Anyone can get acne. It is a common skin condition estimated to impact 9.4% of the global population.¹ It mainly occurs when you reach your teenage years, although it can also affect babies or come later in life. It often presents as annoying and sometimes painful pimples on the face, chest, and/or back.
More than 80% of people between 11 and 30 years old will have acne at some point in their lives.² It usually goes away for most people when they get older, but it may stick around for others.
Acne is also called zits, flare-ups, spots, or pimples. It can present in different ways and types, but acne vulgaris is its most common form.
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Getting the occasional pimple, spot, or zit doesn’t mean you have acne vulgaris. Acne vulgaris is when the skin is affected for a long time or when the symptoms keep coming back. The face is usually the first place where acne appears, but the neck, back, and chest are all common sites as well.
While it is not yet fully understood what causes acne, the simplest trigger is when hair follicles become blocked by skin cells. There are little glands under the skin called the sebaceous glands.³ Their job is to produce oil. The oil sticks to skin cells and forms a plug that blocks the hair follicle.
When the skin is oily, bacteria can grow and cause inflammation. This causes a red or tender pimple to grow.
Adolescents and young adults are more likely to have acne because hormonal changes occur during puberty, which leads to more oil being produced on the skin.² In women who have polycystic ovary syndrome, acne is commonly caused by the increase of steroids produced by this condition.⁴
Acne vulgaris can present in a number of ways, and several types can also occur at the same time.
Superficial lesions are those that sit on top of the skin, including the following.
Blackheads are known as open comedones. They occur when a ‘plug’ blocks the opening to the skin follicle. Blackheads usually have a gray, brown, or black top.
Whiteheads are known as closed comedones. They occur when the follicle is entirely blocked. They are usually skin-colored with a whitish-gray top.
Papules are small red bumps in the skin that don’t contain visible fluid. They are often tender to the touch.
Pustules are small bumps in the skin that contain fluid. They are typically white or yellow on top.
Deeper lesions also exist and tend to be more painful. These include:
Nodules are larger and deeper bumps under the skin’s surface. They are typically inflamed and often tender to the touch.
Cysts are not very common. They present as pus-filled bumps under the skin’s surface.
These deeper lesions are more likely to scar as the bumps heal. It is not yet known why some people develop scars from acne vulgaris while others don’t.⁴
Most often, young adults will get whiteheads and blackheads in what is known as the T-zone, which extends across the forehead, down the nose, and chin.
Acne vulgaris won’t always look the same from person to person. Doctors will categorize it into mild acne, moderate acne, or severe acne depending on how many lesions a person may have, how inflamed these lesions are, and how far across the body they spread.⁵
The type of lesion determines how long the acne will typically last. Deeper lesions can hang around for months, whereas more superficial lesions are usually gone within a couple of weeks.⁶
How acne vulgaris is treated depends on the type and severity of the acne. It can usually be treated within months but can often return.⁷
There are several over-the-counter acne treatments available, and most people do not seek help from their doctor immediately. In moderate to severe cases, medication may be required.
While it is normal to get acne, you can do certain things to make sure it doesn’t get worse.
Wash your face twice a day using warm water and a mild cleanser. If you’re not sure which one to use, ask your doctor for recommendations.
However, be careful not to wash your face too often as it will dry out your skin. Avoid scrubbing your skin as well.
If you wear makeup during the day, always remove it at night so it is less likely to clog your pores.
Avoid picking/squeezing your pimples
It can be tempting to touch your pimples or pick or squeeze them. Sometimes it can feel very satisfying to pop them.
However, to avoid spreading infection, avoid doing so.
Maintain good hygiene
Simple things such as shampooing your hair regularly, keeping hair and hats away from your face, and changing your pillowcase often can help keep unwanted germs away from your face.
Benzoyl peroxide is one of the most common treatments given for acne vulgaris. Sometimes a topical retinoid will also be prescribed. Antibiotics are also commonly given as a treatment option.
Most people will treat their acne with combination topical therapy, which uses two different types of medications.⁸
Here are the details on the various medications used to treat acne vulgaris.
Benzoyl peroxide works by softening and removing the outer layer of the skin and working to stop the growth of bacteria.² A prescription is not always required for benzoyl peroxide. It is available over-the-counter and is a common ingredient in face wash, face creams, and gels.
Benzoyl peroxide comes in numerous products, which work differently for different people. For more sensitive skin or body acne, a cleanser could be the most suitable choice, while gels tend to suit those with oily skin types.
Benzoyl peroxide is available in different strengths, ranging from 2.5 to 10%.² For most people, 2.5% is sufficient. The stronger the concentration, the more likely it is for side effects like dryness, irritation, or redness to occur.
Topical retinoids work by preventing the creation of new skin cells and reducing inflammation.² Retinoids are used when acne is not inflamed. There are two types: adapalene and tretinoin.
Retinoids can take up to a couple of months to start working. Like benzoyl peroxide, they should be built up slowly to help prevent any side effects from occurring. Retinoids can sometimes cause a flare-up before improvements are seen.
Do note that people with sensitive skin may have difficulty tolerating retinoids.
Antibiotics can come in topical form, similar to benzoyl peroxide and retinoids, or pills to be taken orally.⁹ In its cream form, it is applied to areas typically impacted by acne and works to reduce the number of acne bacteria on the skin and in the hair follicles. Sometimes, antibiotics are used in combination with retinoids or benzoyl peroxide.
Oral antibiotics are considered when acne is more moderate or when topical treatments have not been successful over a period of a couple of months.
Oral contraceptive pill
A combined contraceptive pill will sometimes be used to treat mild to moderate acne in women.¹⁰ These pills don’t normally have as many side effects as antibiotics and are usually tried before moving on to antibiotics.
Combination topical therapy
This approach is used in people who have mild acne. It is a combination of benzoyl peroxide and a topical retinoid (a compound that comes from vitamin A).¹¹
Topical treatments are applied directly to the skin and impacted area, like creams and serums.
Isotretinoin is used in cases where acne is more severe or where other treatment options have not worked. It is an effective medication but often has a number of side effects.¹²
It is recommended that people on isotretinoin be monitored by their doctors. Most people will only need to use it once to improve their acne. Others, however, may need more than one course of treatment.
Acne vulgaris is a very common skin disorder that most people will encounter at some point in their life.
While it’s still not exactly known what causes acne, there are a number of ways you can take to help treat acne, whether in the form of self-care, over-the-counter products, or a prescription from your doctor.
How to treat acne | Best Practice Advocacy Centre New Zealand
Acne vulgaris | DermNet NZ
Skin care in the management of acne vulgaris | Research Review
Management of acne (2011)
Topical therapy for acne (2000)