Acne

Acne is one of the most common skin conditions in the world. It affects most teenagers at some point, and a growing number of adults, especially women. Acne happens when pores become blocked with oil and dead skin cells, which leads to spots, blackheads and whiteheads. It is an inflammatory condition, so it can range from the odd breakout to widespread, painful spots that risk scarring. Acne is treatable, though the right approach depends on the type and how severe it is. In this guide we explain what acne is, what causes it, the different types and what triggers it. We also cover the most effective acne treatments from everyday skincare through to prescription and professional procedures.

City Skin Clinic is an online skincare clinic. We provide custom medical skincare and do not offer in-clinic procedures such as chemical peels, laser treatment or energy-based devices. However, we have explained all the options below because we believe the public deserve clear, evidence-led information without commercial bias.

What is Acne?

This is a common inflammatory skin condition that centres on the pores. In your skin each pore contains a hair follicle and an oil gland (sebaceous gland). When a pore becomes blocked with excess oil and dead skin cells, it forms a spot. This can show up as a blackhead, a whitehead, a red bump or a deeper, painful lump.

Acne can appear anywhere the skin has lots of oil glands. It is most common on the face and neck, but it can also appear on the back (often called bacne), chest, shoulders and limbs. Whilst acne itself is not dangerous, it can be painful and persistent. It can also leave acne scars and post-inflammatory hyperpigmentation once spots heal, which is why treating it early matters.

What Causes Acne?

This is a complex condition that develops through a combination of things happening in the pore. First, the skin cells lining the pore make too much keratin and do not shed properly. At the same time, the oil glands produce too much oil (sebum), usually driven by hormones. These two changes together block the pore. The trapped oil then lets a normally harmless skin bacterium, Cutibacterium acnes (formerly known as P. acnes), overgrow. This triggers inflammation, which produces the redness, swelling and pus of a spot. If the inflammation is deep or the pore wall bursts, it can damage the surrounding skin and lead to scarring.

What are the Different Types of Acne?

In general, acne is graded as mild, moderate or severe, based on how many spots you have and what type they are. Most people have a mix of different types at the same time. The main types of acne lesions are:

• Comedonal: These are blackheads (open blocked pores) and whiteheads (closed blocked pores). This is the mildest form and is not inflamed.
• Papules: These are small, red, tender bumps where the pore has become inflamed.
• Pustules: This is the classic pimple, a red bump with a white or yellow head of pus.
• Cysts & Nodules: These are the most severe types and most likely to scar. Cysts are deep, painful, pus-filled lumps. Nodules are large, hard, painful lumps deep under the skin.

What Triggers Acne?

Acne is driven mainly by genetics and hormones. Genetics determine shedding of skin that lines the pores. Androgens (sometimes called male hormones, though everyone has them) make the oil glands larger and more active. This is why acne is so common during puberty, when androgen levels rise. It also explains why many women get acne around their period, during menopause or with polycystic ovary syndrome (PCOS). In adult women, hormonal acne often appears as deep spots along the jawline and chin. Some medicines, including steroids, testosterone and lithium, can trigger acne too. Diet and stress do not cause acne. However, high-sugar diets and stress can make it worse. There is also no good evidence that wearing make-up causes acne, though removing it properly each day helps keep pores clear.

How is Acne Treated?

The right acne treatment depends on the type and severity. Mild acne often responds to a good skincare routine, whilst moderate to severe acne usually needs prescription treatment. The main treatment options are:

• Active skincare: Benzoyl peroxide, salicylic acid, azelaic acid and retinol help unblock pores, calm inflammation and improve texture. These are suitable for mild acne and can also help support the actions of any prescription or professional treatments.
• Prescription topicals: Stronger options include retinoids like adapalene and tretinoin and high strength azelaic acid which can help clear pores. Antibiotics like clindamycin can reduce inflammation whilst spironolactone and Winlevi can reduce the effects of androgens on the skin. These can help treat moderate acne and help fade post-acne marks.
• Oral medication: Moderate to severe acne may need tablets. These include oral antibiotics, spironolactone for hormonal acne in women and isotretinoin (Roaccutane) for severe or stubborn acne.
• Aftercare for marks: Acne often leaves marks behind, and in deeper skin tones these can last far longer than the spots themselves. Treating acne early helps limit them. Fading scars and post-inflammatory hyperpigmentation needs daily sunscreen plus actives like azelaic acid, niacinamide or hydroquinone.

Skin clinics may also use professional treatments like chemical peels, microneedling and laser, mainly for scarring and texture. These need care in deeper skin tones, where they can trigger post-inflammatory hyperpigmentation. They also tend to complement rather than replace skincare and prescription acne treatments.

Whatever the approach, acne takes time to treat and requires long-term maintenance. Most treatments take at least 2-3 months to start to work. Retinoids and other actives can also sometimes cause an initial flare or purging. So it is worth sticking with treatment for at least 2-3 months before judging whether it is working.

Can You Prevent Acne?

You cannot generally prevent acne, especially when it is hormonal or runs in the family. However, you can reduce how often you break out and limit the marks acne leaves. A simple, gentle routine helps. Cleanse twice a day, avoid harsh scrubbing and choose non-comedogenic products that will not block pores. Treating spots early, and resisting the urge to pick or squeeze, reduces the risk of scarring. A daily sunscreen protects healing skin and stops marks darkening. Where acne is hormonal or linked to a medicine, it is worth reviewing this with your doctor to tackle any underlying triggers.

At City Skin Clinic, our doctors create personalised skincare to clear acne and the marks it leaves. Where appropriate, we use actives like tretinoin, azelaic acid, spironolactone, hydroquinone and clindamycin. Every plan starts with an online consultation and is built around your skin and goals. Start your online consultation today. The journey towards great skin starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.