Acne – Causes, Diagnosis and Treatment

Definition

Acne vulgaris is a highly prevalent, chronic inflammatory skin condition that occurs when hair follicles become plugged with oil (sebum) and dead skin cells. Characterized by comedones, papules, pustules, and in severe instances, nodules or cysts, acne primarily impacts skin areas with high sebaceous gland density, including the face, chest, and upper back. While extremely common during adolescence, acne can affect individuals of all age groups and carries a significant psychological and cosmetic burden.

Symptoms of Acne

Depending on how severe the condition is, acne mostly erupts in the form of:

• Pimples
• Blackheads
• Whiteheads
• Small red tender bumps
• Pus-filled lumps
• Large solid painful lumps

Risk Factors

There are a number of factors that may add to developing acne such as:

• Family history of acne
• Contact with greasy or oily substances
• Friction of the skin
• Hormonal changes
• Stress

Diagnosis of Acne

The diagnosis for acne can be self-assessed, based on the symptoms given above. But if the acne persists, medical intervention is required and the doctor may run some basic tests and refer a dermatologist.

Acne Treatment and Management

Treatment for acne depends on the type and severity of lesions. Your dermatologist will recommend a treatment plan based on the predominant type of acne (comedonal, inflammatory, or mixed), severity (mild, moderate, or severe), and individual factors such as skin type, scarring risk, and pregnancy status.

Mild acne (mostly blackheads and whiteheads with few inflammatory papules):

• Topical retinoids (adapalene 0.1%, tretinoin): The foundation of acne treatment. They unclog pores, reduce microcomedones, and have mild anti-inflammatory effects. Available over-the-counter (adapalene) or by prescription (tretinoin, tazarotene).
• Benzoyl peroxide (2.5–10%): Kills acne-causing bacteria (C. acnes) and reduces inflammation. Available over-the-counter. Can be used alone or with a topical retinoid.
• Combination therapy (topical retinoid + benzoyl peroxide) is more effective than either agent alone for most patients.

Moderate acne (widespread inflammatory papules and pustules):

• All of the above, PLUS:
• Topical antibiotics (clindamycin 1%): Always used in combination with benzoyl peroxide to prevent antibiotic resistance. Should NOT be used as monotherapy.
• Oral antibiotics (doxycycline 50–100 mg/day or minocycline): For moderate-to-severe inflammatory acne not responding to topical therapy. Limit duration to 3–4 months to minimise resistance.
• Hormonal therapy (combined oral contraceptives or spironolactone): For female patients with hormonal acne patterns (jawline distribution, premenstrual flares). Spironolactone 50–200 mg/day is effective for adult female acne.

Severe acne (nodular or nodulocystic acne, acne with scarring risk):

• Isotretinoin (0.5–1 mg/kg/day for 4–6 months): The most effective treatment for severe acne. Can produce long-term remission. Requires regular monitoring (liver function, lipids, pregnancy testing). ABSOLUTELY CONTRAINDICATED in pregnancy (Category X) due to severe birth defects.

When to see a dermatologist:

If over-the-counter treatments have not improved your acne after 8–12 weeks, if acne is leaving scars, if acne is affecting your mental health or confidence, or if you have nodular or cystic acne, consult a dermatologist for a prescription treatment plan.

Causes for Adult Acne

Some adults are frequently prone to acne even in their 30s or 40s, and 50s. Acne can first occur in an adult even at the above mentioned age. Dermatologists refer to this as “adult-onset acne” and are more common in women in the menopause stage. Reasons for acne can be any of the following reasons:
Fluctuating Hormone Levels: Adiscrepancy can lead to outbreaks. Women time and again experience fluctuating hormones:

• During their periods
• Pregnancy, around menopause, and during menopause
• Use of oral contraceptives can also affect the sebum production

Stress: Researchers have discovered an interlinked association between stress and acne. Stress increases the production of androgens in our body and these hormones kindle the oil glands and hair follicles in the skin leading to outburst of acne.
Genetic History: Research suggests that some individuals may have a genetic predilection for acne and develop adult acne during their lifetime.
Hair and Skin Care Goods: Using hair and skin care products that contain strong or irritating substances can cause adult acne. At least one of the below terms mentioned in skin and hair products are least likely to cause acne:

• Non-comedogenic
• Non-acnegenic
• Oil-free
• Does not clog pores

Medication Side Effect: One or many components of a medicine can trigger acne. Ifit is a possible side effect, consult the doctor immediately.
Undiagnosed Medical Condition: Acne can be an unnoticed sign of an underlying infection. It clears once the infection is treated.
Consulting a dermatologist also helps in clearing the acne. A couple of sessions of effective treatment with the help of the dermatologist can control acne.