Acne on the Face: Treatment, Causes and Prevention, Types of Pimples

Everybody knows someone who takes great care of their face and never gets a zit. It’s possible for some people to maintain a high standard of skin care while battling breakouts. Is there a reason why some individuals get acne and others don’t? Acne is caused by three key reasons that have nothing to do with skin care or the absence of it. When these variables come together, acne outbreaks are formed. Acne can only arise if all three variables are present.

Sebaceous glands that are overactive can cause acne.

The oil needed to lubricate the skin’s surface is produced by sebaceous glands. The oil glands of those who are prone to acne create more sebum than is required. The sebaceous duct becomes clogged with extra oil, causing a follicular obstruction.

According to the International Dermal Institute, acne sufferers’ sebum has a distinct chemical composition.

It has more squalene and wax esters than usual but less free fatty acids and linoleic acid.

Acne-inducing bacteria thrive in this type of environment.

Excessive skin cell shearing

In a process known as desquamation, the epidermis continuously sheds dead skin cells.

The stratum corneum sheds dead skin cells, which are replaced by new ones.

Acne-prone skin produces four to five times as many new skin cells as normal skin does.

Acne patients also have fewer lamellar granules in their skin.

The stratum corneum’s cells include lamellar granules. It is their job to release enzymes that break down the cell-binding material.

Acne-prone skin generates more dead skin cells than normal, and the dead skin cells are not being effectively shed.

Instead, the cells remain trapped within the follicle, forming a comedo. Bacteria Proliferation

Bacteria called Propionibacteria acnes (P. acnes) are often found on the skin of the majority of the population. In acne sufferers, P. acnes multiplies unchecked.

When dead cells and oil fill the hole, an anaerobic condition is created in which oxygen cannot enter the pore. In such conditions, P. acnes thrives and multiplies.

The P. acnes bacteria make fatty acid waste when they break down the oil. The pore lining is irritated and inflamed as a result of this waste.

It is critical to understand that cleaning alone will not remove P. acnes from the skin.

A lack of hygiene is not indicated by its existence in any way.

Type of Acne

Dermatologists classify types of acne into four grades. Determining acne grade is done by a simple visual inspection of the skin. Specific criteria are used to classify acne symptoms, including:

Types of non-inflamed comedones present
Types of inflamed comedones present
Amount of breakout activity
Amount of inflammation, if any
Areas of the body affected by acne

Knowing the grade of your acne is an important step in treating acne. All acne grades require different treatment methods.

Understanding the grade of your acne can help you choose the course of treatment that will be most effective. It will help you in selecting products. It will help you decide if you can treat your acne at home or if you should see your dermatologist.

Grade I

Grade I acne is the mildest form of acne. There may be minor pimples, but they will be small, appear only very occasionally, and be in small numbers (one or two). Blackheads and milia will be found, sometimes in great numbers, but there is no inflammation in Grade I acne.

Grade I acne is commonly seen in early adolescence, especially on the nose and/or forehead. Many adults also experience grade I acne as blackheads on the nose and forehead. Milia are commonly found in the eye area and on the chin.

This type of acne can be successfully treated at home using an over-the-counter product containing salicylic acid. Results generally are seen quickly. Treating acne while it is still in its early stages helps prevent acne from progressing, especially in teens. Grade I acne
may progress to Grade II if left untreated.

Grade II

Grade II is considered moderate acne. There will be blackheads and milia, generally in greater numbers. You will start seeing more papules and the formation of pustules in this stage. They will appear with greater frequency, and general breakout activity will be more obvious. Slight inflammation of the skin is now apparent.

In teens, you may see the acne progress from the nose and forehead to other areas of the face. Acne may start to affect the chest and shoulders, with occasional breakouts on the back, especially in males. Adult women may find greater breakout activity in the cheeks, chin, and jaw line area, especially just before and during the menstrual cycle.

Grade II acne can still be treated at home, using over-the-counter products. In addition to a salicylic acid, a benzoyl peroxide lotion should be used daily to help kill the bacteria that cause inflamed breakouts. However, if after several weeks of home treatment your acne does not significantly improve, it is time to see a dermatologist. Grade II acne may progress to Grade III, especially if pimples are habitually picked at or squeezed.

Grade III

This type of acne is considered severe. The main difference between Grade II acne and Grade III is the amount of inflammation present. The skin is now obviously reddened and inflamed. Papules and pustules have developed in greater numbers, and nodules will be present.

Grade III usually involves other body areas, such as the neck, chest, shoulders, and/or upper back, as well as the face. The chance of scarring becomes higher as the infection spreads and becomes deeper.

A dermatologist should treat acne at this stage. Grade III acne is usually treated with both topical and systemic therapies available only by prescription. Left untreated, Grade III acne may progress to Grade IV.

Grade IV

The most serious form of acne, Grade IV is often referred to as nodulocystic or cystic acne. The skin will display numerous papules, pustules, and nodules, in addition to cysts. There is a pronounced amount of inflammation and breakouts are severe. Cystic acne is very painful.

Acne of this severity usually extends beyond the face, and may affect the entire back, chest, shoulders, and upper arms. The infection is deep and widespread. Nearly all cystic acne sufferers develop scarring.

Grade IV acne must be treated by a dermatologist. It tends to be hard to control, and almost always requires powerful systemic medications in addition to topical treatments.

Over The Counter Acne Treatments

Choosing Effective OTC Aqne Treatments.Mild acne, or Grade I acne, can be treated at home with over-the-counter acne treatment products. If possible, it’s best to begin treatment during this stage. You’ll get better results.

Mild acne means you’ll see blackheads, whiteheads or milia. You may also have some papules and pustules, but they won’t be too serious. Mild acne can be greatly improved when you start using the right OTC treatments.

Benzoyl Peroxide

One of the most common acne treatments available, benzoyl peroxide is found in cleansers, lotions, and creams. It works by killing Propionibacteria acnes, the bacteria responsible for acne breakouts. Benzoyl peroxide also helps unclog pores and reduces inflammation of the skin. Benzoyl peroxide is sold over the counter in strengths from 2.5% to 10%.

Some common over-the-counter benzoyl peroxide products include:

Proactiv
Benzaderm Gel
Glytone 10% Benzoyl Peroxide Acne Treatment Gel
MD Formulations Benzoyl Peroxide 10
various generic or store brand benzoyl peroxide creams

Sulfur and Resorcinol

Sulfur and resorcinol are usually found together in acne products. Resorcinol helps prevent comedones by removing buildup of dead skin cells. Sulfur has been used for more than half a century to treat acne, although exactly how it works is still unclear. Together, these ingredients also reduce excess oil. Resorcinol and sulfur are typically used in strengths of 2% and 5%-8%, respectively.

Some common acne treatment products containing resorcinol and sulfur are:

Clearasil Medicated Blemish Cream
Clearasil Medicated Blemish Stick
Rezamid Lotion
Glytone Flesh Tinted Acne Treatment Lotion

Salicylic Acid

Salicylic acid works by correcting the abnormal shedding of skin cells, helping the skin to shed dead cells more effectively. In this way, salicylic acid helps reduce the number of pore blockages, preventing breakouts. Salicylic acid works especially well for those with blackheads and whiteheads. It is found in over-the-counter cleansers, lotions, and treatment pads. The usual strength is .5 to 2%.

Products containing salicylic acid include:

Oxy products
Noxzema Anti-Acne Gel
Noxzema Anti-Acne Pads
Stridex
Dermalogica Medicated Clearing Gel

Alcohol and Acetone

Alcohol and acetone are also used in combination in many products for oily skin types. Alcohol is an antimicrobial and may work to reduce acne-causing bacteria. Acetone removes excess oil from the skin. Together they help cleanse excess oil from the skin, reducing the amount of pore blockages. Alcohol and acetone are found mainly in toners, astringents, and cleansers.

Some products containing the combination of alcohol and acetone are:

Tyrosum Liquid Acne Skin Cleanser
Glytone Acne Treatment Toner

Using Your Over-The-Counter Treatments

While it’s tempting to begin assaulting your breakouts with many treatment products at once, doing so could cause irritation of the skin. Most acne treatments dry the skin to some extent, so overuse of these products could cause excessive dryness, peeling, and redness. You may wish to start with a single acne treatment product and slowly add more if needed. This is especially true if your skin tends to be sensitive or easily irritated.

To achieve the best results possible, you must first understand your skin. Non-inflamed acne,
blackheads and milia (whiteheads), often responds well to salicylic acid products. Start with a wash or cleansing pad. If after several weeks of treatment you aren’t seeing noticeable improvement you may add a salicylic acid lotion, provided you aren’t experiencing excessive dryness or irritation.

For those who tend to get inflamed pimples, benzoyl peroxide is a good treatment to start with. Benzoyl peroxide creams and lotions can be found at nearly every drug store. Apply the
lotion as directed for several weeks, and then add a benzoyl peroxide or salicylic acid wash if needed. Again, additional products should be added only if you are not experiencing excessive dryness or irritation.

There are also complete acne regimens, or kits,” available over-the-counter that contain cleanser, toner, and lotion. The products in these kits usually contain a combination of acne-fighting ingredients and can help take the guesswork out of building a daily skin care routine. These regimen programs don’t necessarily work better than products you purchase separately, but some people prefer them because of their ease of use.

Some complete acne regimens include:

Proactiv
Acne Free
L’Oreal’s Acne Response

Part of the battle in treating acne is finding products that work for you. You may need to experiment with several treatment products before finding one that improves your acne, so try not to get discouraged.

If, after several weeks of treating your acne with over-the-counter products you aren’t seeing improvement, don’t hesitate to contact your doctor. He or she is a great asset in the fight against acne.

Acne Treatment Options

Prescriptions, And Procedural Aqne Treatment Options.Although there is no cure, there are plenty of acne treatment options available today that effectively control breakout activity.

Acne treatments are divided into three categories:

Topical,
Systemic,
Procedural.

The course of treatment is determined by the type and severity of acne.

Knowing your grade of acne

will help you choose the most effective treatment plan. Grade I and Grade II (mild to moderate acne) can often be treated with over-the-counter products. A dermatologist must treat Grade III and Grade IV (moderately severe to severe, or cystic acne).

It’s common to try several treatments before finding the one that works for you. Try not to get discouraged. And remember, with any acne treatment or therapy, consistency is key to a successful outcome.

Seeing a Dermatologist

A dermatologist is a medical doctor who specializes in the science of the skin, its treatment, and diseases. Your dermatologist is a great asset in the fight against acne. He can offer many acne treatment options, as well as advice and support.

Your dermatologist will work with you to develop an acne treatment plan that may include topical and systemic medications. If you suffer from severe acne, nodulocystic acne, or cystic acne, you must see a dermatologist. Acne of this severity does not respond to over-the-counter acne treatment. Also, see your doctor if your mild acne isn’t responding to treatment or if you just need guidance in treating your acne.

Seeing an Esthetician

An esthetician, or skin care therapist, specializes in the treatment and beautification of the skin. Estheticians are not medical doctors; rather, they perform cosmetic treatments of the skin, such as facials and waxing. Estheticians are required to complete 300 to 600 hours of education, depending on the state.

If you have mild acne, you may want to see an esthetician. They can recommend skin care products for acne-prone skin and offer advice on daily skin care. Estheticians can also perform deep cleansing treatments to help ward off comedones. Estheticians work at day spas or skin spas. Many dermatological offices and massage therapists also employ estheticians to offer supportive therapy under the supervision of the doctor.

Topical Acne Treatment Options

Topical treatments are products such as creams, ointments, or lotions that are applied to the skin. They are used in the treatment of mild to severe acne, depending on the strength. Topical treatments are available both over the counter or by a prescription. Mild to moderate acne generally responds to over-the-counter treatments while more severe acne will need a prescription medication.

Systemic Acne Treatment Options

Systemic treatments work internally. They may be taken orally, as in pill form, or be injected into the skin. Severe acne and cystic acne must be treated systemically.

Systemic treatments may also be used in cases of moderate acne when topical treatments are not enough. Systemic acne treatments are available by prescription only, and are often used in conjunction with topical treatments.

Systemic acne treatment medications include:

Oral antibiotics – erythromycin, tetracycline, minocycline, doxycycline
Hormonal treatments – birth control pills, spironolactone
Isotretinoin – sold under the brand names Amnesteem, Claravis, Sotret (and formerly sold as Accutane)

Procedural Acne Treatment Options

Procedural treatments are therapies performed by a dermatologist, health care practitioner, or esthetician. They are used in the treatment of mild to severe acne, depending on the treatment. Procedural therapies are meant to be supportive and used in conjunction with topical and/or systemic treatments.

Comedo extractions – Often performed by estheticians during a facial, comedo extractions involve gently coaxing plugs of sebum and cellular debris from the pore. By removing blackheads, milia, and soft closed comedones the overall number of breakouts can be reduced. Estheticians are not permitted to extract cysts or serious lesions. These may only be extracted by a dermatologist through surgical methods.
Light chemical peels – Despite the name, light chemical peels do not “peel” the skin. Instead, they deeply exfoliate the skin using an alpha-hydroxy, beta-hydroxy, or glycolic acid. Light chemical peels improve acne by removing dead skin cells and helping to clear pores of debris. Estheticians may incorporate chemical peels into a facial for those with mild to moderate acne. Those with more serious acne should have their dermatologist perform the chemical peel.
Microdermabrasion – This treatment may be performed at a skin spa or your dermatologist’s office. A machine is used to rapidly discharge super-fine crystals over the skin’s surface, blasting away dead skin cells. It is not painful. A microdermabrasion treatment deeply exfoliates the skin, loosening debris from within the pore. It is best for those who have non-inflamed acne, with many blackheads and/or whiteheads.
Phototherapy – Phototherapy is the term used to describe any treatment utilizing laser or light. They work by killing P. acnes, reducing inflammation, or shrinking the sebaceous glands, depending on what therapy is used. There are many different light and laser treatments available including blue light, red light, and photodynamic therapy.
Phototherapy can be used to treat all stages of acne, from mild to very severe. Your dermatologist can help you decide which treatment, if any, would be most effective for you.
Corticosteroid injections – Cysts are serious lesions that damage skin tissue. Dermatologists can inject a cyst with corticosteroid, reducing inflammation and the chance of scarring. Corticosteroid injections speed healing of the lesion to just a few short days.

How to Diagnosis Acne

How Acne is Diagnosed, Grades of Severity, and Common Acne Look-Alikes. Most people can easily self-diagnose mild acne, which can be treated at home using over-the-counter products. However, if you are unsure if what you are experiencing is acne, or if your acne seems severe, see your dermatologist. Acne is diagnosed by a simple visual inspection by your doctor. There is no test for acne.

Grades of Acne

When diagnosing acne, dermatologists classify it into four grades. They evaluate the types of comedones present, amount of inflammation present, breakout severity, how widespread the acne is and what areas of the body are affected. Grades of acne are classified as follows:

Grade I – The mildest form of acne. The skin will display blackheads, whiteheads or milia,
and occasionally minor pimples. There is no inflammation. Grade I acne can usually be cleared with over-the-counter treatments.
Grade II – Considered moderate acne. A greater number of blackheads and whiteheads are on the skin. Papules and pustules are more frequently found. Grade II acne may also be treated with over-the-counter products. However, if there is no improvement after six to eight weeks, consult your doctor.
Grade III – Moderate to severe acne. The difference between Grade II and Grade III acne is the amount of inflammation present. Papules and pustules will be more numerous and there will be a greater amount of redness and inflammation found on the skin. Nodules are often present. This type of acne should be evaluated by your dermatologist.
Grade IV – The most severe grade of acne, the skin will display many pustules, nodules, and cysts.
Blackheads and whiteheads are numerous. There is pronounced inflammation, and breakouts likely extend to areas other than the face. Grade IV acne, also called cystic acne, must be treated by a dermatologist.

Acne Look-Alikes

Some skin conditions can look remarkably similar to acne, although their causes and treatments are different. Do you have acne or an acne look-alike condition? If you are unsure, it is always wise to consult with a doctor. Common skin conditions that can be mistaken for acne include:

Rosacea – Causes red, flushed skin with papules and pustules, especially in the nose and cheek area.
Folliculitis – Bumps or pustules caused by inflammation of the hair follicle.
Keratosis pilaris – Small, rough, “goose-flesh” like bumps most often found on the upper arms, thighs and buttocks, and sometimes the face.
Miliaria rubra – Small red bumps on the surface of the skin caused by excessive heat exposure. Also known as heat rash.

Symptoms of Acne

What are some common acne symptoms? Surprisingly, signs of acne can go way beyond that typical pimple. Acne vulgaris, or common acne, is a disorder of the pilosebaceous unit, causing some form of lesions on the skin. Acne is characterized by the presence of one or more of the following:

papules
pustules
blackheads
whiteheads or milia
nodules
cysts

Non-Inflamed Acne

Acne can be divided into two categories: inflamed and non-inflamed. Non-inflamed acne breakouts consist of microcomedones, blackheads, and milia. These types of comedones are not red or painful. Symptoms of non-inflamed acne include bumps or bumpiness across the skin’s surface or an uneven skin texture. Even if comedones are not readily visible, they will make the skin feel rough, or “sandpapery.”

People with non-inflamed acne experience blackheads, milia, and closed comedones but rarely have reddened breakouts, such as papules or pustules. Left untreated, non-inflamed acne may progress to inflamed acne.

Types of Non-Inflamed Acne Blemishes
Acne Cosmetica
Smoker’s Acne

Inflamed Acne

Inflamed acne is characterized by redness and inflammation. Those with inflamed acne will have microcomedones, blackheads, and milia, as well as papules, pustules, and possibly nodules and cysts. Symptoms also include redness, swelling, and irritation of the skin, along with possible crusting, oozing, or scabbing of the lesions.

Inflamed acne ranges in acuity from very mild to extremely severe. Some inflamed acne sufferers will experience only the occasional pustule while others will battle angry-looking cysts. Cystic acne is the most serious form of inflamed acne. Inflamed acne sufferers are most at risk for skin damage and scarring.

Types of Inflamed Acne Blemishes
Cystic Acne

Range of Acne

The areas of the body most typically affected by acne are:

Face
Neck
Chest
Shoulders
Upper arms
Back

Less commonly, acne appears on the torso, arms, and legs.

Stages of Acne
Back and Body Acne

Pigmentation and Scarring

Most acne sufferers have to deal with at least some degree of pigmentation problems or scarring. Discolored, darkened, or reddened spots or blotches are common on acne prone skin. These problems can persist even after breakouts have fully healed.

Post-inflammatory hyperpigmentation (PIH) is the medical term used to describe discolored spots (macules) left behind after an acne lesion has healed. Those who have any type of inflamed breakout are at risk for post-inflammatory hyperpigmentation. Luckily, PIH is not a true scar and will fade over time.

More serious scars include: