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Dr Nitin Nair


Acne is a common skin disorder caused due to inflammation of oil-producing glands (sebaceous glands) and hair follicles. Hair follicles are small structures present beneath the skin that act as seeds for the growth of hair while the sebaceous glands produce oil that moisturises the skin and hair. Each strand of hair that grows out of the respective hair follicle carries the oil along with it and pushes out of the skin surface.

At the time of puberty, there is an increase in production of oil and decrease in the shedding of skin cells. These skin cells block the hair follicles and trap the oil within. The bacteria naturally present in hair follicles multiply in the oil-filled pores, eventually resulting in inflammation and acne breakouts.

Acne can develop in both boys and girls during puberty. It can develop in people during adulthood too, even in their 40s and 50s.

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There are mainly six types of acne, including blackheads, whiteheads, pustules, papules, nodules and cysts.

  1. Blackheads: It appears as yellow or black coloured, open bumps on the skin filled with dead skin and excess oil. Black colouration is due to the pigmentation produced by the hair follicle and oxidation of pores due to exposure to air.

  2. Whiteheads: Whiteheads are closed bumps filled with dead skin and oil.

  3. Papules: It appears as small, red bumps. These bumps may be sore or tender to touch.

  4. Pustules (pimples): It appears as small red bumps with a white tip in the centre. As the name suggests, pustules are filled with pus.

  5. Nodules: Nodules are large solid lumps present deep in the skin.

  6. Cysts: Cysts are large pus-filled lumps. It is the most severe form and carries a high risk of causing permanent scarring.


Acne may appear as bumps on the skin filled with or without pus. These bumps usually break and form larger bumps. Acne outbreaks occur especially in the parts of the body that contain a high concentration of oil glands, including face, neck, shoulders, chest and upper back.

Causes And Risk Factors


Acne is commonly caused due to an increase in the levels of androgen hormones at the start of puberty. This hormone enlarges the oil glands and increases oil production. The bacteria present on the skin digest the oil. The products formed from this digestion process irritate the skin and block the pores, which ultimately results in acne.

Other conditions responsible for acne breakouts include:

  1. Fluctuating levels of hormones in women during pregnancy or menstrual cycle.

  2. Pressure or friction on the skin from the use of headgear such as sports helmets or hats.

  3. Use of oil-based personal care products such as hair pomades, heavy lotions/creams, waxes, etc.

  4. Environments with high humidity.

  5. Air pollution.

  6. Working in environments with greasy surfaces such as restaurants.

  7. Use of birth control pills.

There is no correlation between poor hygiene or diet and acne breakout. Apparently, over-washing can worsen acne breakouts.

Risk Factors

Acne commonly occurs in teens and young adults. However, it can affect people of all age groups. It is more common in males during the teenage years and predominant in women during adulthood.


Although it is difficult to prevent acne during normal hormonal changes, it is not impossible. The following measures may help to minimise the chances of development of acne:

  1. Wash your face daily with a mild facial cleanser and warm water.

  2. Apply moisturiser routinely.

  3. Avoid touching the face.

  4. People who wear make-up, should use the products that are labelled “non-comedogenic”. It ensures that the ingredients in the products do not block pores. Remove the make-up before going to sleep.


A doctor usually diagnoses acne just by examining the skin. He or she will identify the type of acne and location of acne breakouts and accordingly recommend an effective treatment plan. Few skin conditions exist that can be mistaken for acne due to similar appearance. However, these conditions often require a different treatment strategy. Some such skin conditions include:

  • Rosaceae

  • Folliculitis


  • A doctor will recommend a treatment plan based on the following factors:

    1. Age of the affected person

    2. Type of acne

    3. Location of acne breakouts

    4. Onset of breakouts

    5. Past treatments

    6. Presence of dark spots or scars caused due to acne

    Topical medicines (gel, cream, lotion or solution) may be prescribed by the doctor to be applied on the skin in the treatment of acne. These are discussed below:

    1. Benzoyl peroxide (to kill the bacteria)

    2. Retinoids such as tazarotene, tretinoin and adapalene (to stop the development of new acne)

    3. Antibiotics such as erythromycin and clindamycin (to slow down the growth of acne-causing bacteria)

    4. Salicylic acid to empty the oil and dead skin cells from whiteheads and blackheads.

    5. Other medicines: Dapsone and azelaic acid.

    Oral medicines (to be taken by mouth) that may be prescribed by the doctor in the treatment of acne are discussed below:

    1. Antibiotics to treat moderate to severe acne. Examples of such antibiotics include dapsone, doxycycline, sulphamethoxazole, erythromycin, trimethoprim, tetracycline and minocycline.

    2. Spironolactone or birth control pill in women. These medicines help to control fluctuating hormonal levels and control acne breakouts.

    3. Isotretinoin to treat severe acne or cysts. It reduces the size of sebaceous glands and increases the shedding of skin cells, which ultimately reduces the development of acne. However, the drug has potential psychiatric side effects.  Pregnant women should not take medicines containing isotretinoin as the drug can cause miscarriage, premature birth or birth defects.

    The treatment may vary depending on the type of acne. The treatment options for acne include medications such as retinoids, isotretinoin, benzoyl peroxide, salicylic acid, azelaic acid; the application of medicines or antibiotics on the skin; or even hormonal treatment.

Lifestyle / Management

In the absence of a proper skin-care routine, the skin will be susceptible to new acne breakouts even after following the prescribed treatment plan. Hence, a doctor may recommend the following skin-care habits in addition to the treatment plan to help achieve the best results from the ongoing treatment:

  1. Wash your face twice a day. In addition, wash your face at the earliest after sweating (especially after wearing a helmet or hat).

  2. Use gentle, alcohol-free products on the skin. Avoid the use of products such as exfoliants, astringents and toners as they may irritate the skin.

  3. Do not scrub the skin.

  4. Use your fingertips instead of mesh cloth or washcloth to apply the cleanser.

  5. Use lukewarm water to rinse.

  6. Avoid the temptation to touch the face throughout the day.

  7. People with oily hair should shampoo regularly.

  8. Stay out of the sun as some medicines used to treat acne increases the skin’s sensitivity to ultraviolet light.

  9. Do not squeeze or pop the acne as they take longer to heal and increase the risk of forming acne scars.

Prognosis And Complications


A proper treatment plan can help control acne breakouts. However, the medicines may require weeks or even months to show results. 


Severe acne can result in lifelong physical scars. It can cause low self-esteem and discourage affected people from participating in social gatherings and sporting activities.

Alternative Treatments

The surgeon may recommend the addition of one of the following specialised therapies to the treatment plan:

  1. Steroids: In rare cases, the doctor may use steroids to treat severe acne or large nodules.

  2. Chemical peels: This therapy may be recommended to reduce acne scars. It involves the use of special chemicals to remove the top layer of the skin.

  3. Dermabrasion: This therapy involves the use of an electrical machine to remove the top layers of the skin and reduce the appearance of scars.

  4. Lasers: These are mainly used to treat acne scars. It involves the use of special lasers that heats the scarred skin and promotes the growth of new skin cells.

  5. Dermal filler injections: These are administered beneath the skin to restore the skin’s collagen and treat acne.

  6. Pulsed light and heat energy therapy: It uses light and heat together to destroy acne-causing bacteria.

  7. Phototherapy/Blue light therapy: A blue light source is used to reduce acne-causing bacteria in the skin.

  8. Autologous fat transfer: This involves the transfer of body fat from one part of the body to the skin surface containing scars. It corrects the skin defects caused by scarring of severe acne.

  9. Punch grafts: It involves the replacement of scarred skin with healthy skin, usually taken from the back of the earlobe. 


  1. Johns Hopkins Medicine. Acne [Internet]. Available at:,be%20either%20superficial%20or%20deep.. Accessed on Feb 15, 2020.

  2. Harvard Health Publishing Harvard Medical School. Acne [Internet] [Updated Jan, 2019]. Available at: Accessed on Feb 15, 2020.

  3. nidirect government services. Acne [Internet]. Available at: Accessed on Feb 15, 2020.

  4. Cleveland Clinic. Acne  [Internet] [Updated Sep 1, 2020]. Available at:,know%20you're%20not%20alone.. Accessed on Feb 15, 2020.

  5. Cleveland Clinic healthessetials. How to get rid of blackheads [Internet] [Updated Jan 30, 2020]. Available at: Accessed on Mar 9, 2021.

  6. BetterHealth Channel. Acne [Internet] [Updated Jun, 2020]. Available at: Accessed on Feb 15, 2020.

  7. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne [Internet]. Available at: Accessed on Feb 15, 2020.

  8. American Academy of Dermatology Association. 10 skin care habits that can worsen acne [Internet]. Available at: Accessed on Feb 15, 2020.

  9. American Academy of Dermatology Association. Acne: diagnosis and treatment [Internet]. Available at: Accessed on Feb 15, 2020.

  10. American Academy of Dermatology Association. Is that stubborn acne really acne? [Internet]. Available at: Accessed on Mar 9, 2021.

  11. American Academy of Dermatology Association. Acne-like breakouts could be folliculitis [Internet]. Available at: Accessed on Mar 9, 2021.

  12. American Academy of Dermatology Association. Acne: Tips for managing [Internet]. Available at: Accessed on Feb 15, 2020.

  13. healthdirect. Acne [Internet] [Updated Oct, 2019]. Available at: Accessed on Feb 15, 2020.


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