Acne & Blemishes

Acne is a very common skin condition characterised by spot breakouts. It usually begins in puberty & varies in severity. Mild acne, for example, is generally not sore and can often be treated with over-the-counter medication. More severe acne types, however, can be painful & in some cases can cause acne scars. In these instances prescription medication & support from a dermatologist may be required.

Young woman suffering from acne on her face Rewonder

Acne & Blemishes

Most commonly, acne develops on the:

  • Face – affects almost all people with acne
  • Back – affects more than 50% of people with acne
  • Chest – affects approximately 15% of people with acne

Whilst acne is a treatable condition in many cases, not all acne treatment approaches are successful & more serious cases can go beyond surface level leading to embarrassment & a lack of self-esteem.

  • Oil secretion – At times of emotional stress or throughout puberty, androgen production increases leading to the over production of oil, or sebum, which further clogs pores. As oil continues to be produced it collects & becomes trapped behind the plug, building up pressure inside the pore.Acne is a complicated cycle which occurs within skin pores, often starting weeks before a spot surfaces and developing in the following four stages:
  • Clogged pores – Acne begins with a blocked pore. As skin cells constantly renew themselves, most dead cells will shed every 30-days, revealing fresh skin underneath. If you are acne prone, however, these dead cells mix with oil & become sticky & instead of shedding, clog pores & trap oil & bacteria inside.
  • Inflammation – As bacteria ingests the oil, they release inflammatory by-products that leak from the follicle. The body recognises these by-products as foreign objects and kick-starts an immune reaction. Red & white blood cells flock to the infection – resulting in swelling, redness & inflammation, forming what you will recognise as a spot.
  • Bacterial growth – The excess production of sebum increases the growth of bacteria known as P.acnes, which grow deep inside the pores. In a plugged follicle, the low oxygen & continually building level of sebum create the perfect environment for the growth & spread of acne bacteria.
Spot Types
Spots caused by acne can be spilt into the following six categories:

Blackheads – Tiny bumps usually black or yellow in colour that develop on the skin. A blackhead is essentially an open clogged hair follicle. The black colour is caused by oxidisation of the debris inside.

Whiteheads – Small white blemishes with white heads. This type of spot is caused by sebum/oil blockages and dead skin cells plugging the follicles.

Papules – Small to medium red bumps that feel tender or sore. This happens when the presence of bacteria under the skin has caused inflammation.

Pustules – Similar to papules but with a build-up of pus inside. Pustules often look like large whiteheads & can be painful to touch. Squeezing them can lead to the development of acne scars so it is advisable to wait until the whitehead is visible.

Nodules – Large inflamed bumps that are firm to the touch. They develop deep within the skin & often cause pain. Nodules should be treated by a dermatologist as over the counter medication may not be strong enough to clear them up.

Cysts – A cyst is the most severe type of spot caused by acne. They are large lumps full of pus that look similar in appearance to boils. Cysts carry the greatest risk of acne scars.

Acne Types

There are a number of different acne types, with are characterised by a different set of symptoms & recommended acne treatment differing for each variety:

Mild Acne – Acne is generally considered to be ‘mild’ when there are a limited number of whiteheads, blackheads, inflamed bumps & lesions visible. This type of acne can often be treated effectively with over-the-counter medication

Moderate Acne – A higher volume of whiteheads, blackheads, inflamed bumps & lesions are visible & prescription medication is generally advised.

Cystic Acne– Cystic acne, also known as Nodulocystic Acne is when multiple inflamed cysts & nodules are present. Acne may be deep purple & often leaves scars. Treatment by a dermatologist could minimise scarring & in many cases, corticosteroids injections may be advised to minimise painful inflammation. 

Acne Conglobata – One of the most severe acne types, involving inflamed nodules that are connected under the skin to other nodules. Acne Conglobata can affect the neck, chest, arms and buttocks & often leaves scars. It is more typically seen in men & is often caused by taking steroids or testosterone.

Acne Mechanica – This kind of acne is caused by heat, friction & pressure against the skin. Often referred to as sports-induced acne, as wearing sporting gear such as a helmet can often be a catalyst for acne development. Simple measures such as wearing absorbent material underneath sports gear can help.


Acne treatment depends on severity of symptoms & it can take some months before an improvement is seen. The most common treatment types are outlined below:

Benzoyl peroxide – Benzoyl peroxide is a topical treatment that kills bacteria, reduces inflammation & helps to unclog blocked pores. Upon contact with the skin, it breaks into two parts: benzoic acid & oxygen. Oxygen instantly kills bacteria & as an exfoliate, benzoic acid causes the skin to dry out & peel, eliminating the build-up of dead skin & sebum in your pores. The treatment is usually available over-the-counter & ranges in strength from 2.5% up to 10%.

Topical retinoids – Topical retinoids remove dead skin cells from the surface of the skin which reduces build-up within the hair follicles. Tretinoin & adapalene are both topical retinoids available in a cream or gel form for the treatment of acne.

Antibiotics for acne – Oral antibiotics are generally used in combination with a topical treatment for more severe cases of acne. Tetracyclines are the most common type of antibiotics prescribed & a course generally lasts between four to six months.

Hormonal therapies – Women who experience flare-ups around the time of their period, or those with hormonal conditions such as polycystic ovary syndrome can benefit from hormonal therapy.

Cocyprindiol – This hormonal treatment helps to slow the production of sebum & can be used to treat more severe acne that hasn’t responded to antibiotics.

Isotretinoin – This drug can only be prescribed by a dermatologist or specially trained GP as it can cause a wide range of side effects. It is mostly taken in tablet form & can help to normalise sebum, prevent clogging in follicles, decrease skin bacteria & reduce & swelling in & around spots.

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