Acne: Causes, Risk Factors, Symptoms, Diagnosis and Treatment

It is a common skin disease caused by the blockage of hair follicles with fat and dead skin cells.

Acne can be persistent, but there are treatments available that are effective.

Acne is a prevalent condition that involves the formation of comedones (blackheads and whiteheads), pustules (pimples), deep bumps (nodules) on the skin, and sometimes scars.

Almost everyone deals with acne at some point, and the severity can vary.

The known causes of acne are summarized as the “four pillars of acne”: clogged pores, increased oil on the face, presence of bacteria, and inflammation.

Not all causes are equally active in each person’s acne; some people may have too much oil production, while others may have a hormonal imbalance.

Acne can cause significant distress, regardless of severity, and finding the correct regimen for your skin is essential.


Causes of acne

Four main factors cause acne:

Clogged pores: There are small holes in the skin’s surface, called pores. The pores open to a follicle containing hair and an oil gland. This clog is not about dirt. The gland releases fat to lubricate and protect the skin.

Acne occurs when dead skin cells are not removed from the follicle, and the glands produce too much oil in the hair, causing the pores to become blocked.

Overproduction of fat: The skin’s sebaceous glands can produce excess oil. Several factors can trigger more fat production, such as hormones and genetics.

Bacterial contamination:  Propionibacterium acnes (now known as Cutibacterum acnes). Everyone has this bacteria on their skin, but in people with acne, this bacteria can proliferate.

Inflammation: the presence of bacteria can trigger inflammation, which worsens acne due to the activation of the immune system. The clogged follicle enlarges, producing a bulge that, if ruptured, releases irritants and bacteria that cause inflammation.

Inflammation on the skin’s surface produces red bumps (papules), and inflammation more profound in the skin causes pustules (pimples). Even deeper inflammation causes complex, painful cysts.

The leading underlying cause of acne is a genetic predisposition, that is, a family history in people whose parents have also developed it.

However, there are other aggravating factors as well.

Hormonal changes related to puberty, menstrual periods, pregnancy, birth control pills, or stress can cause excessive oil secretion that contributes to acne.

Oil-based cosmetics and hair products, and medications, such as corticosteroids, lithium, antiepileptic drugs, and androgens, can also worsen acne.

Pressure or friction on the skin from headbands, helmets, and backpacks can be aggravating factors.

Medical conditions like PCOS are also associated with acne.

Risk factor’s

In the body

  • Age: Acne tends to affect people in their teens and early 20s. However, acne can last up to and including 40 years.
  • Sex: Women are more prone to acne caused by hormones and may benefit from oral contraceptives or other treatments to control their hormone levels.
  • Genetics: If the parents or siblings have had acne, there is a greater chance that a person will also have acne.

The lifestyle

  • Exercise: Exercise is believed to make acne worse. However, one study found that exercise did not increase the body’s chances of acne breakouts. However, women should be careful not to exercise in makeup, as acne can worsen. Make sure you have a clean face before training.
  • Diet: Several studies have shown that the intake of milk, specifically skim milk, and foods with a high glycemic index can be linked to a worsening of acne. People with acne may be advised to minimize their intake of milk and sugary foods and drinks.
  • Stress: stress tends to develop acne, and previous studies have shown that acne can break out at times of increased psychological stress.


Some products cause the pores on the face to get clogged and make acne worse.

Any product that does not have the words non-comedogenic should be used with caution.


Hot climates with heat and humidity have been associated with breakouts.

Acne symptoms

Acne is a typical skin disease of adolescence and early adulthood. Studies have estimated that more than 90% of adolescents will develop acne.

Acne generally affects the face and can affect the neck, chest, and back.

There are two groups of acne lesions known: inflammatory and non-inflammatory lesions.

Inflammatory lesions are red bumps, pus-filled white dots, and deep red lesions known as inflammatory nodules.

Non-inflammatory lesions are not as red and tend to be skin-colored, like comedones.

Acne caused by hormonal imbalances is usually present on the jawline.

Acne can cause dark spots on the skin in those with a darker pigment in the skin. Acne can leave scars.

Acne generally affects the areas of the skin with the highest number of hair follicles, such as the face, upper, and back of the chest.

It can also occur on the arms, legs, and buttocks. The most apparent signs of acne include:

  • Small red bumps (papules).
  • Small red, pus-filled lesions, blisters (pimples and cysts).
  • Raised white bumps (white dots).
  • Small dark spots (blackheads).
  • Cicatrization.


A simple skin exam allows the doctor to diagnose acne. Laboratory tests are generally not required.

However, laboratory tests may be used if polycystic ovary syndrome is suspected in women.

Laboratory tests can also be used in people whose acne does not respond to antibiotic treatment.

Acne Treatments

Acne is a chronic disease that generally improves with age, although it can persist into your 30s and 40s.

Therefore, the treatments require daily maintenance, as there is no total cure for acne.

Treatment revolves around targeting the leading causes of acne by keeping pores clear, reducing oil production, fighting acne-causing bacteria, and decreasing overall inflammation.

Typical treatments include topical or oral medications or a therapy that combines verbal and topical treatments.

Although acne is not an infection, antibiotics are often used to help control inflammation and reduce the number of bacteria (Propionibacterium acnes or Cutibacterium acnes).

Controlling hormone levels with oral medications is another treatment route for people with acne caused by hormonal imbalances.

Acne generally responds well to six to eight weeks of treatment, but it can recur from time to time.

The earlier treatment is started, the less likely there will be scarring.

Treatment based on:

Personal care

Personal care that can help your acne includes:

  • I cleaned the skin with a mild cleanser twice a day.
  • It uses over-the-counter topical medications (applied to the skin) that contain antibacterials and mild exfoliating agents.
  • Wash hair every day and avoid hair touching the face.
  • Avoid repeated scrubbing or washing of the skin.
  • Do not remove pimples (as this can make the infection worse).
  • Use of water-based (rather than oil-based) creams or cosmetics.
  • Remove makeup at night.

If personal care does not improve acne, consult your doctor or a dermatologist (skin specialist).

Products and Medicines

Prescription drugs only include:

Topical treatments
  • Benzoyl peroxide: It is available in many over-the-counter preparations. It helps clean pores and reduce the number of bacteria in lesions. It can be used as part of a daily regimen or as a spot treatment for the occasional annoying pimple.
  • Salicylic acid: It is also available in many over-the-counter preparations. It helps clean pores by removing dead skin cells.
  • Sulfur-Based Washes – Available as a prescription and as over-the-counter preparations. Helps reduce inflammation.
  • Retinoids: The most common retinoids are tretinoin, adapalene, and tazarotene. Most retinoids are available as a prescription, but adapalene can be purchased without a prescription. Retinoids help clean pores, reduce bacteria, and reduce inflammation.
  • Antibiotics – These are available as prescriptions from a healthcare provider. They can be prescribed alone or in a drug combined with a retinoid. Antibiotics help reduce bacteria and inflammation.

Oral treatments

  • Antibiotics – These are available as a prescription from a healthcare provider. They help reduce bacteria and inflammation—through oral antibiotics such as doxycycline and tetracycline.
  • Oral Contraceptives – These are available as a prescription from a healthcare provider. They help reduce the production of oil from the sebaceous glands of the skin by regulating the levels of hormones.
  • Spironolactone – This is available as a prescription from a healthcare provider. It helps reduce oil production from the skin’s sebaceous glands by regulating hormone levels. Spironolactone, a drug that affects hormonal activity, can help some women with persistent acne.
  • Isotretinoin: It is available as a prescription from a healthcare provider. It helps unclog pores, reduces oil production from the skin’s sebaceous glands, reduces the number of bacteria, and reduce inflammation.

People with severe acne may be prescribed higher doses of oral antibiotics or a potent oral retinoid, isotretinoin, which works by reducing oil secretion from the skin.

Due to side effects, including congenital disabilities, isotretinoin is only used under the strict supervision of a doctor or a dermatologist.

Other treatments

Other procedures that can help acne include:

  • Chemical peeling of the skin.
  • Dermabrasion for scar removal.
  • Removal or drainage of large cysts or injection of a corticosteroid.
  • The laser or light therapy.

Nutrition and diet

  • Mediterranean diet: One study found that those who eat a Mediterranean diet are less likely to get acne.
  • Low glycemic index diet: A study in men with acne showed that a low glycemic index diet improved their acne.

Acne and rosacea

From a distance, rosacea and acne look a lot alike. Rosacea is very similar to acne vulgaris, often referred to as acne rosacea.

Although rosacea is remarkably similar to acne, it is entirely different and has its unique symptoms and causes.

To avoid this confusion and ensure better management and treatment, it is essential to perform a differential diagnosis.

Recent discoveries of their very different mechanisms of action allow for better therapeutics, especially antibiotics.

While a rosacea patient also has many of these symptoms, there are many critical differences between acne vulgaris and acne rosacea.

For example, rosacea is a chronic disorder that usually appears in the central part of the face and is characterized by redness, flushing, bumps (papules), and pimples (pustules).

Rosacea can also lead to a bulbous nose and even affect the eyes.

While acne is most commonly seen in teens, rosacea usually occurs much later.

Also, unlike rosacea patients, acne patients have blackheads and sometimes even bumps and pimples on the trunk and arms.

Acne can be caused by many factors that cause blockage of hair follicles, hormonal stimulation of sebaceous gland cells, and bacterial infections.

On the other hand, Rosacea appears to be related to a defect in the body’s natural immune system.