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Acne types and their treatments - help to clear your skin

14 Jul 2020

Whether acne emerges in puberty or adulthood, it comes with effects on self-confidence. But there are treatments available and lifestyle measures that help too

Quick facts:

  • In puberty, acne is especially common in teenage boys
  • Women can be affected in adulthood due to changing hormones
  • Poor hygiene and sexual activity ARE NOT causes of acne

Skin plays a role in our self-perception, so experiencing acne on any level can carry emotional strain and affect self-confidence.

But the good news is, there is plenty that can be done, both in terms of self-help measures and medical treatments.

What causes acne?

There are sebaceous glands in the skin that are met on the skin’s surface by hair follicles. They produce a fatty substance called sebum, which keeps hair and skin soft.

When you reach puberty, sebum production increases along with the bacterium propionibacterium on the skin. Sometimes sebaceous glands produce more sebum than needed and that’s when acne results. This is because the excess sebum and skin residue can clog the hair follicle or the sebaceous gland; or because the bacteria enter it, creating an inflammation or infection.

These changes come about because of an upsurge of testosterone and other hormones during puberty and are especially common in teenage boys. The same effects can also become common in women in adulthood, known as ‘adult acne’ (see below).

What are the different forms of acne?

Acne mostly occurs on the areas of skin where there are more hair follicles found that produce sebum. Thus, the face, back and chest are most affected. It can come in different forms.

Non inflammatory acne which includes:

  • Whiteheads — small bumps that are sebaceous glands where the wall of the hair follicle is closed.
  • Blackheads — small dark dots that occur when the hair follicle is open and sebum and bacteria there have turned black because of contact with air.

Inflammatory acne which includes:

  • Pimples — red and swollen bumps that can progress to the types below.
  • Papules and pustules — these can be hardened, clogged pores surrounded by pink skin, that are usually tender to the touch. Sometimes an infection under the skin’s surface can lead to painful bumps filled with fluid (called pustules) that are yellow or white in colour.
  • Nodules and cysts — These can be painful to the touch and look red and inflamed.

What’s the difference between mild, moderate and severe acne?

  • Mild acne — White and blackheads mostly, with occasional pimples.
  • Moderate acne — More inflammatory papules and pustules that are less than 5mm in diameter, as well as pimples, blackheads and whiteheads.
  • Severe acne — Nodules and cysts that are more than 5mm diameter (along with all or some of the above). In very severe cases, these may join together and leak fluid onto the skin’s surface.

What acne treatments are available?

Mild cases of acne can often be treated at home with the help of your pharmacist. For moderate cases or mild acne that’s not clearing up, talk to a Livi GP about some of the treatments they can offer (see below). In severe cases you may be referred to a dermatologist.

From the pharmacy

For mild acne, over-the-counter products are available that may take up to 8 weeks to make a difference. These include creams that can work on the bacteria causing the pimple as well as cleansers, gels and lotions that work on recurring mild acne and may also help prevention.

From your Livi doctor

If your acne has more sore red pustules or papules, or you develop hard lumps under the skin – nodules or cysts – see a GP. They will be able to recommend a course of treatment that is suitable for you. They will rule out other conditions that may mimic some features of acne (such as rosacea or a hair follicle infection).

Then they can offer a wide range of prescription treatments. These can include prescription creams, topical and oral antibiotics or birth control pills (if you’re not planning on getting pregnant). The latter can help moderate the hormonal action behind the acne.

It’s usually advisable to try any prescribed treatment for around three months. If your acne isn’t clearing up after that, talk to your doctor about changing your treatment.

From a dermatologist

If acne treatments from your pharmacy and GP aren't working, he/she may refer you to a dermatologist for further treatment.

A specialist dermatologist can also advise you about treatments available for acne scarring.

What about adult acne?

For women, hormonal changes related to age or lifestyle and changes in the skin – sometimes triggered by stress – can bring on acne. In this case, the same treatments above apply.

However, as skin is less resilient, it may be better to avoid harsh stripping products and choose milder exfoliating lotions to encourage cell turnover (such as those containing salicylic acid – see above).

There is a theoretical chance that antioxidants like vitamin C in skincare may help acne scarring by stimulating collagen production. But we need more recent studies on whether this helps active acne. Using topical vitamin C could help reduce redness that may be associated with adult acne.

If you develop erratic periods, increased bodily or facial hair growth, alopecia (excessive hair loss from the head) alongside the acne, you may have polycystic ovarian syndrome (PCOS). This can be diagnosed by your doctor.

Lifestyle changes that may improve acne at any age

1. Don’t over-cleanse
Spots are not down to poor hygiene (this is a myth). If you cleanse too aggressively, you may irritate your skin and treatments may sting. Look for non-comedogenic (this means non-pore blocking) products. Ideally wash twice a day with a gentle cleanser that is pH-matched to the skin and use a non-oily moisturiser. Look for oil-free or water-based non-comedogenic make-up. Never pick or squeeze spots.

2. Stop smoking
More spots under the skin surface (acne inversa) occur in smokers. The toxins in cigarettes and vapes and the blood vessel constriction they promote will not be doing skin any favours in general.

3. Deal with stress
Stress can exacerbate any skin condition and research has found that, especially in women, high stress levels can increase the severity of acne. You often can’t avoid it, but you can choose to deal with it better. Try yoga, breathing techniques and meditation – the Headspace app is a great place to start.

4. Don't wear too much make-up
Water-based make-up is less likely to block your pores. Always remove make-up before bed.

5. Drink plenty of water
Dehydration does not help any skin or inflammatory condition (including acne) so keep well hydrated.

6. Take care of your gut health
A nourishing diet for gut health along with good levels of probiotics (that’s healthy bacteria from fermented foods such as sauerkraut, kimchi and natural yogurt) may play a role in healthy skin.

7.Get enough vitamin D
Vitamin D deficiency means we have less protection from inflammation in the body, which may worsen acne. Ensure you get enough sunshine and vitamin D-rich foods.

8. Eat an anti-inflammatory diet
We are beginning to understand the influence of nutrition over the different systems in our bodies, including the skin. It is no longer dismissed that acne is affected by diet. Although more research into this area is needed, many studies are now suggesting that there is enough evidence to encourage the avoidance of high glycaemic index foods such as sugary foods or carbohydrates. Research suggests that foods with a high glycaemic index can increase insulin growth factor (IGF-1). This can block the oil-secreting glands in some people and exacerbate their acne. For good skin health, it is preferable to eat a diet rich in fresh fruits, vegetables, lean meats, fish and seafood.

Reviewed by: Dr Rhianna McClymont, Lead GP, Livi

Last updated:
14 Jul 2020

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