Everything to know about acne

Acne develops when pores become clogged. What type of acne you get depends on what clogs your pores.

When you have acne, you can develop any (or a combination) of these breakouts on your skin:

  • Whiteheads
  • Blackheads
  • Pimples
  • Nodules, cysts, or both (deep and painful)


A whitehead forms when excess oil and dead skin cells build up and plug the opening of a pore. This causes a blemish that is raised and white or flesh colored.

Medical name: Closed comedo, which means “closed pore.”


This type of acne also develops when excess oil and dead skin cells build up inside a pore. As the buildup accumulates, it widens the opening of the pore and you see a blackhead.

Why are blackheads black? Many people mistakenly believe the black speck is dirt. What you are really seeing is a chemical reaction. When the buildup inside the pore reacts with oxygen in the air, the black color appears. This reaction is similar to what happens when a cut-up apple turns brown.

Medical name: Open comedo, which means “open pore.”


Sometimes excess oil, dead skin cells, and bacteria get trapped inside a pore. The bacteria, which are normally found on our skin, can multiple quickly in the excess oil. As the pore fills with bacteria, inflammation (swelling) develops and a pimple appears.

Medical name: If the pimple contains pus, it’s called a pustule. A pimple without pus is called a papule.

Acne nodule or cyst

When a pore fills with enough excess oil, dead skin cells, and bacteria to cause inflammation (swelling) that goes deep into the skin, an acne nodule or cyst develops. Because these breakouts go deep into the skin, they can feel tender or painful.

The main difference between an acne nodule and an acne cyst is that a cyst contains pus. Because nodules don’t contain pus, they feel harder to the touch than do cysts.

Acne can cause more than breakouts

Some people dismiss acne as a skin condition that you’ll eventually outgrow, but it can have a profound and lasting effect on someone’s life. Many people develop one or more of the following after getting acne.

Acne scars: When an acne breakout clears, it can leave a permanent scar. Some scars cause depressions in the skin. Others are raised. It’s impossible to predict who will develop scars when the acne clears, but the following increases your risk:

  • Living with acne for an extended amount of time because you don’t treat it or treatment doesn’t work
  • Having one or more close blood relatives who developed acne scars

Dark spots on the skin: As an acne breakout clears, some people see a spot where the acne once was. This completely flat spot can be pink, red, purple, black, or brown, and it’s often mistaken for a permanent acne scar.

Unlike acne scars, these spots will eventually clear on their own. Clearing can take time, though. Some spots can last for a year or longer. The darker the spot, the longer it will take to clear. Treatment and the right skin care can help clear the spots more quickly and prevent new dark spots.

The medical name for these spots is postinflammatory hyperpigmentation (PIH).

Lower self-esteem: Research shows that acne can deflate one’s self-esteem, and dermatologists see this in many patients who have acne. Lower self-esteem during the teen and early adulthood years can negatively affect one’s life.

For example, lower self-esteem can prevent someone from pursuing a desired career, speaking up in class, getting a part-time job, making friends, or dating.

Low self-esteem is also associated with anxiety and depression.

Treating acne rather than letting it run its course can prevent lowered self-esteem.

Depression: Studies reveal that teens with acne have a higher risk of developing depression, which may include thoughts of suicide, than do teens who have the occasional pimple. This is why dermatologists recommend treating acne when it begins and continuing treatment to prevent new breakouts.

While few people escape acne during their teenage years, some people are more likely to develop deep, painful pimples that leave scars. 

What causes acne?

While scientists are still trying to figure out why some people’s skin seems more likely to develop acne, it’s likely that hormones play a role.

Why does acne usually develop during the teenage years?

Hormones may explain why acne is so common in teenagers. During puberty, hormones called androgens increase the size of the skin’s oil glands. These glands start making more oil, which can clog pores.

Can acne start before (or after) your teen years?

Yes. People can get acne at almost any age.

Around 20% of newborns develop a type of acne called neonatal acne, which usually appears between the second and fourth weeks of life. This type of acne goes away on its own without causing scars. It also does not increase the risk of developing severe acne later in life.

Some children develop infantile acne, which begins between 3 and 6 months of age. Infantile acne can cause deep acne nodules and cysts, leading to permanent acne scars. Fortunately, infantile acne is rare.

Acne is also a growing problem for women over 25 years of age. Most of these women had acne as teens and continue to get breakouts as adults. Some of these women had teenage acne that cleared. Now years later, they are experiencing acne breakouts again. About 20% to 40% of women who have adult acne develop it for the first time as an adult.

Can nicotine cause acne?

One study found that smoking may play a role for some women with acne. In this study, the women had noticeable whiteheads and blackheads that often covered a large area of their face. Some also had a few pimples.

The researchers found that many of the women in this study smoked cigarettes. They also found that the more cigarettes a woman smoked, the more severe her acne. Some of these women developed icepick-type acne scars when the acne cleared.

Other studies have found that smokers are more likely to have acne than non-smokers. This repeat finding suggests that smoking cigarettes may trigger acne.

Can stress cause acne?

While stress cannot cause acne, stress may worsen existing acne. Results from studies suggest that when stress intensifies, the severity of the acne increases.

Can food or anything else worsen acne?

Yes. Acne may worsen if you:

  • Get too little sleep
  • Eat certain foods (white rice, white bread, chocolates, cupcakes, foods high in simple sugars)
  • Use oily makeup and skin care products
  • Apply oily hair care products, such as pomade

Are some people more likely to get acne?

Nearly everyone develops at least a few breakouts during the teenage years. It’s impossible to predict who will develop more severe acne, but you have a higher risk if one or both of your parents (or other close blood relative) had severe acne that left them with acne scars.

The good news is that you don’t have to live with acne. Today, virtually every case of acne can be treated successfully. Sometimes, this requires the help of a board-certified dermatologist.

How do dermatologists treat acne?

The acne treatment plan that’s right for you depends on many considerations, including:

  • What type of acne (i.e., blackheads, pimples, etc.) you have
  • Where the acne appears on your skin
  • What treatments you’ve already tried
  • When the breakouts started
  • Your age
  • Whether the acne has left you with dark spots or scars

While a treatment plan can vary from one patient to the next, even for two patients who have the same type of acne, treatment often follows these guidelines.

Whiteheads, blackheads, or both: If you have these breakouts, you’ll likely apply acne medication to your skin. Your treatment plan may include one of the following:

  • A retinoid
  • A retinoid + benzoyl peroxide, azelaic acid, or salicylic acid
  • Benzoyl peroxide or sulfacetamide/sulfur + an antibiotic you apply to your skin

Pimples: Mild or moderate pimples can be treated with medication you apply to your skin. Treatment will often consist of applying one of the following:

  • Benzoyl peroxide
  • A Retinoid
  • Azelaic acid
  • Benzoyl peroxide or sulfacetamide/sulfur + a retinoid or an antibiotic you apply to your skin

Women who continue to get breakouts may need hormonal therapy with anti-androgenic (anti-male hormone) effects, such as a birth control pill that the U.S. Food and Drug Administration (FDA) has approved to treat acne. The birth control patch may also be effective, as can some other medications (including oral spironolactone).

Acne nodules and cysts: If you have deep, painful acne that often leaves a permanent acne scar, effective treatment can help you see clearer skin and prevent new scars.

Treatment may consist of:

Sometimes acne needs extra help

To help you get the best possible results from treatment, your dermatologist may also recommend adding one of the following to your treatment plan.

Laser or light therapy: Studies show that laser and light devices can help to clear acne. This type of treatment works best when combined with other acne treatment.

A corticosteroid injection: If you have a large, extremely painful and deep acne breakout, a dermatologist can inject it with a corticosteroid. This can rapidly relieve the pain and the size of the breakout. While effective, this treatment is reserved for treating a few severe acne breakouts. Using it more than a few times can cause side effects.

A healthy diet: Some studies suggest that what you eat can also help to give you clearer skin. If you think that what you’re eating could be causing breakouts, be sure to find out what the research shows. A low glycemic diet may lead to fewer pimples while cow’s milk may lead to acne breakouts.

Treatment changes once you get results

Follow treatment plan

To get the best results, follow your dermatologist’s treatment plan exactly as prescribed. If you have trouble following the plan, tell your dermatologist.

Once you get the results you want, follow-up appointments with your dermatologist may seem unnecessary. You want to keep those appointments. Without treatment, many people see breakouts for years. To prevent this, your dermatologist will give you a different treatment or plan (or maintenance therapy).

This treatment plan often involves applying a medication that contains a few different acne treatments, such as benzoyl peroxide and a retinoid, to acne-prone skin. Often, you can apply this every other day.

Acne friendly skin care helps you get the best results

Skin care is so important that without it you may not get the results you want. Even if you follow apply your acne treatment perfectly, new breakouts can appear if you’re too rough on your skin.

You need gentle skin care to clear acne. If you’re scrubbing your face clean or washing it several times a day, you’re irritating your skin. Any time you irritate acne-prone skin, it can lead to breakouts.

10 skin care habits that can worsen acne

Do you do any of these? If so, be sure to read what dermatologists recommend that you do instead. Making some simple changes could be your answer to clearer skin.

  1. Wash twice a day and after sweating. Perspiration, especially when wearing a hat or helmet, can make acne worse, so wash your skin as soon as possible after sweating.
  2. Use your fingertips to apply a gentle, non-abrasive cleanser. Using a washcloth, mesh sponge, or anything else can irritate the skin.
  3. Be gentle with your skin. Use gentle products, such as those that are alcohol-free. Do not use products that irritate your skin, which may include astringents, toners and exfoliants. Dry, red skin makes acne appear worse.
  4. Scrubbing your skin can make acne worse. Avoid the temptation to scrub your skin.
  5. Rinse with lukewarm water
  6. Shampoo regularly. If you have oily hair, shampoo daily.
  7. Let your skin heal naturally. If you pick, pop or squeeze your acne, your skin will take longer to clear and you increase the risk of getting acne scars.
  8. Keep your hands off your face. Touching your skin throughout the day can cause flare-ups.
  9. Stay out of the sun and tanning beds. Tanning damages you skin. In addition, some acne medications make the skin very sensitive to ultraviolet (UV) light, which you get from both the sun and indoor tanning devices.
    • Using tanning beds increases your risk for melanoma, the deadliest form of skin cancer, by 75%.
  10. Consult a dermatologist if:
    • Your acne makes you shy or embarrassed.
    • The products you’ve tried have not worked.
    • Your acne is leaving scars or darkening your skin.

Today, virtually every case of acne can be successfully treated. Dermatologists can help treat existing acne, prevent new breakouts and reduce your chance of developing scars. If you have questions or concerns about caring for your skin, you should make an appointment to see a dermatologist.