Acne

What different types of acne are there?

Acne can present in various forms, depending on the severity and depth of the inflammation. The main types include:

• Blackheads: Open pores filled with excess oil and dead skin cells, which turn dark due to exposure to air
• Whiteheads: Closed plugged pores that remain under the surface of the skin
• Papules: Small red, tender bumps without pus
• Pustules: Similar to papules but with a white or yellow centre due to pus
• Nodules: Large, painful lumps beneath the surface of the skin, often hard to the touch
• Cysts: Deep, pus-filled lumps that can be painful and are more likely to cause scarring

Where on your body might you get acne?

Acne most commonly affects:

• The face: The most visible and frequently affected area
• The back: A widespread location, especially in men
• The chest: Often associated with hormonal changes and sweating
• Shoulders and neck: Areas with high concentrations of oil glands

Acne can appear anywhere on the body where hair follicles and sebaceous glands are present.

What are the symptoms of acne?

Symptoms vary depending on the severity of the condition, but may include:

• Greasy skin
• Whiteheads and blackheads
• Red or pus-filled spots
• Painful nodules or cysts beneath the skin
• Skin discolouration or dark marks after the spots have healed
• Scarring, especially after more severe cases

Acne flare ups can also be linked to stress, hormonal fluctuations, diet, or skincare products that are not right for your skin.

What causes acne?

Acne develops when tiny holes in the skin, known as hair follicles, become clogged with oil (sebum), dead skin cells, and sometimes bacteria. Each follicle is connected to a sebaceous gland, which produces sebum to lubricate the skin and hair. When too much sebum is produced or dead skin cells aren’t properly shed, this combination can block the follicle and create a spot.

Hormonal changes are the most common underlying cause, particularly during puberty, menstruation, pregnancy, menopause, or in conditions such as Polycystic Ovary Syndrome (PCOS). Androgens (male hormones present in both men and women) can increase oil production, making breakouts more likely.

In addition to hormonal factors, several triggers can make acne worse, including:

• Stress: May contribute to flare-ups by stimulating hormone production.
• Diet: Some evidence suggests that high-glycaemic foods and dairy might aggravate acne in certain individuals.
• Skincare and cosmetics: Using greasy or comedogenic products can block pores.
• Medication: Some drugs, including steroids and lithium, can worsen acne.
• Environmental factors: Humidity, pollution, and friction (e.g., from sports equipment or face masks) can all contribute.

While poor hygiene is certainly not the cause of acne, keeping the skin clean, avoiding picking your spots, and steering clear of harsh products can help prevent irritation and reduce the chance of symptoms getting worse.

How can you treat acne?

The treatment that will work best for you will depend on the severity and type of your acne. Mild acne may respond well to over-the-counter products, while more persistent or severe cases may need prescription medication. It’s important not to pick or squeeze spots, as this increases the risk of scarring and infection.

If you follow a simple skincare routine using mild cleansers and non-comedogenic (non-pore-blocking) products, this can help manage breakouts and support other treatments.

Topical treatments for acne

Topical treatments are applied directly to the skin and are often the first-line treatment for mild to moderate acne. These include:

• Benzoyl peroxide: An antimicrobial that reduces bacteria and helps prevent blocked pores.
• Topical antibiotics (e.g., clindamycin): Reduce inflammation and kill acne-causing bacteria.
• Retinoids (e.g., adapalene, tretinoin): Help to unclog pores and promote cell turnover.
• Azelaic acid: Helps with blocked pores and can also improve pigmentation left by acne.
• Salicylic acid: A keratolytic that exfoliates the skin, helping to clear blocked pores.

These treatments may cause some skin irritation initially, so it’s best to follow medical guidance from an experienced dermatologist on how to use them correctly.

Oral medications for acne

If topical treatments do not seem effective for you, you may be recommended a prescription for an oral medication. These might include:

• Antibiotics (e.g., doxycycline, lymecycline): Help reduce bacteria and inflammation. These are usually prescribed for a few months and are often combined with topical treatments.
• Oral retinoids (e.g., isotretinoin): A powerful medication used for severe or cystic acne. It is highly effective but carries a risk of side effects, so it is only prescribed under strict supervision.
• Zinc supplements: Can have anti-inflammatory effects and are sometimes used as an adjunct to other treatments.

Can hormonal therapies help acne?

Hormonal treatments are particularly useful for women with acne, where the acne is thought to be connected to hormonal imbalance. These treatments include:

• Combined oral contraceptive pills: Especially those containing oestrogen and anti-androgens like cyproterone acetate or drospirenone. These can help regulate hormones and reduce acne flare-ups.
• Anti-androgens (e.g., spironolactone – off-label in the UK): Used in some cases to block the effects of male hormones (androgens) that can contribute to acne.

Hormonal therapies are often used when acne is linked to conditions like PCOS or when a breakout persists despite being treated with topical medications or antibiotics.

Visiting our London clinic

We’re here to offer our care and expertise, with appointments often available at short notice. To find out more about acne treatments, please telephone 020 7244 4200 or make an appointment online.