Acne – Symptoms and Causes
Overview
Acne develops when hair follicles get clogged with oil and dead skin cells, creating whiteheads, blackheads, or pimples.
Though teenagers commonly experience acne, it can affect people of any age.
Various effective treatments exist, but acne often persists with a frustrating cycle—as some pimples heal, new ones appear.
This skin condition can lead to both emotional distress and physical scarring, especially when left untreated.
Starting treatment early significantly reduces the risk of lasting skin damage and psychological impacts. For most people, acne requires ongoing management rather than a one-time fix.
Skin Signs
Acne appears in different forms depending on how severe it is. You might notice whiteheads, which are closed pores filled with oil and dead skin cells.
Blackheads are similar but have open pores. Some people get small red, tender bumps called papules, while others develop pustules—pimples with pus at the tips.
More severe forms include nodules, which are large, painful lumps under the skin, and cystic lesions that contain pus deep beneath the skin surface.
These skin concerns typically appear on the face, forehead, chest, upper back, and shoulders.
Medical Attention Needed
See your doctor if home treatments don’t help your acne.
Your primary care provider can prescribe stronger medications than what’s available over-the-counter. For persistent or severe cases, consider seeing a skin specialist (dermatologist).
Women may experience acne for many years, with flare-ups often occurring about a week before their period. Birth control use may help clear this type of acne.
Important Warning: Some skin products can cause serious allergic reactions. If you experience any of these symptoms after using an acne product, get emergency help right away:
- Feeling faint
- Breathing problems
- Swelling of eyes, face, lips, or tongue
- Throat tightness
For older adults, sudden severe acne might signal an underlying health problem that needs medical attention.
Causes of Acne
Acne develops due to four main factors:
- Too much oil (sebum) production
- Clogged hair follicles from oil and dead skin cells
- Bacterial growth
- Inflammation
Acne most often shows up on the face, forehead, chest, upper back, and shoulders. These areas have more oil glands connected to hair follicles.
When a follicle gets plugged, different types of acne can form. A closed plug creates a whitehead. An open pore exposed to air turns dark, forming a blackhead.
This isn’t dirt—it’s oil and bacteria that turn brown when they contact air.
Pimples are red, raised spots with white centers that form when clogged follicles become inflamed or infected. Deep blockages can create painful, cyst-like lumps under the skin.
Several factors can trigger or worsen acne:
Hormonal Changes
- Puberty increases androgens in both boys and girls
- These hormones make oil glands larger and produce more sebum
- Midlife hormone shifts, especially in women, can cause breakouts
Medications
- Some drugs containing corticosteroids
- Testosterone treatments
- Lithium
Diet
- High-carbohydrate foods (bread, bagels, chips)
- More research is needed on specific dietary restrictions
Stress
- Doesn’t cause acne
- Can make existing acne worse
Acne Facts vs. Fiction
Many beliefs about acne causes aren’t supported by evidence:
| Myth | Reality |
|---|---|
| Chocolate and greasy foods cause acne | These foods have little to no effect on acne development |
| Poor hygiene causes acne | Acne isn’t caused by dirty skin—scrubbing too hard or using harsh soaps actually irritates the skin and worsens acne |
| All makeup worsens acne | Oil-free, non-pore-clogging (noncomedogenic) cosmetics don’t necessarily worsen acne when removed regularly |
Complications
Individuals with darker skin tones face a higher risk of certain acne complications compared to those with lighter skin:
Scarring
Two main types of scars can persist after acne heals:
- Pitted scars (depressions in the skin)
- Thick, raised scars (keloids)
Skin Discoloration
When acne resolves, the affected skin may develop:
- Hyperpigmentation (darker patches)
- Hypopigmentation (lighter areas)
These lingering effects often require separate treatment approaches after the active acne has cleared.
Risk Factors
Several factors increase the chance of developing acne:
- Age: Teenagers get acne most often, though people of any age can develop it.
- Hormonal Changes: Puberty and pregnancy often trigger acne due to hormone fluctuations.
- Family History: If both parents had acne, you likely will too. Genetics plays a significant role.
- Oily Substances: Contact with greasy products or oils may cause breakouts where they touch the skin.
- Friction and Pressure: Items pressing against your skin can trigger acne. These include:
- Cell phones
- Helmets
- Tight collars
- Backpacks
