Acne

Acne is caused by a combination of factors. Sebaceous (oil-producing) glands are tiny glands found near the surface of the skin and are affected by our hormones. In acne, the glands are particularly sensitive, even when these hormones are at normal levels.  

This causes the glands to produce too much oil (sebum). At the same time, the lining of the pores (the small holes in the skin’s surface) becomes thickened and dead skin cells build up and block the pores. The mixture of the oil and dead skin cells plugging the pores produces blackheads and whiteheads.  

Harmless bacteria that live on everyone’s skin, usually cause no problems. However, in acne, the build-up of oil creates an ideal environment for the bacteria to multiply and cause inflammation. This leads to the formation of red, swollen or pus-filled spots. (papules, pustules, nodules or cysts).  

Sometimes acne can be caused or made worse by excess hormones. This may occur in women in a condition called polycystic ovary syndrome (PCOS). PCOS is a hormonal imbalance that causes irregular periods, unusual hair growth and hair thinning.  

Acne can also be due to certain hormonal contraceptive preparations or high-dose steroids. Some tablets taken by bodybuilders contain hormones (anabolic steroids) that can trigger acne. 

Occasionally, other types of medications can make acne worse. If you develop acne or it suddenly gets worse, it would be worth discussing this with your healthcare professional. 

Oily skin care products, greasy moisturisers and hair products, or contact with oily substances at work, can also cause or worsen acne. Skin picking can also make acne worse and cause scarring. 

There is not enough evidence to support specific diets for treating acne. However, a healthy, well-balanced diet is advisable. See here for further information.

Is acne hereditary?

Acne can run in families, but most cases are sporadic and occur for unknown reasons.

Acne is a mixture of the following: oily skin, blackheads, whiteheads, red spots and pus-filled pimples. Occasionally, larger, deeper bumps (known as nodules) or cysts (which resemble boils) may develop. Affected skin may feel hot, painful and be tender to touch.  

Acne can leave scars or marks on the skin, particularly in the presence of nodules and cysts. These may be raised and lumpy (known as hypertrophic or keloid scars) or indented (known as pitted or atrophic scars). Acne can also leave discolouration which may be red, hyperpigmented (darker than your usual skin colour) or hypopigmented (lighter than your normal skin colour).  

Not all spots are acne, so if there is something unusual about the rash it is advisable to consult your healthcare professional. 

One important aspect of being affected by acne that is not discussed often is its impact on mental health. Acne can significantly affect an individual’s psychological well-being. This may lead to low self-esteem, lack of confidence, negative body image (appearance-related concerns), anxiety and depression. Severe acne has been associated with suicidal behaviour. It is important to recognise the impact acne may have on how you feel. If required, speak with your healthcare professional about available support.  

Images DermNetNZ.

Acne is easily recognised by the appearance of the spots and by their distribution on the face, neck, chest or back. However, there are several varieties of acne and your doctor will be able to tell you which type you have after examining your skin. The most common type is ‘acne vulgaris’.

Can acne be cured?

At present there is no ‘cure’ for acne, although the available treatments can be very effective in preventing the formation of new spots and scarring.

How can acne be treated?

If you have acne but have had no success with over-the-counter products then it is probably time for you to visit your doctor. In general, most treatments take two to four months to produce their maximum effect.