pimples.

External medical creams, gels, and other products often contain:

  • Retinoids, which are vitamin A compounds
  • Benzoyl peroxide, which provokes oxygen production to kill anaerobic bacteria when it’s applied to the skin
  • Azelaic and salicylic acids, which have antimicrobial and anti-inflammatory effects
  • Antibiotics, which work by killing excess skin bacteria and reducing redness and inflammation.

Any medication should be prescribed by a dermatologist.

Moderate or severe acne can be treated with oral antibiotics or isotretinoin, a derivative of vitamin A. These medications are selected and prescribed on a case-by-case basis.

For some people, the following therapies might be helpful, either alone or in combination with medications.

  • Light therapy — A variety of light-based therapies have been tried with some success. Further study is needed to determine the ideal method, source, and dose.
  • Chemical peel — This procedure uses repeated applications of a chemical solution, such as salicylic acid, glycolic acid, or retinoic acid. This treatment is for mild acne. It might improve the appearance of the skin.
  • Drainage and extraction — A health care provider may use special tools to gently remove whiteheads and blackheads (comedones) or cysts that haven’t cleared up with topical medications. 

Zinc is a trace element essential for keeping skin, hair, and nails healthy. It can successfully fight Propionibacterium acnes. It has antioxidant properties, helps relieve acne inflammation, and makes wounds heal faster.

This nutrient is abundant in seafood, red meat, beans, and pumpkin and sunflower seeds.

Zinc can be found in many externally applied skin products. There are also zinc-based ointments and medications that can only be prescribed by a health care provider.

An overdose of zinc can trigger gastrointestinal tract problems and increase testosterone levels, which will aggravate acne.

Vitamin A is important for healthy skin. Its deficiency can lead to dry skin, dry hair, and fragile nails. Also, vitamin A imbalance can be related to acne. 

Eating a diet rich in vitamin A and zinc can help with acne prevention and treatment. It's known that carotenoids (precursor of vitamin A, found in carrots), retinol (vitamin A), and retinoids (vitamin A metabolites) are absorbed better when consumed together with zinc and vegetable oils. 

In some cases, oral intake of isotretinoin (a derivative of retinol) can be prescribed to address causes of acne.

B vitamins (B2, B5, B6, and B12) improve blood circulation in small blood vessels and promote acne scar healing. Vitamin B3, or nicotinic acid, slows down the function of the sebaceous glands. B vitamins are found in beans and mushrooms.

Vitamin C boosts the skin’s protective function and helps damaged skin heal faster. It can be found in citrus fruit, fresh berries, cabbage, and leafy greens (spinach, parsley, etc.).

Vitamin E helps maintain skin elasticity and protects the skin from environmental pollutants. It can be found in sea buckthorn, nuts (hazelnuts, almonds, and pistachios), and dried apricots.

Vitamin supplements for acne should be prescribed by a health care provider. Self-medication can aggravate the condition.

The main indications for using antibiotics to treat acne are:

  • Lesions affecting a large skin area
  • Numerous lesions of different types (e.g., papules, nodules, and cysts)
  • Active inflammation
  • Ineffective locally applied medications

Antibiotics can have bactericidal (killing bacteria) and bacteriostatic (preventing bacteria growth) properties.

They can be administered locally through ointments or creams and orally.

Antibiotics can improve the condition of the skin within a few days. However, there may be adverse effects (gastrointestinal problems, yeast infections, and allergies, for example).

Long-term antibiotic therapy can sometimes lead to antibiotic-resistant bacteria.

Antibiotics can only be prescribed by a health care provider on a case-by-case basis, according to examination results. Self-medication is not an option.

Hormonal imbalance is one of the possible causes of acne. When it is, excessive sebum production is most often due to a high level of androgens.

Taking hormonal contraceptives can fix the situation because they normalize androgen production.

Choosing the right contraceptive and dosage is important.

This can only be done by a health care provider who will consider age, fertility plans, associated conditions, and medical history before writing a prescription. Self-medication using oral contraceptives can be dangerous.

Ignoring acne, using ineffective medications, and squeezing pimples can lead to the skin becoming discolored and marked with post-acne scars.

Adequate therapy can help treat acne successfully, but creams and oral medications for treating acne won’t minimize the appearance of post-acne marks.

Here are some of the procedures that can help reduce the appearance of acne scars and smooth the skin:

  • Chemical peeling, when dead skin cells are removed with a weak solution of lactic or salicylic acid
  • Mechanical peeling, when the top layers of the skin are removed using special nozzles or products containing abrasive particles
  • Injections of collagen, a protein that makes up most of the body’s connective tissue
  • Laser skin resurfacing, when scar tissue is removed layer by layer, and the skin is smoothed out

A dermatologist or a cosmetologist can assess the extent and depth of the post-acne scars and prescribe adequate treatment.

Acne scar removal can take some time, and it doesn’t always work. The best way to prevent acne scars is to treat acne promptly.

Large pores occur when follicle walls get thicker and consequently expand in diameter. This can be caused by sebum, keratinized epithelium, and the accumulation of leftover makeup.

Cleaning the skin is an important step in making the pores appear smaller. This can be done by using products matching your skin type and washing the face every morning and evening.

Dead skin cells can be removed using an exfoliating scrub (no more than once a week) or chemical peels (for example, products containing fruit acids).

Clay masks that absorb excess oil can help shrink the pores. Drinking at least two liters of water per day and rubbing the face with ice cubes may also minimize the appearance of pores.

A health care provider can also help select an effective method for shrinking large pores. They might recommend tools and products.

It is impossible to completely prevent pimples, but preventive measures might help reduce breakouts.

Here are a few hygiene tips to help prevent acne:

  • Wash skin in the morning and evening using warm (not hot) water. Hands should be clean. Use cleansing products appropriate for the specific skin type.
  • Don’t use washcloths or face sponges that accumulate dirt and can cause an infection.
  • Remove makeup before going to bed because beauty products can clog pores.
  • Avoid touching the face. There are a lot of bacteria on hands that can get on the face. The same goes for mobile phones (don’t completely press it against the cheek) and pillowcases (it’s advisable to change them every week).
  • Personal hygiene items (towels, makeup brushes) should be used by one person only.

Good sleep, a healthy diet, and effectively managing stress can help skin remain healthy.

Facial skin (especially problem skin) requires proper care. It is important to follow a consistent skin care routine.

  1. Cleansing — Remove sweat, dirt, and dust from skin pores every morning and evening. The cleanser should match the skin type.
  2. Toning — Soften the cleanser’s effect and restore the skin’s pH balance. It is best to use alcohol-free toners.
  3. Moisturizing — Saturate the skin with moisture. Moisturizing creams (selected according to the skin type) create a coating that prevents water evaporation and keeps the skin taut.
  4. Nourishing — Saturate the skin with essential ingredients by applying nourishing masks before going to bed or using night creams.
  5. Protecting – Reduce the environmental impact on the skin. This can be done by applying a day cream with sunscreen, which protects the skin from the harmful effects of UV radiation.

Popping pimples doesn’t solve the problem of acne. If anything, it makes it worse. Popping leads to abrasions that can become infected.

Sometimes, squeezing causes small capillaries to burst, which leads to discolored spots. Popping pimples is likely to cause scars that are difficult to get rid of.

Sometimes, only some of the pus in the pimple comes out, and the rest of it is forced deeper into the skin. Once it enters the bloodstream, it can lead to tissue inflammation, causing more pimples.

If a pimple shows up, apply ice to it for 20–40 seconds to constrict the pores and reduce redness.

Then apply a product (preferably prescribed by a dermatologist or cosmetologist) that contains salicylic acid or benzoyl peroxide. This will eliminate the bacteria and stop the inflammation. The pimple will then disappear in a few days.

Avoid touching the face to minimize the temptation to pop pimples.

Pore extraction is a cosmetic procedure aimed at cleaning out facial pores.

It involves cleansing the skin, opening up the pores (using steam or cosmetic products), extracting anything in the pores, then applying pore-narrowing and soothing products.

The process may damage capillaries, which can lead to swelling, redness, and a higher risk of infection.

Pore extraction works for non-irritated skin that doesn’t have pustules or inflamed lesions.

Otherwise, focus should be on eliminating the inflammation first to prevent the spread of infection and only then doing the extraction.

The procedure should be approved by a dermatologist.

Regular extractions can’t make problem skin healthy. It’s important to determine and eliminate the cause of the acne.

It’s okay to wear makeup if you have acne, and there are some things you can do to protect the skin.

Before applying makeup, cleanse the face and apply a moisturizing cream.

Non-comedogenic makeup products don’t clog pores. Their labels may say “non-comedogenic” or “for problem skin.”

Choose light makeup if you have acne.

Opt for water-based (rather than oil-based) foundation.

Products that contain alcohol often overdry the skin, which can cause the skin to produce oil in response. 

Before going to bed, remove all makeup, preferably in several stages: with a washing foam, plain water, or micellar water. Micellar water contains micelles, which are tiny particles that may remove greasy residue that other cosmetic products can’t.

Practice a consistent daily skin care routine.

Makeup doesn’t cure acne. Proper treatment can help get rid of acne.

Most people get pimples at least once in their lifetime. Statistically, about 10 percent of the planet’s population constantly experience acne. 

Modern medicine has all the necessary means to treat acne. The main thing is to find the cause of the condition and work up a treatment plan together with a health care provider.

Melnik, Bodo. “Dietary Intervention in Acne: Attenuation of Increased mTORC1 Signaling Promoted by Western Diet.” Dermato-Endocrinology, Landes Bioscience, 1 Jan. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3408989/.

“I Have Acne! Is It Okay to Wear Makeup?” American Academy of Dermatology, www.aad.org/public/diseases/acne-and-rosacea/makeup-with-acne.

Heng, Anna Hwee Sing, and Fook Tim Chew. “Systematic Review of the Epidemiology of Acne Vulgaris.” Scientific Reports, vol. 10, no. 1, 2020, doi:10.1038/s41598-020-62715-3.

Dréno, Brigitte, et al. “The Skin Microbiome: A New Actor in Inflammatory Acne.” American Journal of Clinical Dermatology, vol. 21, no. S1, 2020, pp. 18–24., doi:10.1007/s40257-020-00531-1.

Bagatin, Edileia, et al. “Adult Female Acne: a Guide to Clinical Practice.” Anais Brasileiros De Dermatologia, Sociedade Brasileira De Dermatologia, 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6360964/.

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