Comprehensive Guide to Acne

Guide to Acne and Acne Treatment

Acne (clinically known as acne vulgaris) is the most common skin condition that affects 5.6 million Canadians with more than 80% of the cases occurring between the ages of 12 and 24. Acne occurs when pores become clogged with dead skin cells and oil from the skin.

Acne occurs not only on the face but can occur on the body – most notably the back, chest, and shoulders. Acne comes and goes when we are teenagers due to hormonal changes. However, persistent acne and acne scars can lead to anxiety, lowered self-esteem, and depression.

There is no one-size-fits-all solution for fighting acne which often leads to worse symptoms, confusion, and frustration. Despite being one of the most common skin conditions in the world, relatively little is known. However, promising research over the years have provided us good knowledge on how to approach and handle acne. Continue reading to learn more!

What is Acne?

Acne psilosebaceous unit

Acne is an inflammatory disorder of the psilosebaceous unit which is made up of sebaceous glands, hair follicle, and hair.

Naturally, hormones called androgens signal sebaceous glands to produce oil called sebum that coats the skin and hair in protective oil that keeps them moisturized and healthy. When there is too little sebum production, it can cause dryness and irritation on the skin. When there is too much sebum production, it causes an overly oily appearance on the skin and increases the risk of acne. Acne forms when these hair follicles become clogged with sebum and dead skin cells from the skin.

Swelling and infection of acne occurs when a bacteria called Propionibacterium acnes (P. acnes) induces an inflammatory response from the body. However, there are many types of acne that can occur. In the next section, let’s explore the different types of acne and severity of each type.  

Types of Acne

Acne is a general term that includes blackheads, whiteheads, papules, pustules, nodules, cysts etc. While the definitions on the severity grades of acne vary, most acne can be categorised into three main categories of: mild, moderate, and severe.

Blackheads and whiteheads are both mild forms of acne. Blackheads (also known as open comedones) form when pores become clogged and stays open. The open pore reacts with the air which becomes oxidized and causes the appearance of black dots on the skin. Whiteheads (also known as closed comedones) are clogged pores that are closed or have a narrow opening so it does not oxidize with the air, causing the appearance to stay white.

Moderate forms of acne involve papules and pustules. Papules are advanced forms of whiteheads that are red or pink bumps with a swollen appearance. When bacteria gets trapped in the pores along with oil and dead skin cells, it causes white blood cells to enter the hair follicle, creating inflammation. Pustules are very similar to papules except that they are filled with pus (white blood cells, dead skin cells, and bacteria) and is painful to touch. Pustules look like white/yellowish bumps surrounded by a red ring.  

Lastly, severe forms of acne are in the form of nodules and cysts. Nodules occur when an infection occurs deep within the skin which causes the pore to become red and swollen. Nodules feel like hard knots under the skin and can last a long time – even months. Cysts are similar to nodules but are filled with pus and look similar to boils. The deep infection in both nodules and cysts makes them hard to clear with over-the-counter (OTC) products, often requiring consultation with a dermatologist.

There are many types of acne but how do they occur in the first place? Next, we discuss some commonly known causes of acne.

What Causes Acne?

What you can do to control acne

As previously mentioned, over-production of sebum can cause acne. However, there are other factors that contribute to the formation of acne. Some factors are not in our control but some can be prevented or controlled through lifestyle changes.

Uncontrollable causes of Acne:

  1. One cause of acne that cannot be controlled is largely due to natural hormonal changes. This is most evident in teenagers when they are undergoing puberty and the occurrence of acne is much higher than adults. You can learn more about teenage acne by clicking here. However, this is not exclusive to teenagers as hormonal changes still occurs in adults.
  2. In addition, taking certain medications can induce the formation of acne. Medications can fluctuate hormone levels thus leading to breakouts. Unfortunately, some medications cannot be avoided for specific individuals due to other health complications.
  3. Lastly, another cause of acne that cannot be controlled is due to genetic reasons. Acne tends to run in families as those who have first-degree relatives with adult acne tend to be more likely to develop acne themselves.

Controllable causes of Acne:

  1. Washing your skin will clean off bacteria, built up dirt, and excess oil which will reduce the chance of breakouts. However, frequent washing or over-stripping the skin’s natural oils will cause your skin to panic and overproduce sebum, which ends up increasing the risk of breakouts.
  2. Another hygienic practice to prevent acne is frequently changing your pillowcases. Just as bacteria, dirt, and oil building on your skin over the day, these accumulate on your pillowcase and cause breakouts. You should wash your pillowcase every other day or have spare ones you can change every night.
  3. Moreover, using the right ingredients and products on your skin will reduce your chance of acne. Some products are comedogenic which means that the ingredients clogs pores. If you’re prone to acne, look for skin care products or makeup that says “noncomedogenic”.
  4. Eat low-glycemic foods and avoid high-glycemic foods as they are known to worsen acne. High-glycemic foods include sugary foods, soft drinks, white bread/rice, and potatoes. In some cases, cutting out dairy products showed a reduction in the occurrence of acne. 
  5. It can be hard to resist picking or popping acne but this can cause more inflammation, risk of infection, and take longer to heal. It also increases the chance of forming acne scars so this should only be done by a professional.

If you’ve tried these methods and acne still doesn’t seem like it is going away, seeking professional help might be a solution for you.

Acne and Acne Scars Treatment

Mild to Moderate Cases:

In most mild to moderate acne cases, topical treatment is a great start or sufficient for preventing and treating acne. There are many ingredients that are effective against acne but three ingredients are well-known and studied: Salicylic Acid, Benzoyl Peroxide, and Retinoids/Retinol. Each of the products have different purposes in treating acne so all three of the products may be used if needed.

  1. Salicylic Acid is a type of beta-hydroxy acid (BHA) that exfoliates dead skin cells on the skin that are clogging pores. At the same time, Salicylic Acid improves skin texture and tone. You’ll usually find these acids in concentrations ranging between 0.5 – 2%.
  2. Benzoyl Peroxide works by penetrating deeper into the skin and kills the acne-causing bacteria in pores. It also helps remove excess oil on the skin, but is relatively more drying than Salicylic Acid. In cases where topical antibiotics are given to treat acne, Benzoyl Peroxide is a great addition to prevent antibiotic resistance.
  3. Retinoid/Retinol (Vitamin A) is best-known for their anti-aging properties but also unclogs pores and dissolves dead skin cells. It also prevents acne and acne scars from forming. Retinoids are stronger but must be prescribed whereas Retinols are OTC but slightly less potent. Retinoids/Retinols also possess anti-inflammatory benefits.

All three topical products may be used together but it’s best to consult a professional to create a safe skin care routine for you. Mixing these topical treatments in the wrong order or within the wrong skin care routine can cause irritation or worsen symptoms. Overusing the products can also cause irritation but is easily resolved with proper lotion and creams in most cases.

Moderate to Severe Cases:

For severe cases such as nodules and cysts, it is best-advised to visit a dermatologist. A dermatologist may prescribe stronger doses for topical applications or provide oral medications. Some cases might require a mix of treatment options used together to treat the concern. In other cases, invasive procedures such as making an incision on the skin and draining pus might be required.

While it is tempting to pop one’s own nodules and cysts, doing so will aggravate the acne and make symptoms worse. The healing process will take longer and highly increases the chance of acne scars. A professional can pop them in a safer and less risky way.

Be patient with your skin care professional as approaching acne (regardless if it is mild or severe) is a complicated and long process. You’ll seldom see quick results as most topical treatments require at least 6-8 weeks before improvement is seen.

Treating Acne Scars:

While mild acne is relatively simple to treat in most cases, acne scars are another equally or bigger concern. Acne scars are reddish or brownish marks that remain after the active acne disappears. These scars last months or even years without proper treatment.

After active acne is in control, it is best-advised to change your skin care routine to a hyperpigmentation routine so that you can fade away acne scars. In many cases, a chemical peel treatment can help improve the appearance of acne scars. For severe cases, laser treatment or invasive treatments such as microneedling may be required.

Remember to consult a professional so that you don’t make the hyperpigmentation worse!

And in Closing...

Acne is a complicated skin disorder with a variety of treatment options available. It is advised to consult your skin care provider on the best treatment option for you. Remember to do your part in keeping up with good skin care habits and remember that treating acne and acne scars take time.  

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