About Types Causes Treatments Myths Resources
What is Acne?
Acne is a very common skin condition affecting 85% of Australians aged 15-24 years old. This is a time when teenagers are wanting to look their best and even relatively mild acne can often cause great distress and damage to self-esteem and self-confidence.
Although acne often appears during teenage years, for some people acne can be a continuing problem well beyond their twenties.
Once you reach your mid-20s, acne often clears up by itself, especially in men. However, for some young people, acne is a serious, ongoing problem that needs medical assistance for the physical and psychological issues acne can sometimes cause.
Acne occurs when a hair follicle and its associated oil (sebaceous) gland become blocked and inflamed. This provides an ideal environment for bacteria (Cutibacterium acnes, formerly known as Propionibacterium acnes) to grow and cause the skin to become irritated, red and tender.
People with acne often have larger sebaceous glands and produce more sebum than people without acne. Sebum is a waxy/oily substance that prevents the hair and skin from drying out.
Blackheads, whiteheads, pimples (zits) and cysts tend to develop on the face, neck, back, chest and shoulders, because this is where oil glands are largest and most active.
Acne is a very common skin condition and, because it is caused by hormonal changes resulting in increased oil (sebum) production, it usually begins at puberty.
Non-inflamed acne (comedonal acne)
Comprises of blackheads or whiteheads that result from oil glands becoming blocked. Dermatologists call these 'comedones'. If left untreated, non-inflamed acne can often progress into inflamed acne.
Inflamed acne (inflammatory acne)
Associated with pimples (classified by dermatologists as papules, pustules or cysts, possibly associated with redness of the skin).
Some people will only ever develop mild acne, while others can experience large, deep, painful lumps under their skin, called cysts – a severe form of acne. Unfortunately, cystic acne can lead to permanent scarring, and therefore should be treated as soon as possible.
Puberty is a time when hormone levels increase. Androgens are a group of hormones that are associated with male traits but are present in both males and females. During puberty, androgens cause the oil glands in the skin of the face, neck, back, shoulders and chest to enlarge and produce more oil (sebum).
Girls tend to reach puberty earlier than boys and develop acne at a younger age. Acne can become worse or ‘break out’ at certain times of a girl’s menstrual cycle, usually just before a period.
Research has shown that increased stress can be linked to new outbreaks or worsening acne. During times of stress, cortisol (the stress hormone) increases oil production which can stimulate acne.
Stressful times for teenagers include major exams and other assessment periods during high school or university. It is important to manage your stress by having regular study routines, good planning and time management. You may also try specific relaxation techniques such as deep breathing and meditation.
Despite what many people may think, leaving acne to 'run its course' may not be the best course of action. If acne is not treated effectively, scarring can appear after acne subsides.
Most forms of acne are responsive to treatment and your dermatologist can work with you to advise you on a range of interventions to help your skin.
It is important to understand there is no ‘quick fix’ to treating acne. Up until this time in their life, the experience of most teenagers is only with painkillers or antibiotics, where the relief from symptoms is generally as quick as a day or so. However, acne treatment may take at least 6-8 weeks before noticeable improvement occurs. The aim of treatment is to reduce the number of blackheads, whiteheads and pimples, reduce the inflammation, and prevent scarring.
Regardless of which treatment is used, those with acne should understand the importance of continuing treatment, even if they don’t see immediate results. Acne treatment should start as soon as possible to reduce the risk of scarring and other impacts, for example, anxiety and low self-esteem.
Acne is a chronic condition, meaning it can last for 3–5 years or more. Despite initial treatment being effective, acne may return after treatment is stopped.
There are different ways to manage or treat each type of acne. You can get some treatments over the counter at your local pharmacy, but you will need to visit your GP or dermatologist for others.
See also All About Acne's information on acne treatments.
Tips & Advice
- Don't squeeze acne spots, as this can cause infection and worsen the condition.
- Avoid greasy skincare products, which may add to blocking oil glands. The use of toners may just dry out your skin, leading to more use of moisturizers, which are not necessary. In general, look for ‘oil-free’ and ‘non-comedogenic’ (meaning less likely to block pores) skincare products.
- Do not use harsh chemicals as these may irritate and inflame your skin further.
- Blackheads do not comprise dirt; it is just oxidized sebum and does not need to be scrubbed vigorously.
- Seek advice from a dermatologist.
Some acne treatments can be bought over the counter at pharmacies. These acne products are available to treat mild to moderate acne or periodic breakouts. They include cleansing lotions, gels, foams and towelettes, leave-on products, and treatments or kits. How do you know which one is best for you?
It is a good idea to talk to a pharmacist before you buy a product to find out which treatment might be the most useful for you. A cleanser for acne-prone skin may be all that is needed for mild acne. Don’t rely on advertisements or the advice of friends.
Non-prescription products may cause irritation and dryness in some people. Reduce the frequency of application if this happens. Stop using the product if severe irritation occurs and see your doctor.
Narrow-band blue and red light is also used to treat mild to moderate acne. This pain-free light is safe and uses no ultraviolet (UV) light or lasers. When these lights are used as a treatment for acne, it kills the acne-causing bacteria that can form within the sebaceous glands causing breakouts.
If acne persists after appropriate skincare, there are more sophisticated prescription treatments available. If it is severe or causing concern for any reason, consider seeing your doctor and getting a referral to a dermatologist quickly.
If you have cysts (large, deep, solid and painful lumps under your skin), you may have severe acne.
Severe acne can have a huge impact on self-confidence and self-esteem, leading to anxiety and depression. This type of acne will not usually respond to over-the-counter skincare products available at pharmacies or from supermarkets.
You should see your doctor sooner rather than later, as this form of acne can lead to permanent scarring.
If necessary, your doctor may want to refer you to a dermatologist for specialist assessment and further treatment.
Potential treatments that a dermatologist might recommend include:
- skin care advice
- prescription creams
- blood tests
- prescription tablets including antibiotics or a stronger medication based on Vitamin A such as isotretinoin (Roaccutane© or Oratane©).
It’s important to follow the dermatologist’s instructions completely if you are prescribed these treatments. As mentioned earlier, acne can take several weeks or months to respond to medical treatment. It’s not like pain killers or antibiotics, they take time, and you need to follow instructions carefully.
The results will be worthwhile in the long run.
There are many safe and effective acne treatments available to help acne sufferers. However, according to All About Acne, there is also a lot of misinformation and myths around.
Often people want a ‘quick fix’ and are eager to respond to advertising that promises unrealistic results and unproven remedies.
Here’s a list of points that will help you separate the facts from the fiction.
Poor hygiene causes acne
Acne is not caused by poor hygiene. Acne occurs when the pores in the skin become blocked. Hormones cause the oil glands to produce more oil. If the pores are blocked, a build-up of oil results in acne.
Keeping your skin clean will help manage acne, however you should not scrub your skin as this can cause irritation and inflammation.
Blackheads are not dirt. They are pores clogged with a bit of sebum (oil) that’s open to the air and oxidisation turns it black. If the skin covers the oil and any pus, this presents as a whitehead, pimple or zit.
Picking and squeezing pimples is okay
Picking and squeezing pimples may remove the core of the pimple, but creates more inflammation, which contributes to scarring. It can also spread the bacteria, which may contribute to further outbreaks.
Diet has no effect on acne
There is increasing evidence a low-glycemic (GI) diet can improve skin. Foods such as fruits, vegetables, nuts and grains help keep levels of blood sugar and insulin down.
A high-sugar/high-fat diet can boost levels of blood sugar and increase sebum production, which is known to trigger acne by making the skin's sebaceous glands produce extra oil.
Consumption of dairy products has also been shown to worsen acne.
Cheap make-up and moisturisers make acne worse
A high price tag is not necessarily a guarantee of quality. Look for mild 'soap-free' liquid face cleansers with a pH balance at 5.5 or slightly acidic to match that of the skin, but without abrasives, detergents or alcohol.
Choose water-based, oil-free, non-comedogenic make-up. If your skin is dry, use an oil-free, non-comedogenic moisturizer.
Sunlight or sun-baking will improve acne
There’s no link between sun exposure and acne prevention. In fact, sun exposure can cause real damage including premature wrinkles, ageing, skin cancer and melanoma. It is important to protect your skin from the sun’s harmful ultra-violet (UV) rays.
Many ‘oil free’ SPF30+ broad-spectrum sunscreen products containing physical blockers are relatively heavy creams and may worsen acne. Only those broad-spectrum sunscreens that are labelled as ‘non-comedogenic’ are suitable for acne-prone skin. These are relatively easy to get at your pharmacist or local supermarket.
For further information, you can visit the following resources:
There are educational resources available through #PROJECTACNE, our program designed for schools to provide students with reliable information about acne and skin care.
Acne (https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/acne) viewed 29/11/2017
Acne (https://www.dermnetnz.org/topics/acne/), viewed 29/11/17
All About Acne – Acne Information from Australian Experts (https://www.acne.org.au), viewed 29/11/2017
DermNet NZ (https://www.dermnetnz.org/topics/acne/), viewed 26/11/17
The Australasian College of Dermatologists (https://www.dermcoll.edu.au/atoz/acne-vulgaris/) viewed 29/11/17