Acne explained

What causes acne

Acne starts in the tiny pores of the skin, each linked to an oil gland. Around puberty, and at other times of hormonal change, these glands make more oil. When oil and dead skin cells clog a pore, a blockage forms. Normal skin bacteria can then multiply in the blocked pore, triggering inflammation, which is what turns a simple blocked pore into a red, sore spot. Hormones are a major driver, which is why acne is common in teenagers and why it can flare around periods or with certain hormonal conditions. Contrary to popular belief, acne is not caused by poor hygiene or by eating greasy food, and scrubbing hard can actually make it worse by irritating the skin.

The different types of spots

Acne produces several kinds of spots, and most people have a mix. Blackheads and whiteheads are small blocked pores; blackheads look dark not because of dirt but because the trapped material reacts with air. Papules are small red bumps, and pustules are similar but with a white or yellow tip of pus. More severe acne can cause nodules, which are large, hard, painful lumps deep under the skin, and cysts, which are large pus-filled lumps that feel soft. The more inflamed and deep the spots are, the higher the chance of scarring, which is one of the main reasons to treat acne early and effectively rather than waiting for it to pass on its own.

Everyday skin care that helps

Good daily habits form the foundation of managing acne. Wash affected skin gently no more than twice a day with a mild cleanser and lukewarm water, as harsh scrubbing and strong products irritate the skin and can worsen spots. Avoid picking or squeezing spots, tempting as it is, because this pushes inflammation deeper and greatly increases the risk of scarring and marks. Choose skin and make-up products labelled non-comedogenic, meaning they are less likely to block pores, and remove make-up before bed. While no food has been proven to cause acne, a generally balanced diet supports overall skin health. Being patient matters too, as most treatments take several weeks to show their full effect.

NHS treatments step by step

Treatment is matched to how severe the acne is. For milder acne, treatments applied to the skin are the usual first step, and some are available from a pharmacist who can advise on how to use them. If these are not enough, or acne is more inflamed, a GP can prescribe stronger creams or gels, and for many people a course of antibiotic treatment or, for some, hormonal options. It is normal for treatments to take six to eight weeks or longer to work, and to need to keep using them to hold the improvement. If acne is severe, causing scarring, or not responding to GP treatment, referral to a dermatologist is recommended, where powerful specialist medicines that need careful monitoring can be considered.

Scarring, wellbeing and when to seek help

Acne can leave marks and scars, especially when severe spots are squeezed or left untreated, so early and effective treatment is the best way to protect the skin. Once acne has settled, treatments exist to improve some types of scarring, usually through specialist services. Just as important is the emotional side: acne can affect self-esteem, mood and social confidence, and this is a valid reason to seek help, not something to feel embarrassed about. See a GP if acne is moderate to severe, is not improving with pharmacy treatments, is causing scarring, or is affecting your wellbeing. Effective help is available, and with the right treatment the large majority of people see real, lasting improvement.