Acne Treatment and Causes

What causes acne?

You get acne when your pores become blocked with excess oil. Normal amounts of oil (or sebum) produced in the skin by glands found next to the hair follicles – called sebaceous glands – help to moisturise the skin. But when these glands are affected by a rise in hormones called androgens, they start overproducing oil. This then triggers a change in a normally harmless skin bacterium called P. acnes, making it cause inflammation and pus.  A rise in androgen production also blocks the pores because it makes the lining of the hair follicles thicker. All this skin activity causes blackheads, whiteheads, pustules (spots filled with pus) and hard, painful lumps under the skin. Spots eventually heal, but some people may find their skin remains discoloured for some time after having a spot, which is known as post-inflammatory hyperpigmentation.

In 99 percent of cases, acne affects the face (ii). But it’s also common to have spots on your back and/or chest. Unfortunately for teenagers, larger-than-normal levels of androgens are triggered during puberty, which explains why so many teens get spots. And if one or both parents had acne, it’s likely that their children will have it when they’re teenagers too.

The majority of acne cases are mild. But around three out of 10 teenagers are estimated to have severe acne that needs treatment to prevent scarring (iii).
 

Women and acne

There is, however, no evidence that poor hygiene (excessive washing may even make spots worse), diet or sexual activity cause acne. There’s also no proof to suggest that sunbathing or using sun beds and sunlamps could improve acne. For some women, there may be a hormonal link to acne, caused by polycystic ovary syndrome (PCOS).

Acne treatments

The type of treatments you can try to clear your acne depends on how severe it is. If you have a mild case of acne, with just a few blackheads, whiteheads and spots, the following over-the-counter pharmacy products may be useful:

Benzoyl peroxide

Gels or creams that contain an ingredient called benzoyl peroxide are designed to help dry up spots and kill the bacteria that cause them. Benzoyl peroxide works by reducing the concentration of the bacteria that triggers acne (P acnes), and slows down the production of a natural substance in the skin called keratin, which means it helps with shedding of the skin.

You should apply a thin layer of benzoyl peroxide cream once or twice a day onto thoroughly cleansed and dried skin. If applied regularly, it may improve mild acne (though bear in mind that it can take months of treatment before you see results).

The most common side effects of benzoyl peroxide are dryness and flaking, but they are generally mild and can be counteracted by using an oil-free moisturising lotion. Some people’s skin may be sensitive to benzoyl peroxide, which can cause redness, inflammation and soreness. If this happens, you should stop using your skincare product immediately. Also avoid contact between benzoyl peroxide and the eyes, mouth and other mucous membranes, as well as clothing and bedding, as it can bleach fabrics.

Salicylic acid

Another ingredient in lotions, creams and cleansing pads to look out for is salicylic acid. This can help unblock pores and prevent scarring. But while it may help to keep pores clear, salicylic acid doesn’t kill bacteria. As with benzoyl peroxide, you have to keep using products with salicylic acid for as long as you want to treat acne – if you stop using it, your spots may return.

Tea tree oil products, or oil dabbed neat onto spots, may help too. Some over-the-counter products designed to reduce or prevent acne scarring are also available, including specialist skincare oils.
 

Prescription treatments

If you suffer from more severe acne, your GP can recommend one of the prescription medicines that are available, including antibiotics in cream, gel or tablet form, retinoid gels or creams, azelaic acid creams and the oral contraceptive pill. In severe cases, you may be advised to use a gel or cream as well as tablets.

• Antibiotics
  These prevent the growth of P acnes, thereby helping to control acne. Antibiotic creams and gels work best for inflamed acne. Antibiotic tablets, however, are usually only prescribed in severe cases of acne.

• Retinoids
  Gels and creams that contain vitamin A derivatives are called retinoids. They cause your skin to exfoliate, which prevents pores from clogging and turning into blackheads and whiteheads. Retinoids prevent P acnes from spreading and help speed up skin peeling.

• Azelaic acid
  Belonging to a class of medicines called dicarboxylic acid, azelaic acid also kills P acnes and slows down keratin production. 

• Contraceptive pill
  Some women find the oestrogen in the combined oral contraceptive pill helps with acne if their skin flares up because of hormone changes.

Q. What’s the best way to cleanse your skin if you have spots?

Experts recommend using a mild soap or cleanser with lukewarm water (avoid water that’s very hot or very cold). Only cleanse twice a day – once in the morning and before going to bed. You may feel like washing your skin more often, but it can irritate your skin and make your spots worse.

Q. Should you use a moisturiser if you have acne?

If you have very oily skin, you may feel you don’t need a moisturiser. However, using a very small amount of a water-based, fragrance-free, oil-free moisturiser may help to maintain your skin’s moisture balance, whatever your skin type. Using a light moisturiser may also help if you’re using acne creams or lotions, some of which can make your skin dry and flaky.

Q. Is it a good idea to squeeze blackheads?

Some skincare experts say it’s fine to squeeze them as long as they are black. Others say you should never squeeze blackheads or spots, as it can make them worse and possibly lead to scarring. If you are determined to squeeze, find a skincare specialist who treats acne-prone skin and ask for their advice.
In general, try not to touch your spots, as it can damage your skin and the spot may last much longer than if you’d left it alone.

Q. What's the best way to conceal spots?

If your spots are red and swollen, try a concealer with a yellow tone. If you have used an acne cream or lotion, wait 20 minutes before applying make-up. Then after applying your normal foundation, use a clean brush to apply the concealer where it’s needed, or press it into your skin gently using clean fingers. Finally fix the concealer in place by dusting your skin with translucent powder.
If possible, choose water-based make-up that’s labelled non-comedogenic (this means it won’t block your pores). Also wash your make-up brushes and sponges thoroughly and regularly to avoid spreading bacteria.

Q. Is it bad for your skin if you forget to take your make-up off at night occasionally?

It’s not a good idea if you have spots, as going to bed with your make-up on could result in clogged pores. However, with so many make-up remover products available these days, there’s no excuse for going to bed wearing make-up, even if you’re really tired. Make-up remover wipes, for instance, are really quick and easy to use.

Natural Acne Remedies

Eating a healthy balanced diet with plenty of fresh fruit and vegetables can help support your skin and your overall health. But if you have acne, there are a few nutritional supplements that you could try, including the following:
 

Vitamin B5

Pantothenic acid – or vitamin B5 – is thought to help with acne because it may reduce the amount of oil produced by your sebaceous glands. In one study, volunteers who took a vitamin B5 supplement had fewer spots after 12 weeks compared to those who took a placebo (v). You can get a range of B vitamins, including B5, in a high-strength multivitamin and mineral formula, or in a vitamin B5 formula if you need higher levels of the B nutrient.

 

Zinc

Some experts believe zinc is an important nutrient for reducing or preventing acne, since some studies have found that people with acne have lower-than-normal zinc levels (vi). Unfortunately, much of the evidence to support zinc as an effective treatment for acne involves high doses of the nutrient, which can be harmful. However, some studies involving lower doses claim zinc may be helpful too (vii). Researchers elsewhere have looked at zinc levels in people with acne, and while they concluded there’s no significant difference between people with low zinc levels and those with normal levels, they claim if you’re low in zinc and you do have acne your spots may be severe (viii).

Zinc – best taken as part of a multivitamin and mineral formulations – is also beneficial as it may enhance immune system function.

 

Selenium

Acne sufferers may also find antioxidant supplements are beneficial. In one study, researchers tested a group of antioxidants including selenium on volunteers with acne, and found they were all beneficial, with selenium reducing the number of spots and inflammation (ix). As with zinc, selenium may also be worth trying because of its positive effect on the immune system, and is found in all high-quality multivitamin and mineral supplements.

 

Turmeric

The antioxidant found in turmeric called curcumin is widely thought to have anti-inflammatory properties, with studies suggesting it has significant anti-inflammatory effects in the treatment of acne and other skin conditions (x). One in vitro study also suggests curcumin is an anti-bacterial substance that acts against the bacteria linked to acne, P. acnes, and that it may be 36 times stronger than azelaic acid (a prescription treatment for acne, see above) (xi). You can use turmeric as a cooking spice, add some to warm milk to make a turmeric latte, or take it in supplement form.

 

Green tea

Antioxidants called polyphenols may also be useful for acne, especially those found in green tea. Studies suggest tea polyphenols may help reduce the production of oil in the skin and in the treatment of acne (xii), both when taken as a drink and when applied topically. Green tea also contains antioxidants called epigallocatechins, which have been shown to modulate the production and biological actions of androgens and other hormones (xiii).

 

Live bacteria

Products containing live (or ‘friendly’) bacteria such as L acidophilus are recommended frequently for acne, since acne is often considered a symptom of bacterial imbalance in the gut. Indeed, one study suggests more than half of people with acne may have impaired gut flora, and that it may be possible to halve the amount of time it takes to treat their acne by correcting the imbalance (xiv). Probiotic lactic acid bacteria have also been shown to have an anti-bacterial effect against P. acnes in lab studies (xv). For more information on ways to treat acne, see our guide

There’s also lots of information and advice about a wide range of health conditions in our health library

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