Acne vulgaris can manifest in both inflammatory and non-inflammatory forms. Inflammatory acne is the pustules, deeper papules, and cystic lesions that, as the name suggests, come with inflammation. Non-inflammatory acne includes the familiar whiteheads and blackheads. Acne most commonly appears on the face but can also be on the chest and back. It typically starts in adolescence and, can resolve by the mid-twenties.

Numerous factors work in concert to produce acne such as clogged pores and hormones, play significant roles. The skin has more oil (sebum) as hormones increase around puberty. This, combined with sticky dead skin cells, causes your pores to clog up. Normal bacteria on your skin also get trapped in these pores, triggering an inflammatory response in the skin. Clogged pores without many bacteria give you whiteheads and blackheads, whereas larger bacterial counts create inflammatory lesions like pustules, papules (small bumps), cysts, and nodules (hard, solid lesions).

These are the primary factors for acne. However, other conditions influence the production of acne. For example, a high-glycemic-index diet (consuming sugary processed foods) increases acne, causing more inflammation and sebum production. Hormone imbalances can contribute to greater sebum production as well. Consequently, the presence of acne can be an indicator of other processes occurring in the body.

• Increased hormones leading to sebum production.
• Sticky dead skin cells lead to clogged pores.
• Increased bacterial flora.
• Increased inflammation.

• High-glycemic index diet
• Insulin resistance
• Hormone imbalance, such as in polycystic ovarian syndrome (PCOS)
• Medications such as steroids and anticonvulsants
• Occlusive cosmetics or moisturizers
• High environmental humidity

Today, there are numerous effective treatments available for acne. A one-size-fits-all treatment option is often insufficient because of the many factors behind acne. Therapies are personalized to each patient, given their unique circumstances. Acne treatments do not work overnight. Improvement can be seen over four to eight weeks.

The treatment goals are to unclog pores, reduce acne-causing bacteria, and decrease sebum production and inflammation. Prevention of scarring from acne is also essential. Combination therapy is recommended. Therapies like topical retinoids help unclog pores by increasing the exfoliation of dead skin cells. Chemical peels containing glycolic acid and salicylic acid can aid exfoliation and oil reduction. Topical and oral antibiotics help reduce the skin’s bacterial count and inflammation. Phototherapy can also be used to reduce bacteria and inflammation. Women with hormonally driven acne or PCOS may be candidates for oral contraceptives or other oral therapies to address hormonal balances. In severe cases of nodular and cystic acne, isotretinoin (previously known as Accutane) effectively reduces the skin’s oil production.

As acne becomes more severe, the risk of scarring also increases. It is essential to start therapies early in the development of acne for scar prevention. However, there are numerous therapies to address acne scarring once it occurs. These include microneedling, chemical peels, laser therapy, and more.