Acne, Explained: Causes, Treatment, and Complications

Acne breakouts are the most common during your teenage years — but their impact can last well into adulthood. Leaving behind scars and blemishes that can persist for years, acne causes embarrassment, a lack of self-confidence, and social dysfunction.

Context: Acne affects up to 50 million Americans annually, with about 85 percent of cases experienced by people aged between 12 and 24.

• People can also experience adult acne, especially women — a survey suggests that 35 percent of women aged 30 to 39 and 26 percent aged 40 to 49 experience some form of acne.
• Acne treatment is a gigantic business, with the acne medication market worth about $10.1 billion in 2021.
• An estimated $400 million was lost among patients and caregivers due to productivity losses from acne in 2013.

There’s no best way to cure acne, but the condition is often treatable by a combination of medication and lifestyle interventions. Treatment is often skin- and condition-specific, but some generic medications can also be effective.

What causes acne?

Experts consider it a disease of Western civilization — almost non-existent in non-westernized societies like the Eskimos and rural Brazil, living and eating in a “traditional manner.”

Factors that can make your skin prone to acne include:

• hormonal changes, like those that occur during puberty, pregnancy, or menopause
• the “Western diet,” rich in fatty and sugary foods, low in probiotics and fiber
• certain medications, like steroids, lithium, thyroid hormones, vitamin B12, and some antibiotics
• indirect agents, like stress, poor sleep, and cigarette smoking

Other potential triggers include long-term use of electronics, sun exposure, air pollution, or an allergic reaction to certain cosmetics.

Acne can be influenced by genetics and other health conditions, with only a small percentage of teenagers ever having clear skin.

• Each acne begins with small openings in your skin called pores, which are the openings for hair follicles and oil glands. These oil glands release sebum, which travels out of the pores to keep your skin moisturized.
• Acne occurs if your pores produce too much of this sebum, or if they get clogged with dirt, dead skin cells, or bacteria.
• The sebum, no longer able to leave the pore, can lead to the development of a blackhead or whitehead. If the pore gets inflamed, it turns into a pimple.

Understandably, acne most commonly develops on areas of the skin that have an abundance of oil glands — like the face, shoulders, chest, and back.

Different types of acne

• Whiteheads are closed comedones that form when a pore is clogged with sebum and dead skin cells. Since the top of the pore remains closed, it looks like a small, white bump underneath a thin layer of skin.

• Blackheads are formed when a pore is clogged with sebum and dead skin cells, similar to whiteheads. Unlike whiteheads, however, they are closed comedones — exposed to the air which causes a black appearance.

• Papules are small, tender bumps that are tender to the touch and about 1 cm in diameter. The surrounding skin may be red and irritated.

• Pustules, also called pimples, are pus-filled bumps that typically appear red with a yellow or white head.

• Cysts are pus-filled acne that forms deep under the skin. They are painful and the most likely to cause scarring.

• Nodules are hard knots that develop under the skin — appearing as red bumps. They can be painful to the touch and are at least a centimeter in diameter.

Complications that can last a lifetime

The most common complication of acne is scarring — caused when inflamed acne damages the surrounding skin. Different types of acne include:

• Ice pick scars
• Rolling scars
• Boxcar scars

Left untreated, acne scars can persist for a lifetime — accompanied by serious psychological symptoms in some people.

While the emotional toll varies with the severity of acne or acne scars, some cases are known to contribute to a mental health disorder.

• Acne vulgaris can have a negative impact on the psychological status of patients, worsening the symptoms of psychiatric disorders like obsession, depression, anxiety, and phobia.
• A study found that acne patients reported a quality of life on par with diseases like asthma, diabetes, and arthritis.
• While a negative impact on psychological symptoms could be observed across all people, the quality of life of young females is the most affected by acne.

Experiencing acne in your late 30s can get even more troublesome — an increasingly prevalent problem among adult women with wide-ranging implications.

Treating acne

The skin is part of a dynamic, complex ecosystem — and soap can devastate this landscape. Washing your face with soap doesn’t just strip away your skin’s natural oils, but also many helpful microorganisms.

Treating acne, therefore, requires a delicate approach.

• Washing the face should typically be limited to twice a day. Not every skin type is the same, and you should choose a cleanser that suits yours.
• Common topical medications include retinoids, salicylic acid, antibiotics, benzoyl peroxide, and azelaic acid.
• While the influence of diet is under debate, experts typically recommend reducing processed foods, fats, oils, and sugars.
• Some natural options that are primarily supported by anecdotal evidence include green tea, tea tree essential oil, honey, aloe vera, and turmeric.

Remember to avoid irritating your skin when treating acne. Some topical treatments can cause irritation and photosensitivity — in which case you should see a dermatologist.  ❏