Acne
Also known as Acne vulgaris, Spots
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is acne?
Acne occurs when hair follicles become blocked with oil and dead skin, then colonised by bacteria and inflamed. It is driven by hormones and genetics, not by poor washing or diet, and scrubbing harder makes it worse. Treatment takes six to eight weeks to show benefit, and stopping early is the most common reason it appears not to work.
Causes
- Increased sebum production driven by androgens
- Blockage of follicles by dead skin cells
- Overgrowth of Cutibacterium acnes
- Inflammation of the follicle wall
- Some medicines including steroids and lithium
Symptoms
- Blackheads and whiteheads
- Red inflamed spots
- Painful deep lumps or cysts
- Oily skin
- Scarring or dark marks after spots heal
- Most often on the face, chest and back
Risk factors
- Puberty and adolescence
- Family history of acne
- Polycystic ovary syndrome
- Certain medicines
- Occlusive cosmetics and heavy oils
- Friction from helmets, straps or masks
Diagnosis
- Clinical diagnosis from appearance and distribution
- Grading severity as mild, moderate or severe
- Hormonal testing if there are signs of androgen excess
- Assessment of scarring and psychological impact
Treatment
- Topical retinoid, the mainstay for blackheads and whiteheads
- Benzoyl peroxide
- Topical antibiotic combined with benzoyl peroxide, never alone
- Oral antibiotics such as lymecycline for moderate disease
- Combined hormonal contraception in women
- Isotretinoin for severe or scarring acne, under specialist care
Self care
- Wash twice daily with a gentle cleanser, no scrubbing
- Use non comedogenic moisturisers and makeup
- Do not pick or squeeze, which causes scarring
- Apply treatments to the whole area, not just visible spots
- Give any treatment at least six to eight weeks before judging it
- Use sunscreen, especially on retinoids or doxycycline
When to see a doctor
Book an appointment if:
- Over the counter treatment has not worked after two months
- Spots are deep, painful or cystic
- Scarring is developing
- Acne is affecting your mood or confidence
- Sudden severe acne with irregular periods or excess hair growth
- Acne starting for the first time in adulthood
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Acne cannot be reliably prevented, but scarring can
- Treat early rather than waiting for it to worsen
- Avoid picking and squeezing
- Use non comedogenic products
- Continue maintenance treatment after clearance
Outlook
Most acne improves through the late teens and early twenties, though it can persist into adulthood, particularly in women. Treatment controls it well in the large majority. Isotretinoin produces long term remission for most people with severe disease. The lasting problem is usually scarring, which is why early effective treatment matters more than waiting it out.
Common questions
Does chocolate or greasy food cause acne?
No. The evidence does not support chocolate or greasy food as a cause. There is weak evidence that high glycaemic index diets and skimmed milk may aggravate it in some people, but diet is not the driver for most.
Why does my skin get worse when I start treatment?
Retinoids and benzoyl peroxide commonly cause an initial flare and dryness for two to four weeks as they clear blocked follicles. Starting every other night and using moisturiser helps you get through it.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.