Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It is a medical condition and not merely a cosmetic concern. Treating it as a surface-level issue risks delays in proper care, which can lead to complications like scarring and hyperpigmentation—especially in skin of color, which is more prone to these long-term effects. Effective acne management requires timely medical intervention, such as prescription medications or targeted therapies, to address the root cause and minimize the need for costly, time-consuming procedures later. The goal is to treat acne as the disease it is, preventing damage before it occurs, rather than relying on cosmetic fixes after the fact. Before deciding on a treatment plan, it’s important to understand the root cause of your acne and consult with skincare experts to determine the most effective approach.
What Causes Acne?
Acne is most commonly associated with teenagers, but it can affect people of all ages. Genetics also play a role, as acne often runs in families.
At its core, acne is caused by clogged hair follicles or pores. Hair follicles are tiny tubes that hold individual strands of hair, and several glands connected to these follicles can contribute to blockages. When too much material builds up inside a follicle, it leads to a clog. Here’s what can block your pores:
Sebum: This oily substance is naturally produced by your skin to keep it hydrated and protected. However, excess sebum can mix with dead skin cells and clog pores.
Bacteria: While small amounts of bacteria naturally live on your skin, an overgrowth can lead to clogged pores and infections.
Dead Skin Cells: Your skin constantly sheds old cells to make way for new ones. When these dead cells aren’t cleared away, they can accumulate and block hair follicles.
When pores become clogged, they trap these substances, leading to the formation of pimples. This process often triggers inflammation, which can cause pain, swelling, and visible redness around the affected area.(1)
By understanding the causes of acne, you can better navigate the options for treatment and care, whether they’re medical, cosmetic, or a mix of both.
Understanding Triggers
Acne can be influenced by a variety of factors, from hormonal changes to lifestyle habits. Identifying and understanding these triggers can help you manage breakouts more effectively. Here are some common culprits:(2, 3)
Hormonal Changes: Fluctuating hormone levels can increase oil production in the skin, leading to clogged pores. This is why acne is common during puberty, menstrual cycles, pregnancy, and menopause. Hormonal shifts caused by starting or stopping birth control pills can also play a role.
Stress: When you’re stressed, your body produces more androgens, a type of hormone that stimulates oil glands and hair follicles. This can lead to acne flare-ups, especially if stress is ongoing.
Cosmetic and Hair Products: Greasy or oily products can clog pores and worsen acne. Always look for labels like non-comedogenic, non-acnegenic, oil-free, or won’t clog pores when choosing skin care or hair care items.
Medications: Certain drugs, such as steroids, testosterone, estrogen, and phenytoin, can trigger acne as a side effect. Even some birth control devices, like hormone-releasing IUDs, may contribute to breakouts.
Environmental Factors: Heavy sweating, humidity, and excessive touching or rubbing of the skin can irritate pores and lead to acne.
Family History: Genetics can play a role in acne. If a close family member, like a parent or sibling, has struggled with acne, you may be more prone to it as well.
Undiagnosed Medical Conditions: In some cases, acne may be a sign of an underlying health issue. Treating the condition often helps clear the skin.
Diet: Foods like chocolate, nuts, and greasy snacks are often blamed for acne, research doesn’t strongly support this link. However, some studies suggest that diets high in refined sugars or dairy products might contribute to breakouts in certain individuals, though this remains a topic of debate.
How Severe Can Acne Be?
Acne isn’t a one-size-fits-all condition—it varies in severity, and understanding the grade of your acne is crucial for effective treatment. Acne is categorized into four grades, each with distinct characteristics:
Grade 1 (Mild): This is the mildest form, primarily consisting of whiteheads and blackheads, with occasional papules (small red bumps) and pustules (pus-filled bumps).
Grade 2 (Moderate or Pustular Acne): At this stage, you’ll notice more papules and pustules, often concentrated on the face.
Grade 3 (Moderately Severe Nodulocystic Acne): This grade includes inflamed nodules (larger, painful bumps) alongside papules and pustules. It can also affect areas like the back and chest.
Grade 4 (Severe Nodulocystic Acne): The most severe form, characterized by numerous large, painful pustules and nodules, often accompanied by significant inflammation.
Identifying the grade of your acne helps determine the best course of treatment, whether it’s over-the-counter products or prescription medications.
Medical vs. Cosmetic Problem: What’s the Difference?
Acne is a chronic inflammatory disease requiring medical treatment, not cosmetic solutions. Aesthetic-focused remedies fail to address its root causes—hormonal imbalances, excess sebum, and inflammation—risking delays that worsen scarring, especially in skin of color. International guidelines prioritize evidence-based therapies like retinoids, antibiotics, or hormonal medications to halt progression and prevent sequelae.(4) Early medical intervention reduces reliance on corrective procedures, emphasizing care that treats the disease, not just its appearance.
Is acne a one-time fix?
Unfortunately, no. Acne often requires a combination of aggressive treatment and long-term maintenance to keep it under control. The goals of treatment include:
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Clearing clogged pores
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Increasing skin cell turnover
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Reducing excess sebum production
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Decrease inflammation
Treatment plans are tailored to your specific needs and may evolve over time. Patience and consistency are key, as acne management is often a gradual process.
Not All Bumps Are Acne: Mimickers to Watch For
Not every skin condition that looks like acne is actually acne. Several conditions can mimic acne, making it essential to get a proper diagnosis. Some common acne mimickers include: (5)
Acne Rosacea: Redness and bumps that resemble acne but are caused by a different condition.
Perioral Dermatitis: Small, red bumps around the mouth.
Occupational Acne: Caused by exposure to certain chemicals.
Drug-Induced Acne: Triggered by medications like steroids or hormonal treatments.
Folliculitis: Inflammation of hair follicles, often mistaken for acne.
Milia: Tiny, white cysts that appear under the skin.
Sebaceous Hyperplasia: Enlarged oil glands that look like small bumps.
By understanding the severity, underlying causes, and potential mimickers of acne, you can take a more informed approach to managing your skin health.
Why Consult a Dermatologist for Acne?
Dealing with acne or blemishes isn’t just about slapping on a cream and hoping for the best. Some treatments, like topical medications (e.g., tretinoin), can be tricky to use and may take time for your skin to adjust. If not used correctly, they can do more harm than good. Additionally, certain treatments may not be suitable for specific situations, such as during pregnancy.
This is where a dermatologist comes in. They can guide you on the right way to use medications, recommend safe alternatives for special scenarios, and help you avoid potential pitfalls. Consulting a dermatologist ensures you’re not just treating the symptoms but addressing the root cause of your skin concerns.
Seeking Professional Diagnosis: Why It Matters
While acne is a common skin condition that many people think they can self-diagnose, the truth is that numerous skin conditions are often mistaken for acne. From acne rosacea to perioral dermatitis, the wrong diagnosis can lead to ineffective or even harmful treatments.
A dermatologist can accurately diagnose your skin condition and create a tailored treatment plan. They can recommend the right skincare products, dermatologic procedures, and preventive measures to keep your skin healthy and glowing. Remember, the best results come from knowing exactly what you’re dealing with. (6)
Knowing the Difference Means Finding the Right Solution
It’s tempting to let your skin “heal on its own” or rely on over-the-counter products. While this might work for some, it’s not a guaranteed solution—especially if you’re dealing with a condition that mimics acne. Without the right diagnosis, you could be treating the wrong problem entirely. (5)
Dermatologists are trained to distinguish between acne and its look-alikes. By seeking their expertise, you can ensure that your treatment plan is effective and tailored to your specific needs. After all, treating acne won’t clear up flare-ups caused by other skin conditions.
The Right Concentration and Formulation: Key to Success
Not all skincare products are created equal. The right concentration and formulation of active ingredients can make all the difference in how well a treatment works for you. For example, what works for someone else might be too harsh or too mild for your skin type. Not all skincare products are created equal. The right concentration and formulation of active ingredients can make all the difference in how well a treatment works for you. For example, what works for someone else might be too harsh or too mild for your skin type.
Formial labs (link) can help you find the perfect match for your skin. Our quick consultation includes photo submission and a series of questions, so our expert team can design a personalised formula and treatment plan just for you!
References:
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Cleveland Clinic [Internet]. Acne: Types, Causes, Treatment & Prevention. Available from: https://my.clevelandclinic.org/health/diseases/12233-acne
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Acne - Symptoms and Causes | Penn Medicine [Internet]. Available from: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/acne
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Adult acne [Internet]. Available from: https://www.aad.org/public/diseases/acne/really-acne/adult-acne
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Guidelines of care for the management of acne vulgaris - Journal of the American Academy of Dermatology [Internet].
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Al-Natour SH. Acne mimickers: Another cause for unresponsive acne. J Saudi Soc Dermatol Dermatol Surg [Internet]. 2012 Jul 1;16(2):35–40. Available from: https://www.sciencedirect.com/science/article/pii/S2210836X12000073
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Castro N. U.S. Dermatology Partners. 2024. More Than Acne: Understanding Skin Conditions That Mimic Acne. Available from: https://www.usdermatologypartners.com/blog/conditions-mimicking-acne/
