Acne is a chronic inflammatory skin condition that affects hair follicles and oil glands.

Although most common during adolescence, acne can also develop in adults. It typically affects the face, back, chest, and shoulders, causing blackheads, whiteheads, inflamed pimples, and sometimes deep, painful lumps.

Acne is more than a cosmetic concern. Without appropriate treatment or control, it can lead to permanent scars, dark marks, and reduced quality of life.

Effective treatments are available for different types of acne. Appropriate treatment can reduce new breakouts and lower the risk of permanent scarring.

What Causes Acne?

Four main mechanisms contribute to acne:

• Increased oil production: Hormonal influences can increase oil gland activity.
• Clogged pores: A buildup of skin cells and oil within hair follicles leads to comedones—blackheads and whiteheads.
• Cutibacterium acnes: This bacterium naturally lives on the skin and is involved in the inflammatory processes associated with acne.
• Inflammation: Immune responses contribute to the development of red, painful pimples.

Genetic predisposition, hormonal changes, certain medications, and unsuitable cosmetic products may also contribute.

Acne is not simply caused by dirty skin. Washing frequently or scrubbing vigorously will not clear acne and may irritate the skin.

What Are the Different Types of Acne?

Acne can take several forms.

Comedonal Acne

Blackheads and whiteheads are the main features. They commonly appear on the forehead, nose, and chin.

Papular and Pustular Acne

This form causes red, raised pimples, some of which contain pus. It may be mild or moderate in severity.

Nodular Acne

Large, firm, painful inflammatory lesions can develop deeper within the skin. These carry a higher risk of permanent scarring.

Treatment decisions consider more than the number of pimples. The type, depth, and location of lesions, along with the risk of scarring, are also assessed.

How Is Acne Diagnosed?

Acne is usually diagnosed through a dermatologic examination.

The examination assesses blackheads and whiteheads, the number of inflammatory lesions, nodules, and existing scars.

Hormone testing is not necessary for every patient with acne.

However, hormonal causes may be investigated in women with irregular periods, excessive hair growth, hair loss, or sudden-onset acne that is difficult to treat.

Current Acne Treatment Options

Treatment is planned based on acne severity, skin type, age, pregnancy status, and previous treatments.

1. Topical Medications

Topical treatments are often the first choice for mild to moderate acne.

Topical retinoids: Medications such as adapalene and tretinoin help reduce clogged pores and prevent new comedones.

Benzoyl peroxide: This treatment is effective against acne-associated bacteria and inflammatory lesions.

Azelaic acid: It may help treat acne lesions and reduce the dark marks that remain after breakouts.

Topical antibiotics: These may be used alongside other treatments in suitable patients. Because of antibiotic resistance, they should not be used alone or without medical supervision.

2. Oral Antibiotics

Oral antibiotics may be prescribed for suitable patients with moderate to severe inflammatory acne.

They are used for the shortest effective duration, usually alongside topical treatments such as benzoyl peroxide.

Dermatologic follow-up is important because prolonged or unnecessary antibiotic use can contribute to resistance.

3. Isotretinoin

Isotretinoin is an effective systemic treatment, particularly for severe or nodular acne, acne with a high risk of scarring, or acne that has not responded adequately to standard treatments.

Side effects such as dryness are common. Laboratory monitoring and regular follow-up are required based on the patient’s circumstances.

Isotretinoin must never be used during pregnancy. Patients who could become pregnant must follow the necessary pregnancy prevention and monitoring measures.

4. Hormonal Treatments

Hormonal treatments may be considered for some women, particularly when hormonal influences contribute to acne.

Options include combined hormonal contraceptives and, in selected patients, spironolactone.

These medications are not suitable for everyone. Treatment decisions take medical history, other health conditions, and the possibility of pregnancy into account.

5. Newer Topical Treatments

Medications with more selective mechanisms of action have been developed in recent years.

These include newer topical retinoids such as trifarotene and topical antiandrogens such as clascoterone.

Their use depends on the patient’s clinical findings, the appropriate indication, and local regulatory approval and availability.

Can Laser and Light Treatments Help Acne?

Certain laser and light technologies may be considered as complementary treatments for selected patients.

However, they are not the first choice for every type of acne and cannot always replace medication.

Treating active acne is different from treating acne scars.

Fractional laser treatments, microneedling, and certain other procedures are more commonly considered for scars that develop after acne.

Their suitability depends on the presence of active inflammatory lesions and the patient’s skin characteristics.

How Long Does Acne Treatment Take?

Acne treatment requires patience and consistent use.

With many treatments, initial improvement may become noticeable within 6–8 weeks. Effectiveness is usually reassessed at around 12 weeks.

After breakouts improve, maintenance treatment may be recommended for suitable patients to help prevent new lesions.

Can Acne Scars Be Prevented?

The risk of scarring is higher with deep, inflamed, persistent lesions.

Squeezing or picking pimples and injuring the skin can increase that risk.

Early, effective acne treatment is one of the most important ways to reduce the risk of new permanent scars.

Red or brown marks left after acne are different from permanent, indented scars. They also require different treatment approaches.

Daily Skincare Tips for Acne-Prone Skin

• Wash your face morning and evening with a gentle cleanser.
• Avoid abrasive scrubs, harsh exfoliation, and excessive rubbing.
• Choose a moisturizer suited to your skin type that will not clog pores, labeled noncomedogenic.
• Use a broad-spectrum sunscreen during the day.
• Do not squeeze or pick pimples.
• Avoid using multiple products with active ingredients at the same time.
• Do not stop treatment on your own simply because results are not visible early on.
• Consult your dermatologist if your medications cause excessive dryness or irritation.

Does Diet Affect Acne?

Research has identified some associations between diet and acne.

Evidence suggests that a high-glycemic-load diet may worsen acne in some people.

Some studies have also reported an association between milk consumption and acne. This does not mean that everyone with acne needs to eliminate all dairy products.

No single diet has been proven to cure acne.

A balanced diet, adequate sleep, and reviewing habits that appear to worsen your own breakouts may be helpful.

When Should You See a Dermatologist?

Dermatologic evaluation is particularly important if:

• You develop deep, painful, or nodular acne.
• Permanent scars are beginning to form.
• Acne persists despite the products you have tried.
• Acne affects your self-confidence or quality of life.
• Severe acne develops suddenly in adulthood.
• Acne occurs alongside irregular periods or excessive hair growth.

Dermatologic Evaluation and Treatment

Acne treatment aims to reduce existing breakouts, prevent new lesions, lower the risk of permanent scarring, and protect long-term skin health.

At Dr. Armin Müştak’s private dermatology practice, patients with acne receive a dermatologic examination. A treatment and follow-up plan is developed based on the type and severity of acne, skin characteristics, and previous treatments.

Early treatment, appropriate medication selection, and regular follow-up are important for reducing the risk of permanent acne scars.