What Is Acne? Symptoms, Causes, Diagnosis, Treatment, and Prevention

We’ve all been there: It’s the morning of a big date or an important meeting. You look in the mirror, and what do you see? A breakout.

Whether it’s one pimple or a cluster of blemishes, acne is a common problem that affects people of all ages — boys, girls, men, and women. (1)

Acne, or acne vulgaris, occurs when glands in the skin produce and secrete too much of the skin’s natural oil, called sebum.

Sebum, along with dead skin cells, can clog pores, resulting in acne. And sometimes, bacteria called Cutibacterium acnes (C. acnes) gets into pores, causing inflamed acne. (1)

Acne is the most common skin condition affecting people in the United States. (2)

As many as 50 million Americans live with acne, and most of them are in their teen or young adult years. About 85 percent of teenagers will eventually get acne. (3)

Acne is a broad term for different types of breakouts that all have different symptoms. (4) There are six specific types of acne: (5,6)

• Whiteheads A whitehead forms when a closed pore becomes impacted with oil and dead skin cells. It appears as a white bump on the skin’s surface.
• Blackheads In a blackhead, the pore is only partially clogged and remains open. Blackheads turn black when oil and dead skin cells react to oxygen in the air.
• Papules Papules are tiny, red, hard pimples. They form when bacteria get trapped in a pore.
• Pustules Pustules are similar to papules but contain pus that’s made of dead white cells.
• Nodules These large inflamed lesions occur when a pimple extends into the deeper layers of the skin.
• Cystic Acne This type of severe acne is similar to nodules and forms when the deeper layer of skin becomes inflamed. The difference is that cysts contain pus. These red lumps are soft, painful, and difficult to treat. Usually, they require a visit to a dermatologist.

In the same way that acne can take various forms, the severity of acne also varies depending on the type.

Blackheads and whiteheads are noninflammatory and typically easier to control. Papules and pustules are an inflammatory type of acne. But inflammation doesn’t necessarily mean severe acne. (7)

“People with mild acne can have some whiteheads and blackheads and a few — but not more than 10 — inflamed, red pimples called papules or pustules,” says San Francisco-based dermatologist Yoram Harth, MD, chief medical officer for MDacne.

Whiteheads and blackheads, while the less severe types, can still become a moderate problem. “People with moderate acne can have many blackheads and whiteheads, as well as 10 to 30 red, inflamed acne pimples,” Dr. Harth says.

Severe acne includes the presence of nodules and cysts or many breakouts on different parts of the body — face, back, neck, and chest. (7) Sometimes, severe acne can qualify as acne fulminans, which is a rare, highly inflammatory, immunologically induced form of acne that occurs mainly in male patients between the ages of 13 and 22 years.

“People with severe acne will usually have more than 30 red, inflamed pimples at any moment in time. They can also have a few deep cysts and nodules, which are more difficult to treat and usually heal with scars,” Harth says.

Learn More About Signs and Symptoms of Acne

Even if you understand the how of acne (oil + dead skin cells = clogged pores) you may wonder why your skin breaks out while other people seem to always have clear skin.

A number of factors can exacerbate acne or increase your risk.

Changes in Hormone Levels Changing hormones (such as during puberty or menstruation) can cause the sebaceous glands to secrete more sebum. (8)

Cosmetics or Hair-Care Products Oily cosmetics can clog your pores, making you susceptible to breakouts.

Family History There appears to be a connection between acne and genes. So if your parents struggled with acne, you may, too. (1)

Some Medications You may have acne if you take other medications like corticosteroids or lithium (Lithobid). (1)

Skin Friction Breakouts can also occur whenever there’s any type of pressure or friction on your skin, such as a hat, helmet, or face mask, says Kara Shah, MD, a board-certified dermatologist based in Cincinnati, Ohio. With the increased use of face masks to prevent COVID-19 and other viruses, maskne, or “mask acne,” has unsurprisingly become a problem, given what dermatologists know about the effects of friction on skin.

Stress Stress increases your body’s level of cortisol, a hormone that causes your glands to produce more sebum. (9)

Learn More About the Causes of Acne: Common Risk Factors, Genetics, and More

A doctor or dermatologist can usually diagnose acne by looking at your skin. (10) They’ll examine your face, chest, back, and any other areas where acne appears.

Some skin conditions are sometimes mistaken for acne. If you believe you have acne yet your skin doesn’t improve with treatment or worsens, your doctor can make an accurate diagnosis. (10)

The duration of acne varies from person to person. When acne develops in the teen years, it often becomes less of an issue by the time a person is in their mid-twenties. (11)

Unfortunately, some people struggle with acne even through their twenties. In fact, about 3 percent of adults over age 35 continue to have acne off and on. (11)

There’s no cure for acne, but treatments can get rid of breakouts and prevent new ones. (12) The acne treatment that’s best for you depends on the severity of your acne.

A good skin-care regimen is often the first line of defense for mild acne or the occasional pimple. But sometimes, treatment is needed to keep skin healthy.

Over-the-Counter Products

These solutions include medicated cleansers, lotions, creams, gels, and face pads. They typically contain acne-fighting ingredients, such as: (13)

• Benzoyl peroxide
• Glycolic acid
• Salicylic acid
• Azelaic acid
• Niacinamide
• Topical retinoids

These ingredients work by preventing the plugging of hair follicles, fighting bacteria on the skin, reducing oil production, or exfoliating the top layer of skin. (13)

Harth explains that to heal body acne — such as back acne — you will need an effective anti-acne treatment, such as benzoyl peroxide, which is the most effective for body acne. (14)

Prescription-Strength Products

Options for ointments, creams, and lotions that you can receive from your dermatologist include: (13)

• Topical antibiotics (Benzaclin Pump, BenzaClin, Neuac, Onexton, Duac, and Acanya)
• Oral antibiotics, such as minocycline (Minocin) and doxycycline (Vibramycin)
• Retinoids, such as adapalene topical (Differin) and tazarotene topical (Tazorac)
• Oral contraceptives for women (Yaz)
• Oral antihormonal medications for women, such as spironolactone (Aldactone)
• Topical antihormonal medications for women, such as clascoterone (Winlevi)
• Isotretinoin (Accutane), a pill that is selectively prescribed to manage very severe acne and is under close supervision by a healthcare professional
• Injections of a corticosteroid

Dermatology Procedures

For stubborn acne, your dermatologist may recommend an in-office treatment, such as laser resurfacing therapy or a chemical peel. (13) Other in-office treatments include light therapy, steroid injections, or drainage and extraction of cysts and pimples. (1)

The Importance of Consistency in Treating Acne

You’ll probably need to treat acne for an extended period — not only during a breakout. Also, don’t stop an acne treatment until your doctor says it’s okay — otherwise, you run the risk of having another breakout just when your skin starts to clear. (16)

Without treatment, you may have persistent breakouts and scarring of the skin. Anxiety and low self-esteem are also associated with persistent acne, according to a review published in 2018. (17)

Learn More About Treatment Options for Acne

Alternative and Complementary Therapies

Although traditional acne therapies are proven effective, you may want to experiment with home remedies to complement your plan. While these options won’t be as effective as medications or procedures, they may come with fewer side effects. Some acne medicines can cause dizziness, upset stomach, sun sensitivity, and blood clots. (3)

Ingredients that may help fight acne include:

• Cucumbers (18)
• Honey (19)
• Yogurt (20)
• Oatmeal (21)
• Turmeric (22)

More research is needed to determine the effectiveness of acne home remedies. (13)

Learn More About Home Remedies for Acne

It isn’t enough to understand what causes acne. You should also take steps to stop pimples before they pop up.

• Wash your face twice a day. Use warm water and a mild cleanser, and don’t scrub too hard, or else you could damage the protective layer of your skin and make acne worse, warns Harth. (9)
• Keep hair off your face. Greasy, oily hair can make your skin oily, which can clog your pores and cause acne. Wash your hair regularly, and keep hair off your face. (9)
• Use oil-free skin-care products. Look for “noncomedogenic” skin-care products, which don’t clog pores. Noncomedogenic products are less likely to result in acne breakouts.
• Don’t sleep in your makeup. Removing all traces of makeup before bedtime keeps your pores open and prevents acne. Sometimes, warm water isn’t enough to remove makeup. “You will usually need to use oil-free makeup remover wipes in addition to your cleanser,” notes Harth. Some dermatologists recommend micellar water, too, as part of a double-cleanse routine to help remove makeup without leaving an oily residue behind.
• Don’t touch your face. The more you touch your face, the greater the risk of transferring oil and dirt from your hands to your face. (23) Acne tends to occur on the face and forehead because this part of the body has more sebaceous glands. (1)

Maybe you’ve heard that soda, chocolate, and junk food can cause acne. (1,4) Some people claim that these and other foods trigger their breakouts. Yet registered dietitians and researchers are split on whether food is a culprit.

According to Harth, multiple studies have found that acne tends to be worse in people who eat sugary foods, refined carbohydrates, and dairy.

A study published in 2016 investigated the link between dairy and acne in teenagers between ages 14 and 17. According to these findings, milk consumption was associated with more acne. But oddly enough, this study found a link only with low-fat or skim milk, and not full-fat (whole) milk. (24)

Past research evaluating the association between diet and acne in teenage girls, however, did find a positive link between acne and the consumption of whole milk. (25)

Milk and other dairy products appear to raise levels of insulin-like growth factor 1 (IGF-1), which may trigger greater sebum production and contribute to breakouts.

Blood sugar spikes sparked by eating sugary foods and refined carbohydrates can also lead to skin inflammation and cause the skin to produce more oil. (26)

While the jury’s still out on whether diet choices definitely contribute to acne, Harth recommends erring on the side of caution. “The best diet for people with acne should include anti-inflammatory foods with a low glycemic load,” he says.

The glycemic index (GI) ranks carbohydrates by how fast they increase blood sugar. Since low-GI foods eliminate blood sugar spikes, they might also reduce acne. (27) “Good examples are cold-water fish like mackerel, salmon, and sardines; leafy greens; nuts; certain seeds; and complex carbs like wild rice and quinoa,” says Harth.

Learn More About What to Eat and Avoid to Manage Acne

An unfortunate side effect of acne is scarring, which may take weeks or months to disappear. (28)

Scarring is more likely with moderate or severe acne, and includes black marks or spots where acne once appeared. (28) The best way to reduce the risk of scarring is to leave acne alone — no touching, squeezing, or picking at bumps. (28). If you can’t keep your hands off your face, cover acne with a pimple patch. As a bonus, these patches contain salicylic acid to help treat breakouts.

If scars don’t fade, work with your dermatologist to reduce their appearance.

Your doctor might recommend an acne medication that gets rid of blemishes and stimulates collagen production. Collagen can minimize the appearance of existing scars. (29)

Procedures to reduce or eliminate acne scars include: (28,30)

• Dermabrasion
• Microdermabrasion
• Chemical peels
• Microneedling
• Laser treatments
• Fillers
• Punch excisions

Learn More About Acne Scar Treatments

Acne affects as many as 50 million people in the United States each year. And although it’s common during puberty, there’s been an increase in the number of adults getting acne. It affects up to 15 percent of women. (3)

Clinical studies have found that persistent, low-grade acne affects about 40 to 55 percent of the adult population. (31)

But acne doesn’t only affect people physically; it also affects some people financially. In 2013, an estimated 5.1 million people sought treatment for acne. (3)

Acne and its effects occur in varying degrees in Black, Indigenous, and People of Color (BIPOC) groups and in white people. Although acne affects all racial groups and ethnicities, it’s more prevalent among Black Americans, Hispanic Americans, and Asian Americans compared with white Americans and Native Americans, according to survey results published in 2014. (32)

Black Americans and Acne

Acne is one of the most common dermatological problems among Black people. (33) It can appear on any part of the body, but often appears near the hairline in Black women. (32) Acne in this area is likely the result of hair-care products clogging pores near the hairline.

More than two-thirds of Black women with acne also develop post-inflammatory hyperpigmentation and scarring. (32) But despite the prevalence of acne among this group, Black individuals are less likely than their white counterparts to see a dermatologist for treatment, per research published in 2018. Researchers said more studies are needed to understand the cause of this disparity. (34)

Hispanic Americans and Acne

Acne is a common dermatological diagnosis among Hispanic Americans.

In a previous study of nearly 3,000 women treated with acne (between ages 10 and 70), acne was more prevalent in Hispanics (32 percent) compared with white participants (24 percent). (35) The research also found that hyperpigmentation, dyspigmentation, and atrophic scarring were more common among Hispanic individuals than white people.

Asian Americans and Acne

Among Asian Americans, acne is the second most common dermatological complaint, the first being dermatitis. (33) Dyspigmentation and scarring aren’t as common among Asian Americans, but hyperpigmentation does affect a greater percentage of this group. (35)

Even though acne develops when pores become clogged with dead skin cells or dirt, it can also occur alongside other conditions or as the result of hormonal changes.

Conditions related to acne include: (10)

• Menstruation
• Pregnancy
• Polycystic ovary syndrome (PCOS)
• Depression
• Stress
• Anxiety

Remedying acne is also tricky because there’s a lot of misinformation about this skin condition. And unfortunately, some advice can make acne worse.

Maybe you’ve heard that it’s okay to pop a pimple yourself.

A dermatologist can safely remove pimples, but popping a pimple yourself increases the risk of scarring. Plus, you can spread bacteria from your hands to your face. (9)

Maybe you’ve been told that spending time in the sun will improve your acne. This is also a myth.

Some acne medications can make your skin more sensitive to the sun. So if you’re outdoors too long without wearing sunscreen, you can make your acne worse and increase your risk of skin cancer. (23)

If you have acne-prone skin, choose a product labeled oil-free or noncomedogenic to avoid clogging pores. (36) You should also look for a physical or mineral sunscreen. This is ideal for sensitive skin because it’s also less likely to clog pores. (37)

Rather than believe anything you hear, consult your dermatologist and get answers to your acne questions.

Learn More About Acne Myths