Acne is a common skin condition that affects most people at some point. It causes spots, oily skin and sometimes skin that’s hot or painful to touch.
Acne most commonly develops on the:
face – this affects almost everyone with acne
back – this affects more than half of people with acne
chest – this affects about 15% of people with acne
Picture of acne spots
Types of spots
There are six main types of spot caused by acne:
blackheads – small black or yellowish bumps that develop on the skin; they’re not filled with dirt, but are black because the inner lining of the hair follicle produces pigmentation (colouring)
whiteheads – have a similar appearance to blackheads, but may be firmer and won’t empty when squeezed
papules – small red bumps that may feel tender or sore
pustules – similar to papules, but have a white tip in the centre, caused by a build-up of pus
nodules – large hard lumps that build up beneath the surface of the skin and can be painful
cysts – the most severe type of spot caused by acne; they’re large pus-filled lumps that look similar to boils and carry the greatest risk of causing permanent scarring
What can I do if I have acne?
These self-help techniques may be useful:
Don’t wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse.
Wash the affected area with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse.
Don’t try to “clean out” blackheads or squeeze spots. This can make them worse and cause permanent scarring.
Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic (this means the product is less likely to block the pores in your skin).
Completely remove make-up before going to bed.
If dry skin is a problem, use a fragrance-free, water-based emollient.
Regular exercise can’t improve your acne, but it can boost your mood and improve your self-esteem. Shower as soon as possible once you finish exercising, as sweat can irritate your acne.
Wash your hair regularly and try to avoid letting your hair fall across your face.
Although acne can’t be cured, it can be controlled with treatment. Several creams, lotions and gels for treating spots are available at pharmacies.
If you develop acne, it’s a good idea to speak to your pharmacist for advice. Products containing a low concentration of benzoyl peroxide may be recommended – but be careful, as this can bleach clothing.
If your acne is severe or appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are only available on prescription.
When to seek medical advice
Even mild cases of acne can cause distress. If your acne is making you feel very unhappy or you can’t control your spots with over-the-counter medication, see your GP.
Also see your GP if you develop nodules or cysts, as they need to be treated properly to avoid scarring. Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring.
Treatments can take up to three months to work, so don’t expect results overnight. Once they do start to work, the results are usually good.
Why do I have acne?
Acne is most commonly linked to the changes in hormone levels during puberty, but can start at any age.
Certain hormones cause the grease-producing glands next to hair follicles in the skin to produce larger amounts of oil (abnormal sebum).
This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus.
The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Cleaning the skin doesn’t help to remove this blockage.
Other possible causes
Acne is known to run in families. If both your mother and father had acne, it’s likely that you’ll also have acne.
Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women.
There’s no evidence that diet, poor hygiene or sexual activity play a role in acne.
Acne is very common in teenagers and younger adults. About 80% of people aged 11 to 30 are affected by acne.
Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties.
In some cases, acne can continue into adult life. About 5% of women and 1% of men have acne over the age of 25.
Acne is caused when tiny holes in the skin, known as hair follicles, become blocked.
Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum.
In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle.
If the plugged follicle is close to the surface of the skin, it bulges outwards, creating a whitehead. Alternatively, the plugged follicle can be open to the skin, creating a blackhead.
Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts.
Teenage acne is thought to be triggered by increased levels of a hormone called testosterone, which occurs during puberty. The hormone plays an important role in stimulating the growth and development of the penis and testicles in boys, and maintaining muscle and bone strength in girls.
The sebaceous glands are particularly sensitive to hormones. It’s thought that increased levels of testosterone cause the glands to produce much more sebum than the skin needs.
Acne in families
Acne can run in families. If your parents had acne, it’s likely that you’ll also develop it.
Acne in women
More than 80% of cases of adult acne occur in women. It’s thought that many cases of adult acne are caused by the changes in hormone levels that many women have at certain times.
These times include:
periods – some women have a flare-up of acne just before their period
pregnancy – many women have symptoms of acne at this time, usually during the first three months of their pregnancy
polycystic ovary syndrome – a common condition that can cause acne, weight gain and the formation of small cysts inside the ovary
Other possible triggers of an acne flare-up include:
some cosmetic products – however, this is less common as most products are now tested, so they don’t cause spots (non-comedogenic)
certain medications – such as steroid medications, lithium (used to treat depression and bipolar disorder) and some anti-epileptic drugs (used to treat epilepsy)
regularly wearing items that place pressure on an affected area of skin, such as a headband or backpack
smoking – which can contribute to acne in older people
Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood. There are many myths and misconceptions about it:
“Acne is caused by a poor diet”
So far, research hasn’t found any foods that cause acne. Eating a healthy, balanced diet is recommended because it’s good for your heart and your health in general.
“Acne is caused by having dirty skin and poor hygiene”
Most of the biological reactions that trigger acne occur beneath the skin, not on the surface, so the cleanliness of your skin has no effect on your acne. Washing your face more than twice a day could just aggravate your skin.
“Squeezing blackheads, whiteheads and spots is the best way to get rid of acne”
This could actually make symptoms worse and may leave you with scarring.
“Sexual activity can influence acne”
Having sex or masturbating won’t make acne any better or worse.
“Sunbathing, sunbeds and sunlamps help improve the symptoms of acne”
There’s no conclusive evidence that prolonged exposure to sunlight or using sunbeds or sunlamps can improve acne. Many medications used to treat acne can make your skin more sensitive to light, so exposure could cause painful damage to your skin, and also increase your risk of skin cancer.
“Acne is infectious”
You can’t pass acne on to other people.
Your GP can diagnose acne by looking at your skin. This involves examining your face, chest and back for the different types of spot, such as blackheads or sore, red nodules.
How many spots you have and how painful and inflamed they are will help determine how severe your acne is. This is important in planning your treatment.
Four grades can be used to measure the severity of acne:
grade 1 (mild) – acne is mostly confined to whiteheads and blackheads, with just a few papules and pustules
grade 2 (moderate) – there are multiple papules and pustules, which are mostly confined to the face
grade 3 (moderately severe) – there’s a large number of papules and pustules, as well as the occasional inflamed nodule, and the back and chest are also affected by acne
grade 4 (severe) – there’s a large number of large, painful pustules and nodules
Acne in women
If acne suddenly starts in adult women, it can be a sign of a hormonal imbalance, especially if it’s accompanied by other symptoms such as:
excessive body hair (hirsutism)
irregular or light periods
The most common cause of hormonal imbalances in women is polycystic ovary syndrome (PCOS). PCOS can be diagnosed using a combination of ultrasound scans and blood tests.
Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve.
If you just have a few blackheads, whiteheads and spots, you should be able to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide.
Treatments from your GP
See your GP if your acne is more widespread, as you probably need prescription medication. For example, if:
you have a large number of papules and pustules
over-the-counter medication hasn’t worked
Prescription medications that can be used to treat acne include:
in women, the combined oral contraceptive pill
If you have severe acne, your GP can refer you to an expert in treating skin conditions (dermatologist). For example, if you have:
a large number of papules and pustules on your chest and back, as well as your face
A combination of antibiotic tablets and topical treatments is usually the first treatment option for severe acne. If this doesn’t work, a medication called isotretinoin may be prescribed.
Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne. However, the progestogen-only pill or contraceptive implant can sometimes make acne worse.
Many of these treatments can take two to three months before they start to work. It’s important to be patient and persist with a recommended treatment, even if there’s no immediate effect.
Topical treatments (gels, creams and lotions)
Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin. It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect.
Benzoyl peroxide is usually available as a cream or gel. It’s used either once or twice a day. It should be applied 20 minutes after washing to all of the parts of your face affected by acne.
It should be used sparingly, as too much can irritate your skin. It also makes your face more sensitive to sunlight, so avoid too much sun and ultraviolet (UV) light, or wear sun cream.
Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair or clothes.
Common side effects of benzoyl peroxide include:
dry and tense skin
a burning, itching or stinging sensation
some redness and peeling of the skin
Side effects are usually mild and should pass once the treatment has finished.
Most people need a six-week course of treatment to clear most or all of their acne. You may be advised to continue treatment less frequently to prevent acne returning.
Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. They’re available as a lotion or gel that is applied once or twice a day.
A six- to eight-week course is usually recommended. After this, treatment is usually stopped, as there’s a risk that the bacteria on your face could become resistant to the antibiotics. This could make your acne worse and cause additional infections.
Side effects are uncommon, but can include:
minor irritation of the skin
redness and burning of the skin
peeling of the skin
Tetracyclines can make your skin sensitive to sunlight and UV light, and can also make the oral contraceptive pill less effective during the first few weeks of treatment.
You’ll need to use an alternative method of contraception, such as condoms, during this time.
Hormonal therapies can often benefit women with acne, especially if the acne flares up around periods or is associated with hormonal conditions such as polycystic ovary syndrome.
If you don’t already use it, your GP may recommend the combined oral contraceptive pill, even if you’re not sexually active. This combined pill can often help improve acne in women, but may take up to a year before the full benefits are seen.
However, there’s a range of informally run message boards and blogs about acne on the web. You may find it supportive to read about other people’s experience of living with acne.
For example, talkhealth provides a free acne support and information community.
The Mix (formerly Get Connected) also has a website and helpline for teenagers and young people with emotional and other difficulties.
Make-up can help cover up scars and can be particularly useful for facial scars.
Camouflage make-up specially designed to cover up scars is available over the counter at pharmacies. You can also ask your GP for advice.
If you’re interested in learning more about covering a mark, scar, non-infectious skin condition or a tattoo, you can also visit the Changing Faces skin camouflage service or call 0300 012 0276.