Your guide to understanding acne: Causes, Prevention, Treatment

The occurrence of acne in adults isn’t uncommon—here’s why it happens and what you can do to manage an outbreak

While often associated with teenagers navigating puberty, acne can be a persistent concern for adults too, irrespective of their age. It manifests in different forms, ranging from mild whiteheads to severe cystic lesions, often leaving behind acne marks and pimple scars. 

Managing acne itself can be challenging, but dealing with its aftermath—persistent blemishes, acne marks on the face, and scars—can be even more difficult. But what exactly causes acne? How can you prevent or treat it? This in-depth primer covers it all. 

What is Acne?

At its core, acne occurs when hair follicles—tiny structures on the skin that house a strand of hair—become clogged. This clogging is often a mix of sebum, dead skin cells, and sometimes bacteria, which results in the telltale bumps or lesions we know as acne. Acne isn’t just of any single kind, it can manifest on the skin in several forms. 

Whiteheads: These small, white bumps occur when a pore becomes fully clogged with oil and dead skin cells, trapping the material beneath the skin. They remain closed and are less prone to becoming inflamed but can still lead to lingering acne marks.

Blackheads: Often mistaken for dirt, blackheads form when a pore is partially clogged and exposed to air. The exposure causes oxidation, which turns the clog black. While they’re not typically painful, blackheads may leave subtle pimple scars if improperly extracted.

Pustules are inflamed lesions filled with pus that appear red and swollen. When they burst—whether naturally or from picking—they can leave behind deeper, more noticeable acne scars.

Nodules: These are firm, painful lumps that develop deep within the skin. Nodules are more severe and often require medical attention and can leave persistent indentations or pimple scars.

Cysts: It is the most severe form of acne; they are large, pus-filled lesions that occur deep in the skin. They are prone to scarring and are the most likely to leave behind hard-to-treat acne marks.

Cause of Acne

While it’s common to hold greasy meals or avoiding double-cleansing the skin responsible for acne, it  stems from a combination of both internal and external factors. Let’s understand the reasons behind acne and what makes it persist.

Hormonal Changes: The Invisible Trigger for Acne Formation

It’s no surprise that acne often coincides with significant hormonal stages like puberty, menstruation, pregnancy, or even menopause. These changes ramp up the activity of sebaceous glands, causing them to produce excessive sebum, or oil.

Excessive oil production clogs pores, creating an environment for acne-causing bacteria to thrive. This explains why teenagers are particularly prone to breakouts and why many adults struggle with acne marks on their faces during certain phases of their lives. 

How Diet and Lifestyle Influence Acne Development

Consuming high-glycaemic-index foods and processed snacks can spike blood sugar levels, which, in turn, leads to inflammation and increased sebum production. These conditions make your skin more susceptible to clogged pores and stubborn acne scars.

Adding to this is stress, inadequate sleep, and minimal physical activity. Stress, for example, releases cortisol, a hormone that exacerbates oil production and worsens breakouts. Similarly, a lack of exercise slows down blood circulation, making it harder for your skin to heal. 

Genetics: How Your DNA Influences Acne Risk

While diet and skincare routines can be controlled, genetics is a key factor too. If your parents dealt with acne, there’s a strong likelihood that you’re predisposed to it as well. Genetic factors influence your skin’s tendency to overproduce sebum, respond to inflammation, and form scars after breakouts.

Environmental Factors: The Hidden Aggressors

Environmental factors including high humidity levels and air pollution, create havoc on your skin through clogged pores and inflammation. Moreover, excessive sun exposure can exacerbate acne scars and other skin imperfections. Tiny particles from pollution can settle on your skin, mixing with sweat and oil, leading to blackheads, whiteheads, and, eventually, more severe acne lesions.

Skincare Products: Are They Helping or Harming Your Skin?

Using comedogenic products—those that clog pores—can make even the best intentions backfire. Heavy creams, oils, or make-up with pore-clogging ingredients can trap dirt and bacteria, leading to severe breakouts.

Additionally, an overuse of harsh cleansers or exfoliants can deplete the skin’s natural oils, prompting it to overproduce oil in an effort to restore balance. This vicious cycle leaves the skin irritated, inflamed, and prone to acne scars. 

How does acne occur?

Acne formation is a multi-step process, each step contributing to the eventual breakout or inflammation that can lead to lasting skin issues: 

Sebum Overproduction: The Starting Point for Acne

The first step in acne formation starts with the sebaceous glands. These glands produce sebum, the natural oil that keeps our skin moisturised and protected. However, when there’s an imbalance, these glands can begin to overproduce sebum. Excess oil causes the hair follicles to become clogged, setting the stage for acne. The excess sebum not only contributes to the blockage but also creates an environment where bacteria can thrive. 

Dead Skin Cell Accumulation: A Key Contributor to Clogged Pores

Normally, skin sheds dead cells in a regular cycle, but when this process is disrupted, the dead skin cells can accumulate. When these dead skin cells mix with the excess sebum produced by the sebaceous glands, they form a thick plug that blocks the pores. This plug is what’s often seen as whiteheads or blackheads. Without proper exfoliation, the trapped mixture of sebum and dead skin cells creates an even more effective breeding ground for bacteria. The accumulation of dead skin cells also contributes to inflammation, which worsens existing acne symptoms, making skin red and irritated.

Bacterial Growth: Fuelling the Acne Cycle

Once the pore is blocked by sebum and dead skin cells, the next issue is bacterial growth. The skin naturally harbours a type of bacteria called Propionibacterium acnes (P. acnes), which can lead to acne. Under normal circumstances, these bacteria coexist harmlessly. However, when a pore becomes clogged, it creates an anaerobic environment (lacking oxygen) that allows P. acnes to multiply rapidly. As the bacteria feed on the trapped sebum, they break it down into fatty acids, which further irritate the surrounding skin tissue. This bacterial overgrowth leads to inflammation and the formation of pustules or pimples.

Inflammation and Lesion Formation: The Skin’s Immune Response

As the bacteria multiply and cause further irritation, your body’s immune system jumps into action to fight the infection. This immune response creates redness, swelling, and the formation of lesions. The skin becomes inflamed and may present as painful, swollen pimples, pustules, or cysts. In some cases, the inflammation is so severe that it results in cystic acne, which is deep under the skin and can take longer to heal. These types of lesions are often associated with more severe acne scars.

While the body’s immune response is designed to fight off infection, this inflammation can also have lasting effects on the skin. The healing process may not always be perfect, and this is when acne scars begin to form.

Treatment and Management

The good news? Your skin doesn’t have to battle acne forever. With the right approach and dedication, you can effectively manage both active breakouts and the acne marks or pimple scars they leave behind. From over-the-counter remedies to advanced dermatological procedures, a wide range of treatments cater to various skin types and severities: 

Over-the-counter (OTC) Treatments

For mild acne, OTC products containing salicylic acid, alpha hydroxy acids or benzoyl peroxide can be effective. These ingredients target the root causes of acne while reducing the appearance of acne marks on the face over time.

Prescription Medications for Severe Acne

For more stubborn or severe acne, a dermatologist might prescribe any of the following:

• Topical Retinoids: These improve cell turnover, helping fade acne scars and prevent future breakouts.

• Oral Antibiotics: They tackle bacterial growth and inflammation.

• Hormonal Treatments: Birth control pills or spironolactone can regulate hormones and reduce the risk of long-term pimple scars.

Lifestyle Modifications for Acne Management

Regular exercise boosts circulation, while a balanced diet rich in antioxidants can reduce inflammation. Avoiding smoking and ensuring proper hydration also contribute to better skin health, reducing the likelihood of acne marks.

Advanced Procedures for Scar Treatment

When it comes to stubborn pimple scars or deep acne marks, advanced treatments are often necessary. Some options include the following:

• Chemical Peels: They exfoliate the skin, reducing surface-level blemishes.

• Laser Therapy: Widely regarded as one of the best treatments for acne scars, lasers stimulate collagen production to improve skin texture.

• Microneedling: This technique creates micro-injuries to boost skin regeneration, effectively addressing deep scars.

Prevention Tips for Acne

Developing a consistent skincare routine and lifestyle changes can work wonders, not only to prevent acne but also keeping acne marks and pimple scars at bay. Here’s how to prevent breakouts effectively:

Maintain a Consistent Skincare Routine: The Importance of Cleansing Twice Daily

One of the most effective ways to prevent acne is to wash your face twice daily—once in the morning and then before going to sleep. This removes excess dirt, oil, and sweat from your skin, which can add to clogged pores. Keeping your skincare routine simple—cleansing, toning, and moisturising—can go a long way in helping you manage acne and reduce acne marks.

Don’t Pick or Pop Pimples: Preventing Pimple Scars

Resist the urge to pick at pimples—we all know how tempting it can be, especially when they seem so glaringly obvious on your skin. However, doing so will only exacerbate the problem, potentially causing them to spread. If you’re tempted to squeeze a pimple, try using spot treatment gels with benzoyl peroxide or salicylic acid. These gels help reduce inflammation and speed up healing without causing scarring.

Daily Sunscreen Application: Protecting Your Skin from UV Damage

One of the most critical steps in preventing acne marks on the face is using sunscreen daily. Acne-prone skin can be sensitive, and exposure to the sun can make matters worse. UV rays can darken existing acne marks and pimple scars, making them more visible and harder to treat. 

Consider alternatives like zinc oxide or titanium dioxide that protect against harmful rays while keeping your skin clear. Make sunscreen part of your daily morning routine, even on cloudy days or when indoors, as UV exposure can still affect your skin.

Choose Non-Comedogenic Skincare Products: Keep Your Pores Clear

Make sure that all your skincare products—moisturisers, sunscreens, make-up—are non-comedogenic. This means they won’t clog your pores and contribute to breakouts. When shopping for skincare, look for products labelled “oil-free” or “non-comedogenic.” Opting for these formulas helps to prevent excess oil build-up, reducing the likelihood of acne and allowing your skin to breathe freely. Products with ingredients like niacinamide or hyaluronic acid can hydrate the skin without irritating or clogging the pores.

Avoid Touching Your Face: Reduce Bacteria and Oil Transfer

Every time you touch your face, you transfer oils, bacteria, and dirt from your hands to your skin, which can clog pores and cause inflammation. This can lead to more breakouts and increase the risk of developing acne marks and scars.

Manage Stress Levels: Prevent Acne Triggered by Hormones

Managing your stress through meditation, yoga, deep breathing exercises, or regular physical exercise can help regulate cortisol levels and reduce the likelihood of acne breakouts. Additionally, getting enough sleep each night allows your skin to repair and renew, preventing the onset of new breakouts and helping fade existing acne marks.

Diet and Hydration: What You Eat Matters

What you put into your body plays a crucial role in how your skin behaves. A diet that comprises vitamins and minerals can regulate sebum production while improving overall skin health.

An intake of more fruits and vegetables and lean protein, can control sebum levels and enhance skin health. Drink plenty of water throughout the day to keep your skin hydrated from within, which can help flush out toxins that may otherwise contribute to acne.

Also Read: Can acne take a toll on your mental health? Experts say yes

Also Read: Can vitamin C worsen acne?

Also Read: Here’s how adult acne differs from hormonal acne