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When someone mentions acne, most people think about teenagers. However, people of any age can be affected by acne.

Acne itself does not pose a threat to someone’s health. It can be painful if severe and leave scars.

Some people with severe acne may experience emotional distress, self-esteem, and self-confidence issues.

What is Acne?

Acne is a skin condition that happens when hair follicles become clogged. The skin produces sebum which is an oil to keep the skin from drying out. When a hair follicle becomes clogged with dead skin cells and sebum, bacteria can grow. This causes inflammation.

Acne is usually found on the face, forehead, upper back, shoulders, or chest of the affected person.

Acne is a common condition. It affects people of all ages and races. For most people, it goes away by their 30s.

Sudden acne breakouts in older people may mean there is an underlying disease that needs to be taken care of.

Types of Acne

There are several ways acne appears on the skin. This includes:

  • Whiteheads –  bumps that are closed by oil and dead skin cells.
  • Blackheads – open bumps that are filled with oil and dead skin cells. They are dark in color, it looks like there is dirt on the bump.
  • Papules – small bumps that are inflamed, they can be red or pink.
  • Pustules – pimples that contain pus. They have a white top surrounded by red skin. If picked at they can leave scarring.
  • Nodules – solid pimples that are deep in the skin. They can be large and painful.
  • Cysts – large pus-filled pimples that can cause scars.

Acne can be mild, moderate, or severe. Dermatologists rank acne by how severe it appears on the skin.

Grade 1 (mild)Mostly whiteheads and blackheads, maybe a few papules and pustules.
Grade 2 (moderate)Multiple papules and pustules, mostly on the face.
Grade 3 (moderately severe)Many papules and pustules, may be some inflamed nodules. Can also affect the back and chest.
Grade 4 (severe nodulocystic acne)Many large, painful, inflamed pustules and nodules.


There is a variety of bacteria that lives on human skin. Some bacteria are beneficial, some are not. The name of the bacteria that contributes to pimples is Propionibacterium acnes. Some research shows that the severity level of acne may depend on the strain of bacteria present.

Other factors contribute to acne development. Hormones are one thing that affects acne.

When adolescence begins the levels of the hormone androgen rises. Higher androgen levels cause the oil glands under the skin to grow. This produces more sebum.

Having a large amount of sebum breaks down the cellular walls of the pore. This causes bacteria to grow.

Hormonal acne during puberty usually slows down when the person becomes an adult. Often the breakouts end completely.

Other Risk Factors for Acne

It is still unknown why some people develop acne and others do not. There are some risk factors that experts think may contribute to acne, or make the condition worse.

This includes:

  • Beauty products with high oil content, like cleansers, moisturizers, or creams
  • Stress
  • Cigarette smoking
  • Poor sleep
  • Some medications, including hormonal birth control or steroids
  • Polycystic ovarian syndrome (PCOS) or other endocrine conditions
  • Family history of acne
  • Hormonal changes from pregnancy


Pimples can cause a rough uneven texture on the skin. Other symptoms of acne include:

  • Skin discoloration – redness or dark patches and spots
  • Pain and tenderness when touched, sometimes pain without being touched
  • Swelling and inflammation


There are over-the-counter treatment options that someone can try to clear up acne. If after a few weeks there is no improvement a doctor or dermatologist can prescribe a stronger medication.

Prescription medications can be topical or oral. It may take four to eight weeks to see improvement. It can take much longer for acne to clear up completely.


There are several kinds of topical medications available for acne.

Retinoids are topical drugs that contain retinoic acids. They can be gels, lotions, or creams. It works by preventing the plugging of hair follicles. Some examples are:

Topical antibiotics work by killing the bacteria on the skin. This includes:

Azelaic acid naturally occurs in yeast. This has antibiotic properties. Prescription-strength azelaic acid is Azelex or Finacea.

Oral medications include for moderate to severe acne include:

  1. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne. August 2020. Available at
  2. Cleveland Clinic. Acne. September 1, 2020. Available at
  3. Medical News Today. What You Need To Know About Acne. November 27, 2017. Available at
  4. Healthline. What are the Risk Factors for Developing Acne? February 23, 2022. Available at
  5. Avita. July 22, 2022. Available at
  6. Retin-A. July 12, 2022. Available at
  7. Tazorac. September 24, 2020. Available at
  8. Duac. September 1, 2021. Available at
  9. Benzamycin. July 12, 2022. Available at
  10. Azelex. June 11, 2021. Available at
  11. Finacea. July 8, 2021. Available at
  12. Erythromycin. April 1, 2021. Available at
  13. Ortho Tri-Cyclen. June 14, 2021. Available at
  14. Aldactone. April 4, 2022. Available at
  15. Claravis. October 12, 2021. Available at

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