Acne

Acne Vulgaris: Symptoms, Causes, and Treatment 

Acne vulgaris is a skin condition where pimples and spots on your skin begin to develop. Such blemishes may include blackheads, whiteheads, or raised bumps filled with pus. If you have acne, you may notice these spots primarily on your face, chest, back, or neck. 

As the most common skin condition in the world, acne vulgaris affects almost 10% of the world's population and is most prevalent in adolescents [1]. 

In this article, we'll explore the causes, symptoms, diagnosis, and treatment of acne vulgaris. 

What Causes Acne Vulgaris? 

When your skin produces too much sebum, this can lead to acne. Essentially, sebum is an oily substance that is produced and released by sebaceous glands in your skin. It helps to form a protective layer on your skin, preventing it from drying. 

While it is useful, too much sebum can mix with your dead skin cells and form a plug, which can clog your hair follicles and form blackheads or whiteheads. Bacteria may also build up in your pores, leading to the development of pimples. 

Any changes in your hormone levels may also lead to an acne flare-up, which explains why acne is the most prevalent in adolescents and teenagers. During that age, your hormones constantly fluctuate, leading to excessive sebum production, which is the primary cause of acne. 

The levels of a hormone called androgen also increase during puberty, and this hormone is another culprit that enlarges pores and boosts sebum secretion, triggering acne. 

Some other factors that may trigger or worsen acne include the following:-

• Menstruation 
• Stress
• Poor sleep 
• A diet high in carbohydrates and sugars [2] 
• Family history of acne
• Certain conditions that affect your hormone levels, such as polycystic ovarian syndrome (PCOS) 
• Specific medications that alter hormone levels, such as birth control pills 

It's important to realize that poor hygiene or sexual activities do not cause acne.

How Is Acne Diagnosed? 

Most people start with self-diagnosing and treating their acne at home. 

Acne can typically be managed without needing to consult a doctor, especially in mild cases. But if you have any concerns, you can still seek help and advice from a board-certified dermatologist. 

Consulting a professional is recommended in the following circumstances:-

• Over-the-counter (OTC) medications, gels, and creams are not helping much with your symptoms.
• You're experiencing emotional distress from acne, including poor self-esteem, depression, or anxiety. Mild cases of acne can still lead to reduced self-esteem and negative emotions. 
• Your pimples are usually painful and sore or leave scars upon healing. Cysts and deep nodules may lead to permanent scarring if not managed well. Hence, cystic, severe, and highly-inflamed acne should warrant a visit to your doctor. 
• You suspect that a medication you're taking may aggravate or trigger your acne symptoms. If so, your doctor may be able to recommend an alternative medication that doesn't exacerbate acne. 

Your healthcare professional will perform a physical examination of the affected area and assess how severe your symptoms are. 

They may also perform additional checks or tests to investigate if there may be an underlying cause for your acne. For instance, one such condition is PCOS, which affects women and alters the level of specific hormones in the body, leading to symptoms such as acne. 

Your doctor will then give you a diagnosis and typically classify your symptoms into any of the following categories [3]:-

• Grade 1 (Mild acne): You'll notice mainly blackheads and whiteheads. Occasionally, a few pustules and papules may appear. 
• Grade 2 (Moderate acne): Multiple pustules, papules, whiteheads, and blackheads are present. Most of the acne spots are confined to the face. There may be some mild scarring. 
• Grade 3 (Moderate to severe acne): A high quantity of pustules and papules affect your face, back, and chest. You'll also notice highly-inflamed nodules. 
• Grade 4 (Severe acne): There are many pustules and papules, as well as evident scarring and large and painful nodules. 

The severity of your acne will determine the most suitable treatment for it.

Acne Treatment and Management Options 

Acne can be treated using either topical products applied to the skin or oral medications. Let's take a look at some of the most common treatment options for acne vulgaris based on its severity. 

Mild Acne 

Mild acne is typically treated using topical medications. You may purchase OTC medications to help treat any pimples as they pop out. 

Some common active ingredients you'll find inside pimple creams or medications include:-

• Salicylic acid: Salicylic acid helps to combat any redness or inflammation associated with acne and removes dead skin cells that clog your pores. 
• Benzoyl peroxide: Benzoyl peroxide attacks the bacteria responsible for causing acne. It also helps to unclog your pores and prevent blockages by removing excess sebum and dead skin cells [4]. 

Moderate Acne 

If your symptoms have not improved with OTC therapies, you may wish to seek the advice of a healthcare professional. 

They may recommend some prescription medications to reduce your symptoms and prevent scarring. Such medications may include:-

• Azelaic acid: Azelaic acid helps to get rid of acne-causing bacteria and reduce any inflammation, redness, and irritation related to acne. 
• Topical retinoids: Topical retinoids help to remove dead skin cells that clog your pores, lessen the appearance of darkened blemishes, and reduce inflammation [5]. 
• Oral antibiotics: These reduce inflammation and the amount of acne-causing bacteria present on your skin. 
• Topical antibiotics: Topical antibiotics also reduce the population of acne-causing bacteria on your skin. 

Your doctor may also recommend combination products, for instance, a cream that contains both benzoyl peroxide and an antibiotic. 

Severe Acne 

Severe acne cases should be treated by a dermatologist. They will be able to recommend suitable prescription medications, such as the following:-

• Hormonal birth control (for women) 
• Topical antibiotics
• Oral antibiotics 
• Topical retinoids 
• Oral isotretinoin

Oral isotretinoin is a vitamin-A medication usually reserved for severe cases of acne. It works by shrinking your sebaceous glands and regulating the production of sebum. Additionally, it makes your skin's microenvironment less favorable for the growth of acne-causing bacteria [6]. 

Take note that many acne treatments will likely take several months of consistent use before you can observe significant improvements. Patience is key here to successful outcomes!

Lifestyle Modifications to Prevent and Treat Acne 

Acne can be difficult to prevent. Certain factors, such as fluctuating hormones due to puberty, are simply out of your control and cannot be altered. 

However, there are still certain steps and modifications you can make to reduce your risk of experiencing acne, improve your symptoms, and limit acne scarring. 

• Choose a face cleanser suitable for sensitive and acne-prone skin. When washing your face, avoid using hot or very cold water or scrubbing too hard, as this may worsen your acne. 
• If you'd like, you can incorporate a fragrance-free, water-based moisturizer into your routine to keep the skin hydrated. 
• Avoid washing your face with a cleanser more than two times each day. Washing your face too often can irritate your skin and aggravate any acne. 
• Ensure you shower or wash your face immediately after exercising. 
• Avoid touching your face or picking and popping pimples. Touching your face can spread bacteria to the face, and popping your pimples increases the risk of scarring or infection. 
• Try to use minimum makeup or cosmetics. If you do, ensure you remove any makeup using a suitable cleanser and makeup remover before you sleep. Excessive makeup and leaving makeup on overnight can further clog pores and worsen acne. 
• Stay well-hydrated, as this can prevent your skin from drying out. Dry skin may lead to excessive sebum production [7]. 

Minimizing stress can help reduce pimples and breakouts [8]. While it's easier said than done, well-managed stress may help combat acne flare-ups. Practicing a healthy and balanced lifestyle, getting enough sleep, and trying out various relaxation methods like meditation or yoga are some ways to reduce stress.