Acne: Types, Symptoms, Treatment

What is acne?

Acne is a prevalent skin condition that occurs when hair follicles under the skin become clogged. Pores are clogged by sebum, the oil that prevents skin from drying out, and dead skin cells, resulting in outbreaks of lesions commonly called pimples or zits.

The outbreaks usually appear on the face but can also happen on the back, chest, and shoulders. Acne most commonly emerges on the:

• Face: Affecting almost everyone who has acne.
• Back: Affecting more than half of people who have acne.
• Chest: Affecting about 15% of people who have acne.

What are the types of acne?

Did you know that acne results in a few types of lesions or pimples? Doctors use the term comedones to describe enlarged hair follicles.

• Whiteheads: A white bump is produced due to plugged hair follicles that remain underneath the skin.
• Blackheads: These plugged follicles open up when they reach the surface of the skin. They appear black on the skin surface not because they are dirty, but due to the air discolouring the sebum.
• Papules: Inflamed lesions that typically show up as small, pink bumps on the skin and can be soft to the touch.
• Pustules or pimples: Papules covered by white or yellow pus-filled lesions may appear red at the base.
• Nodules: Large, painful solid lesions deeply embedded within the skin.
• Severe nodular acne (sometimes called cystic acne): Pus-filled lesions that are deep and painful.

What causes acne? 

Many people think acne is caused by dirt, certain foods, and a host of other reasons. However, these are not the actual causes of acne.

Doctors and researchers suggest the development of acne may be influenced by one or more of the following factors:

• Surplus or high oil production in the pore.
• Dead skin cells have built up in the pore.
• Bacteria growth within the pore.

How is acne diagnosed?

Acne is typically diagnosed through a clinical examination by a healthcare professional, such as a dermatologist. The doctor will ask about your medical history, including any previous skin issues, family history of acne, and factors that might be contributing to the condition, such as stress, diet, medications, and hormonal changes.

The doctor will then perform a visual examination of the skin to assess the types and severity of acne lesions. The severity of your acne will guide where you should seek treatment and the specific type of treatment that may be recommended.

The seriousness of acne is usually categorised as follows:

• Mild: Mainly whiteheads and blackheads, with a few papules and pustules.
• Moderate: More prevalent whiteheads and blackheads, with numerous papules and pustules.
• Severe: Many big, painful papules, pustules, nodules, or cysts; you may experience some scarring as well. 

What are the treatment options for acne?

Acne treatments aim to heal existing lesions, prevent the formation of new ones, and stop scarring. Some causes of acne, like abnormal cell clumping in follicles, high sebum levels, bacteria, and inflammation, can be addressed with medication.

Your doctor may recommend over-the-counter or oral prescription medication or topical applications to apply on the skin.

Topical treatments

• Benzoyl peroxide to reduce bacteria and helps prevent clogged pores. Available over-the-counter or in prescription strength.
• Topical retinoids such as tretinoin, adapalene, and tazarotene to help unclog pores and reduce inflammation.
• Topical antibiotics such as clindamycin or erythromycin to reduce bacteria and inflammation.
• Salicylic acid to help exfoliate the skin and unclog pores.

Topical medicines appear in many forms such as gels, lotions, creams, soaps, and pads. However, they may cause side effects such as skin irritation, burning, or redness in some people. Consult your doctor regarding any side effects that you experience. 

Oral medications

• Antibiotics such as doxycycline, minocycline, and erythromycin to reduce bacteria and inflammation.
• Hormonal treatments such as oral contraceptives and anti-androgens to help women with hormonally-influenced acne.
• Isotretinoin may be prescribed if patient is not responding to other treatments. It reduces oil production, unclogs pores, and has anti-inflammatory properties.

Other therapeutic options

• Chemical peels (solutions) to exfoliate the skin and reduce acne lesions.
• Light and laser therapy to reduce bacteria and inflammation, which helps with acne scars.
• Manual extraction of whiteheads and blackheads by a dermatologist.
• Corticosteroid injections for severe nodular or cystic acne to reduce inflammation and pain.

What can I do to prevent and manage acne?

• Use a mild soap or cleanser and lukewarm water to wash the affected part of your skin. Overly hot or cold water can worsen your acne.
• Never try “cleaning out” blackheads or squeeze spots as it can worsen them and cause permanent scarring.
• Do not use oil-based (sometimes labelled “comedogenic”) make-up, skincare, and sun care products. Start using non-comedogenic products as they are less likely to clog the pores in your skin.
• Remove make-up completely before heading to bed.
• Use a fragrance-free water-based emollient if dry skin is an issue.
• Exercise can help to brighten your mood and improve your self-esteem. Once you are done exercising, take a bath as soon as possible because your acne can be irritated by sweat.
• Wash your hair often and try not to let your hair fall across your face.

Many individuals experience acne irregularly for several years before seeing improvements in their symptoms as they age.

When people with darker skin tones experience significant scarring, they can experience skin discoloration after the acne heals. Your doctor can recommend a treatment plan that can help fade existing dark spots. Also, it is important to use sunscreen outdoors to aid in treating and preventing dark spots.

Make an appointment at Pantai Hospitals

Consult your doctor if your acne worsens or if you notice new breakouts. A dedicated and expert team of dermatologists at Pantai Hospitals is available for consultation to provide the best care and assistance.

Pantai Hospitals has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.