Causes and Treatment for Acne

Solutions for Acne

Acne is a widespread skin condition that affects individuals of all ages, but it is particularly prevalent during adolescence. This chronic inflammatory disorder manifests itself in the form of blackheads, whiteheads, pimples, and cysts, primarily on the face, neck, chest, and back. While acne may seem like a superficial concern, it can have a profound impact on one’s self-esteem and overall well-being.

Contrary to popular belief, acne is not just a cosmetic issue; it is a complex condition with various underlying causes. To effectively manage and treat acne, you should understand its root causes.

Dr Dalia is a UK-trained Consultant Dermatologist based in Chester and North Wales, with a strong focus on both adult and paediatric dermatology. She is deeply passionate about helping patients achieve their best skin through evidence-based treatments.

What Are the Causes of Acne?

Acne is a multifactorial condition, meaning that various factors interplay to trigger its development.

Hormonal factors

Hormones play a significant role in the development of acne. During puberty, increased levels of androgens (male hormones) stimulate the sebaceous glands to produce excess sebum (oil). This excess sebum, combined with dead skin cells, can clog pores and create an ideal environment for the proliferation of acne-causing bacteria.

Even after puberty, hormonal fluctuations during menstrual cycles, pregnancy, or conditions like polycystic ovary syndrome (PCOS) can contribute to acne breakouts in women. Men, too, can experience hormonal imbalances that trigger acne.

The role of genetics in acne development

Genetics plays a role in determining your susceptibility to acne. If one or both of your parents had severe acne, you may be more likely to experience similar skin issues. Certain genetic factors can influence sebum production, skin cell shedding, and inflammatory responses, all of which contribute to acne formation.

Environmental factors that trigger acne

Environmental factors can exacerbate or trigger acne breakouts. These include:

• Stress: High levels of stress can disrupt the body’s hormonal balance and increase inflammation, leading to acne flare-ups.
• Diet: While diet alone may not directly cause acne, certain foods high in refined carbohydrates, dairy products, and unhealthy fats can contribute to inflammation and hormonal imbalances, potentially worsening acne.
• Cosmetics and skincare products: Certain cosmetics, hair products, and skincare formulations containing comedogenic (pore-clogging) ingredients can exacerbate acne by blocking pores and trapping sebum and dead skin cells.
• Medications: Certain medications, such as corticosteroids, anabolic steroids, and lithium, can increase the risk of acne or worsen existing breakouts.

Despite widespread misconceptions, acne is not caused by poor hygiene, excessive sweating, or specific foods like chocolate or greasy foods. While these factors may aggravate existing acne in some individuals, they are not the primary causes of the condition.

Types of Acne and Their Causes

Acne can manifest in various forms, each with its own underlying causes:

• Comedonal acne: This type of acne involves clogged pores, resulting in blackheads (open comedones) and whiteheads (closed comedones). It is often caused by excess sebum production, irregular shedding of skin cells, and bacterial overgrowth.
• Inflammatory acne: Inflammatory acne includes papules (red, solid bumps), pustules (pus-filled lesions), and cysts (deep, painful lesions). This type of acne is typically caused by an immune system response to bacteria, leading to inflammation and infection.
• Hormonal acne: As mentioned earlier, hormonal fluctuations can trigger acne breakouts, particularly in women. Hormonal acne often appears in the form of deep, cystic lesions along the jawline, chin, and neck.
• Acne mechanica: This type of acne is caused by friction, pressure, or rubbing against the skin, such as from tight clothing, backpacks, or helmets. It commonly appears on the back, shoulders, and chest.

Treatment Options for Acne

Since acne is a complex skin condition influenced by various factors such as hormones, genetics, lifestyle, and environmental triggers, the most effective treatment plan must address the type and severity of your acne as well as its underlying causes. Here are some topical and oral treatment strategies, as well as how they work to alleviate acne:

Topical Treatments for Acne

Topical treatments are often the first line of defence in combating acne, particularly for mild to moderate cases. These treatments are applied directly to the skin, targeting specific symptoms like clogged pores, excess oil, and bacterial overgrowth. Below are some commonly prescribed topical treatments for acne:

• Retinoids Retinoids, derived from vitamin A, are widely used to treat acne due to their ability to normalise the shedding of skin cells and prevent pore blockage. By promoting cell turnover, retinoids such as tretinoin (Retin-A) and adapalene (Differin) can help unclog pores and prevent the formation of new comedones (blackheads and whiteheads). Over time, retinoids also help to reduce the appearance of post-acne marks and improve skin texture. However, they can cause initial irritation, redness, and peeling, so starting with a lower concentration and gradually increasing usage is recommended.
• Benzoyl Peroxide Benzoyl peroxide is a potent antimicrobial agent that targets the Propionibacterium acnes bacteria, which contribute to acne inflammation. It not only kills bacteria but also helps reduce oil production and slough off dead skin cells, preventing clogged pores. Benzoyl peroxide is available in different concentrations, and while it’s effective, it can cause dryness, irritation, and bleaching of clothing or bedding. Combining benzoyl peroxide with other treatments like antibiotics or retinoids can enhance its efficacy.
• Salicylic Acid Salicylic acid is a beta-hydroxy acid (BHA) that works by penetrating the pores and exfoliating from within. It helps dissolve the debris that clogs pores, making it particularly effective for treating comedonal acne. Salicylic acid also has anti-inflammatory properties, which can help calm irritated skin. It’s often found in over-the-counter cleansers, toners, and spot treatments, making it a convenient option for people looking for non-prescription solutions.
• Topical Antibiotics For cases where bacterial infection plays a considerable role, topical antibiotics such as clindamycin and erythromycin are prescribed. These antibiotics work by reducing the number of bacteria and decreasing inflammation. However, due to the risk of bacterial resistance, they are typically used in combination with other treatments like benzoyl peroxide or retinoids. This combination helps reduce the chances of resistance and enhances the overall efficacy of the treatment.

Oral Medications

For moderate to severe cases, or in cases where topical treatments prove insufficient, oral medications are often required. These systemic treatments work internally to address more complex or persistent forms.

• Oral Antibiotics Oral antibiotics, such as doxycycline, minocycline, and erythromycin, are commonly prescribed for moderate to severe cases with significant inflammation. They work by reducing bacteria and inflammation from the inside out. Oral antibiotics are typically used for short-term treatment (three to six months) to control flare-ups. Long-term use is avoided due to the potential for antibiotic resistance and side effects such as gastrointestinal discomfort, photosensitivity, and potential disruptions in gut microbiome health. When combined with topical treatments, oral antibiotics can provide faster results.
• Oral Contraceptives For women whose acne is primarily caused by hormonal fluctuations, oral contraceptives can be an effective treatment option. Birth control pills containing a combination of oestrogen and progestin help regulate hormonal imbalances, reducing the overproduction of sebum (oil) and controlling outbreaks. This method is particularly useful for women who experience cyclical breakouts, such as during menstruation. Some oral contraceptives are specifically used for treatment, but they are only suitable for women who are not planning pregnancy and who have no risk factors for blood clots or cardiovascular disease.
• Isotretinoin (Accutane) Isotretinoin, commonly known as Accutane, is a powerful oral retinoid used to treat severe, cystic, or treatment-resistant acne. Isotretinoin targets several aspects of acne development: it reduces oil production, shrinks sebaceous glands, decreases inflammation, and prevents the formation of new lesions. It is highly effective, with many patients experiencing long-term remission after one course of treatment. However, isotretinoin is associated with significant side effects, including dryness, peeling, joint pain, and, in some cases, severe depression or suicidal thoughts. It also has teratogenic effects, meaning it can cause birth defects if taken during pregnancy, so patients must follow strict pregnancy prevention protocols during treatment.

Complementary Strategies and Combined Approaches

While topical and oral medications are the basis of treatment, a combined approach often yields the best results. For example, pairing topical retinoids with benzoyl peroxide or antibiotics can target different mechanisms of acne development, leading to more effective management. Likewise, oral treatments like antibiotics can be combined with topical therapies to enhance results while minimising the risk of side effects. Dr Dalia tailors treatments to individual skin types, sensitivities, and lifestyle factors to optimise results.

Additionally, Dr Dalia can incorporate adjunctive therapies like laser treatments, chemical peels, or microneedling into treatment plans to complement pharmaceutical approaches. These treatments can help reduce inflammation, improve skin texture, and fade post-acne hyperpigmentation or scars, enhancing overall outcomes.

Natural Remedies

While not a substitute for medical treatment, some natural remedies may help manage mild to moderate cases:

• Tea tree oil: This essential oil has antimicrobial and anti-inflammatory properties that can help reduce lesions.
• Green tea: Rich in antioxidants, green tea may help reduce inflammation and improve skin health.
• Zinc supplements: Zinc can help with wound healing and may help regulate oil production, making it beneficial for acne-prone skin.

Lifestyle Changes to Prevent and Manage Acne

In addition to medical treatments, certain lifestyle changes can help:

• Maintain a consistent skincare routine: Gently cleanse your skin twice daily, use non-comedogenic (non-pore-clogging) moisturisers, and avoid harsh scrubbing or over-exfoliating.
• Manage stress: Stress can exacerbate this condition, so practice stress-reducing techniques like meditation, yoga, or deep breathing exercises.
• Exercise regularly: Regular physical activity can help regulate hormones and improve circulation, both of which can benefit acne-prone skin.
• Eat a balanced diet: While diet alone may not cause acne, a nutritious diet rich in fruits, vegetables, and lean proteins can support overall skin health.
• Avoid picking or squeezing lesions: As tempting as it may be, picking or squeezing acne can lead to further inflammation, scarring, and the spread of bacteria.

Seeking Professional Help for Treatment

If over-the-counter treatments and lifestyle changes fail to improve your acne, it is advisable to seek professional help from a dermatologist. Dr Dalia can accurately diagnose the type and severity of your acne and recommend the most appropriate treatment plan tailored to your specific needs. Schedule a consultation today and take the first step towards a personalised treatment plan that targets the root causes.

FAQs about Causes and Treatment for Acne

Can acne be completely cured, or is it only manageable?

• Acne is typically a chronic condition, meaning it often requires long-term management rather than a permanent cure. While certain treatments can lead to clear skin for extended periods, factors like hormonal changes, stress, and lifestyle choices may cause acne to recur. Consistent skincare, tailored treatments, and sometimes ongoing maintenance therapy can help keep acne under control.

Are there any acne treatments specifically designed for sensitive skin?

• Yes, people with sensitive skin can still treat acne with products specifically formulated for gentler use. For example, lower-strength retinoids, benzoyl peroxide in concentrations as low as 2.5%, and salicylic acid products designed for sensitive skin can be effective without causing excessive irritation. Dr Dalia may also recommend non-comedogenic moisturisers and anti-inflammatory ingredients like niacinamide to reduce sensitivity.

How long does it typically take to see results from acne treatment?

• The time frame for seeing results can vary based on the treatment method and the severity of the acne. For topical treatments like retinoids or benzoyl peroxide, it may take 6–12 weeks to see noticeable improvements. Oral medications, like antibiotics or isotretinoin, might show effects sooner, but full results usually require several months of consistent use.

What are some professional treatments beyond medication for acne?

• Beyond topical and oral medications, Dr Dalia may recommend professional treatments such as chemical peels, light therapy (e.g., blue light to kill bacteria), laser treatments, and extractions. These treatments can accelerate the clearing of acne, reduce inflammation, and help improve skin texture by targeting deeper layers of the skin. They are often used in conjunction with standard acne treatments for optimal results.

How can I prevent scarring from acne breakouts?

• To prevent scarring, it’s important to avoid picking or popping acne lesions, as this can cause further damage and increase the risk of permanent marks. Using treatments like retinoids, which speed up cell turnover, can help prevent scarring. Early intervention with professional treatments like cortisone injections for cysts or laser therapy can also minimise the risk of scars. Additionally, wearing sunscreen daily helps prevent post-inflammatory hyperpigmentation from worsening.

Further Reading about Procedures at Cheshire Cosmetic Surgery

• Read more about Avoiding and Managing Complications of Dermal Fillers
• Read more about How to Reduce Eyelid Swelling after Blepharoplasty
• Read more about Treatments and Solutions for Prominent Ears
• Read more about Treatment Options for Lipoma and Other Swellings
• Read more about Causes and Treatments for Facial Wrinkles and Lines
• Read more about Causes and Treatment for Urticaria

Medical References for Acne

• Oral Doxycycline in the Management of Acne Vulgaris
• Isotretinoin capsules (Roaccutane): medicine to treat acne
• A review of diagnosis and treatment of acne in adult female patients
• Complementary therapies for acne vulgaris
• Female type of adult acne: Physiological and psychological considerations and management.