Acne is one of the most common skin conditions in the world, and one of the most surrounded by myths and misinformation. Nearly everyone experiences at least a mild form of it at some point in life, most often during the teenage years, but adults are far from immune. While acne is rarely dangerous to physical health, it can significantly affect self-esteem and, in more severe cases, leave permanent scarring, making an accurate understanding of its causes and treatment options genuinely important.
What are Acne and Pimples?
Acne is a skin condition characterized by the appearance of a range of skin eruptions commonly known as pimples or spots.
Pimples primarily appear on the:
- face,
- neck,
- back,
- chest,
- and shoulders.
Acne is the most common skin condition worldwide, and although it does not pose a threat to overall health, severe acne can significantly affect the appearance of the face and lead to permanent scarring.
The causes of acne have given rise to a great many myths. Some people blame certain foods, while others believe it is caused by dirty skin. In reality, there is little solid evidence that either of these factors plays a decisive role in acne for most people.
Acne affects people of all ethnic backgrounds and all ages. Between the ages of 11 and 30, roughly 4 out of every 5 people experience some form of acne. It is most common among teenagers and young adults. Although it generally does not put a person’s health at risk, acne can be genuinely distressing and can leave permanent scars. Fortunately, for most people, it tends to resolve on its own after the age of 30.
Should you pop pimples or not?
Dermatologists are essentially unanimous in advising against popping or squeezing pimples, for several important reasons:
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doing so can push debris trapped in the pore even deeper into the follicle, causing it to rupture and release infected material into the dermis, the deeper layer of the skin,
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a new pimple can appear right next to the original one within just a few hours,
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squeezing significantly increases the risk of permanent scarring and dark marks,
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a small nodule or cyst can develop in place of the squeezed pimple, which is often harder to treat than the original blemish.
That said, in certain selected cases, it may be appropriate to undergo a professional facial extraction, performed either at a specialized skincare clinic or by a dermatologist. In these settings, the pimple is indeed physically extracted, but under much safer conditions:
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using sterile, professional instruments specifically designed to prevent pus and debris from being pushed deeper into the skin,
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typically after the face has been exposed to steam to help open the pores beforehand, making extraction gentler and more effective.
Debunking a few myths
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Acne is not caused solely by eating greasy foods like fries or chocolate, although diet may influence inflammation in people who are already genetically predisposed to acne.
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Washing your skin does not stop acne from developing. In fact, excessive washing can actually make the problem worse by irritating and drying out the skin. As the old saying goes, “virtue lies in moderation”: clean your skin regularly, and especially after heavy sweating, but avoid rubbing it too vigorously when drying your face.
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Wearing makeup does not necessarily cause pimples, but it is wise to choose oil-free products and to wash your face regularly to prevent pores from becoming clogged with makeup residue.
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Stress does not cause acne on its own, but in many people it can worsen existing inflammation, making breakouts feel more frequent or severe during stressful periods.
Causes
The process behind acne begins in the skin’s sebaceous glands. Sebum, the oily substance these glands produce, flows along a small channel called the hair follicle, which also contains a hair. Sebum is normally drained onto the surface of the skin through the opening of the follicle, known as the pore.
Hair, sebum, and the skin cells lining the follicle can combine to form a plug that blocks the pore, preventing sebum from reaching the surface. This mixture of oil and dead skin cells creates an ideal environment for the proliferation of bacteria that normally live harmlessly on the skin, allowing them to multiply within the clogged follicle. The body’s immune defenses respond to this bacterial overgrowth, triggering an inflammatory reaction in the affected area.
If the blocked follicle remains beneath the surface of the skin, it forms a small white bump known as a whitehead. If it reaches the surface and opens up, it is called a blackhead. Dirt has nothing to do with the dark color: the trapped oil turns dark simply because it becomes oxidized upon exposure to air. Both whiteheads and blackheads can persist for a long time. Over time, the wall of the blocked follicle can rupture, giving rise to a red, inflamed pimple.
One key factor underlying acne is a rise in certain hormones during puberty. These hormones cause the sebaceous glands to enlarge and increase their production of sebum. Hormonal changes associated with pregnancy, or with starting or stopping hormonal contraception (the pill), can likewise trigger or worsen acne.
Scientific evidence suggests a degree of family predisposition to developing acne, indicating that genetic makeup also plays a meaningful role in an individual’s susceptibility.
Stress does not directly cause acne, but it has been observed that, in people who already have the condition, periods of high stress can lead to noticeable flare-ups.
Certain medications can also promote the development of acne, including corticosteroids, lithium, anticonvulsants, and barbiturates, as can greasy cosmetic products, which can alter the cells lining the follicle, making them stickier and more prone to forming blockages. If you are prone to acne, try switching to oil-free cosmetics, and look specifically for products labeled “non-comedogenic”, meaning they are formulated not to clog pores.
Symptoms
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Comedones (whiteheads or blackheads), or papules. The comedone is the basic acne lesion, essentially a blocked pore. When the blockage remains beneath the skin’s surface, it is called a closed comedone and appears as a small white bump. A blackhead, by contrast, is a comedone that opens to the surface and appears as a dark spot on the skin. As noted above, this dark color is not due to dirt but to the chemical reaction between air and the trapped oil.
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Pustules, or pimples. These are inflamed acne lesions containing pus, typically appearing red and swollen at the base.
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Nodules. These represent a more severe form of acne. Nodules develop deep within the skin and are more likely to leave permanent scarring.
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Cysts. Like nodules, cysts are deep, painful skin lesions filled with pus, and they too carry a significant risk of scarring.
Diagnosis
The diagnosis of acne is essentially clinical and is typically made by a primary care physician or, ideally, by a dermatologist during a specialist consultation. The clinician examines the skin to identify the different types of lesions present and to assess how extensively they involve the face, chest, and back.
The modern diagnostic process generally involves several steps:
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Grading severity. Acne is classified as mild, moderate, or severe. This distinction is essential for determining whether a topical treatment (creams or gels) will be sufficient, or whether a systemic approach (oral medication) is needed.
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Identifying the predominant lesion type. Dermatologists distinguish between comedonal acne (predominantly blackheads and whiteheads), papulopustular acne (predominantly inflamed pimples), and nodulocystic acne (deep, painful lesions).
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Assessing scarring risk. The doctor evaluates the skin’s tendency to form scars, a factor that may prompt earlier and more aggressive treatment to prevent permanent disfigurement.
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Medical history and hormonal screening. Particularly in adult women, the doctor will ask about menstrual cycle regularity and look for other signs of hormonal imbalance, such as excess facial or body hair (hirsutism). In some cases, blood tests to check androgen hormone levels, or a pelvic ultrasound to rule out polycystic ovary syndrome (PCOS), may be recommended.
It is important not to dismiss acne as merely a “phase of growing up”. Timely diagnosis and treatment are key to preventing permanent scarring and to reducing the psychological toll that persistent acne can take, particularly during the already sensitive adolescent years.
Treatment
The main goals of acne treatment are to reduce sebum production, speed up skin cell turnover, combat the bacteria involved in the inflammatory process, and reduce inflammation itself. Treating acne is a personalized process that requires patience: most people do not see significant improvement until after 4 to 8 weeks of consistent treatment.
Topical treatments (creams, gels, and lotions)
For mild to moderate acne, topically applied medications represent the first line of treatment:
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Topical retinoids (such as adapalene and tretinoin): These help unclog pores and prevent the formation of new comedones. They can cause initial redness or flaking, which typically improves as the skin adjusts.
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Benzoyl peroxide: A powerful antibacterial agent that also helps reduce inflammation. It does not lead to bacterial resistance, but it can bleach fabrics such as towels and pillowcases, so care should be taken when applying it.
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Topical antibiotics: Often combined with benzoyl peroxide or retinoids to boost their effectiveness and to help prevent bacteria from developing resistance to the antibiotic.
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Azelaic acid: Useful both for its antibacterial properties and for helping fade the dark marks that sometimes remain after a pimple has healed.
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Clascoterone: One of the more recent innovations in acne treatment, this is a topical anti-androgen that acts directly on hormone receptors in the skin, and is suitable for use in both men and women.
Systemic therapies (oral medications)
When acne is moderate to severe, or does not respond adequately to topical treatments, a dermatologist may prescribe oral medications:
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Oral antibiotics: Usually tetracyclines (such as doxycycline), prescribed for short courses to reduce inflammation and bacterial load.
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Hormonal therapy: In women, combined oral contraceptive pills can be highly effective at regulating excess sebum production. In some cases, spironolactone is added, which counteracts the effect of androgen hormones on the skin.
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Isotretinoin: This is the most powerful acne treatment available, reserved for severe, cystic, or treatment-resistant forms. It addresses essentially every underlying cause of acne simultaneously, but it requires close medical supervision due to potential side effects and carries an absolute contraindication during pregnancy, due to the significant risk of severe fetal malformations. Patients prescribed isotretinoin who can become pregnant are typically required to use reliable contraception and undergo regular pregnancy testing throughout treatment.
In-office treatments and technologies
In addition to medication-based therapy, a dermatologist may also recommend:
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Chemical peels: The use of acids (such as salicylic acid or glycolic acid) to exfoliate the skin and help clear clogged pores.
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Photodynamic therapy and laser treatments: Used to reduce bacterial load and inflammation, or to treat scarring left behind by previous breakouts.
Lifestyle and diet
While it cannot replace medical treatment, proper daily skincare and lifestyle habits play an important supporting role:
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Cleansing: Wash the skin twice a day using a gentle cleanser, particularly after physical activity and sweating. Avoid excessive scrubbing, which can irritate the skin and worsen inflammation rather than improve it.
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Diet: Current scientific consensus suggests that a healthy diet with a low glycemic index (limiting refined sugar, sweets, and white flour) and moderate consumption of dairy products may help reduce the severity of acne in many patients, although individual responses can vary considerably.
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Sun protection: Many acne medications make the skin more sensitive to sunlight. It is essential to use a sunscreen specifically formulated for acne-prone skin (labeled non-comedogenic) to prevent sunburn and permanent dark spots, which can be more likely to develop while on certain acne treatments.
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Stress management: Since stress can trigger flare-ups through the release of cortisol, relaxation practices such as regular exercise, meditation, or adequate sleep may have a positive indirect effect on skin health.
Sources and references
- National Institutes of Health (NIH). “Understanding Acne”. NIH News in Health. newsinhealth.nih.gov
- Office on Women’s Health, U.S. Department of Health and Human Services. “Acne”. womenshealth.gov
- Office on Women’s Health, U.S. Department of Health and Human Services. “Acne”. GirlsHealth.gov. girlshealth.gov
- American Academy of Dermatology Association (AAD). “Acne: Diagnosis and Treatment”. aad.org
- National Center for Biotechnology Information (NCBI). “Acne Vulgaris: Management”. StatPearls. ncbi.nlm.nih.gov
- Mayo Clinic. “Acne”. mayoclinic.org
