What is acne?

Acne is a common skin condition that affects roughly 95% of people aged 11 to 30 at some point in their life. It occurs when your hair follicles become plugged with dead skin cells and oil. Acne causes spots and sometimes skin that is painful or hot to touch. Acne normally develops on the face which affects almost everyone with acne. It can also develop on your back and chest.

What are the different types of acne?

There are several different forms of acne, with the most common types listed here:

• Blackheads - small black or yellowish bumps, which are caused by hair follicles filling with excess oil and dead skin.
• Whiteheads - small white spots, which are similar to blackheads. These are usually firmer than blackheads
• Nodules - large hard lumps under the skin which can be skin-coloured or red, and are often tender and sore
• Cysts - large and sore bumps under the skin, usually filled with pus. These form when bacteria, dead skin, and oil gets trapped under the skin and become infected.
• Papules - small hard bumps on the skin that may feel sore. These happen when oil, bacteria, and dead skin cells get deeper into the skin and cause inflammation. 
• Pustules - similar to papules, but have a white tip and are filled with pus. 

What are the symptoms of acne?

Common signs and symptoms of acne include:

• black or yellowish bumps (blackheads or whiteheads)
• small red bumps (papules)
• red bumps with a white tip in the middle (pustules)
• large hard lumps (nodules)
• large pus-filled lumps (cysts)
• redness around the affected area
• scarring

What does acne look like?

Acne can look different depending on what type you have. For example, if you have black or brownish spots, you may have blackheads. If you have white or yellowish spots, you may have whiteheads.

Many people with acne find their spots stick out from their skin. Other people can see that their spots contain pus. This can make the skin look lumpy or uneven. Some types of acne may not be visible, but you can feel it under the skin.

What does acne feel like?

Acne can feel different depending on the type of acne you have but the affected skin can feel painful, hot, and tender to touch. Acne can leave marks or scars on the skin, especially if you have cysts and it can feel lumpy, raised or indented. It’s important to get treatment for your acne early on to try to prevent scarring before it starts.

Does acne only affect the face?

No. Acne can affect other areas of the body, such as the back. Back acne can happen because of oil and dead skin cells blocking pores. This can cause inflammation.

Butt acne refers to a condition known as folliculitis. This looks like acne anywhere else on the body but it is instead caused by a mild infection of blocked hair follicles, which lead to acne-like bumps on the buttocks.

How long does an acne flare up last?

How long your acne flare up lasts will depend on what form of acne you have. Some people with acne will have times when their acne is under control. However, it can flare up occasionally. During this time, you may have more spots. Some people will have acne that does not go away without prescription treatment.

Long-lasting effects of acne

As well as the physical symptoms, some people suffer with  psychological problems as a result of their acne . Studies that have shown that acne can have a negative psychological impact as it can affect self-esteem and mood. Severe acne has been linked with suicidal thoughts. If you have acne and feel depressed, suicidal, or anxious, you must speak to your doctor urgently about how you are feeling or reach out to a service like: NHS 111 or 999 to get help. 

How long do acne scars last?

If you have acne, scarring can sometimes develop. This is more common if you have the most serious types of spots, like cysts and nodules which burst. Acne scars do not go away on their own. If you are at risk of developing scars despite trying prescribed acne treatments your GP will likely refer you to a dermatologist to discuss starting a medication called Isotretinoin. 

Treatment for acne scarring is generally not available on the NHS however there are treatments available privately which include:

• micro needling
• laser treatment
• steroid injections
• subcision

What causes acne?

Acne is caused when sebum (an oily substance that lubricates your skin and hair) and dead skin cells plug hair follicles. Bacteria can cause inflammation and infection, which can result in more severe acne.

What causes acne flare ups?

Several things can cause acne flare ups. These include:

• genetics
• hormones
• diet
• certain medications
• stress
• hair and skin products
• makeup

What increases your risk of acne?

• Certain conditions and medications can increase your risk of acne, such as:
• taking certain medications including steroids 
• polycystic ovary syndrome
• using progesterone only contraception such as the mini pill

Some studies have confirmed that dairy products and a high sugar diet are risk factors for acne. Teenagers are the most likely age group to develop acne. This is thought to be triggered by higher levels of a hormone called testosterone that happens during puberty. Research suggests that stress can be a possible cause of acne too.

What can trigger an acne flare up?

Acne flare ups result in more spots which can become inflamed and painful. Certain triggers can cause acne flare ups. However, a trigger for one person’s acne may not be a trigger for someone else.

Common triggers of an acne flare up include:

• diet – saturated fats, refined sugars, and dairy products may cause inflammation and clogged pores
• makeup – oil based cosmetics like foundation can cause sensitive skin and trigger an acne flare up
• certain medications – hormonal birth control and steroids list acne as a side effect on their labels
• genetics – if a close family member or relative had acne, you are at a higher risk of getting it as well
• hormones – hormone changes linked to progesterone and oestrogen can make breakouts worse

How is acne diagnosed?

If you think you have acne, you will need to see a doctor. Only a medical professional can officially diagnose you with acne. The severity of your acne will determine what type of treatment you have and where you should go for treatment.

How severe your acne is will often be categorised as:

• mild – mostly blackheads and whiteheads, with a few pustules and papules
• moderate – more widespread blackheads and whiteheads, with many pustules and papules
• severe – lots of big, sore pustules, papules, cysts, or nodules; you may also have scarring

What tests would a doctor perform?

There is no test for acne. Instead, a doctor will diagnose acne by taking a look at your skin. This includes examining your face, back or chest for different kinds of spots. These include blackheads, whiteheads, or red, sore nodules or cysts.

How is acne tested for?

Acne is diagnosed by a straightforward visual inspection by your doctor. You can visit the Superdrug Online Doctor acne diagnosis service if you are not sure if you have acne and would like advice about acne treatments.

How do I know if I have acne?

If you notice spots with a black or white dot, these are signs of blackheads or whiteheads which could mean you have acne. If you have small red, sore bumps, these are other signs you may have acne.

How is acne treated?

How you are treated for acne will depend on how severe it is. For your symptoms to improve, it can take many months of treatment before you see results.

If you have a couple of whiteheads, blackheads, or spots, your doctor or pharmacist may recommend over-the-counter or prescription creams or gels (topical treatments) first line.

Can acne be cured?

Acne cannot be cured, but, it can be controlled with treatment. If you have acne, you should speak to a doctor or pharmacist for advice. There are also lotions, gels, and creams that you can use to treat spots that are available to purchase from a pharmacy.

How to get rid of acne permanently

There is no completely foolproof method to get rid of acne permanently. Although, you can reduce breakouts and keep your skin healthy by not washing your face more than twice a day and using acne treatment.

When should I talk to a doctor about my acne?

You should talk to your doctor if you have moderate or severe acne, or if you develop cysts or nodules. This is because they will need to be properly treated to avoid scarring. Avoid squeezing or picking your spots as this can cause permanent scarring.

How to treat acne on the face

At Superdrug Online Doctor, we offer a range of treatments that can treat acne on the face. Our doctors will review your answers to a short questionnaire and photos of your acne and recommend a treatment. It’s important to tell your doctor if you are pregnant, suffer from any health conditions or take any other medications before you start treatment for acne. Treatments include:

Lymecycline

Lymecycline is an antibacterial medication which can be used to treat acne. This medication works by killing bacteria responsible for acne. In most instances, you should take 1 capsule per day. You must drink lots of water when you take the capsule. This is to stop any irritation to your oesophagus (food pipe). Research indicates that lymecycline can reduce the severity of acne by over 42%. It’s always recommended to use lymecycline in combination with a topical acne treatment for the best effects. 

Oxytetracycline

Oxytetracycline is a broad-spectrum antibiotic. This means the medication can be used to kill a variety of bacteria, especially those responsible for acne. Your doctor will advise the correct dose for you. You should take these tablets 1 hour before you eat, or 2 hours after you have eaten. You must avoid drinking milk 2 hours prior to or after taking oxytetracycline. Studies show that this medication can reduce acne symptoms by roughly 70%.

Epiduo Gel

Epiduo gel is a topical gel that contains Benzoyl Peroxide and Adapalene. This combined works to unblock pores and kill bacteria which causes acne. Simply apply a thin layer of Epiduo gel to the affected area once each day. You should take care when applying the gel to make sure it does not go on a cut, scratch, or sunburnt area. Studies show that participants using Epiduo gel noticed a reduction in acne by over 75% in the total number of lesions in combination with topical treatments.

Zineryt

Zineryt is a skin lotion which contains the antibiotic erythromycin with zinc. Zinc is a healing agent. This means it can repair some damage caused by pimples and spots. You should apply Zineryt directly to the affected area twice each day and ensure you cover the whole area. Treatment should be used for up to 10 to 12 weeks. One study found that Zineryt was 64% effective at reducing acne by the end of treatment.

Aknemycin

Aknemycin contains tretinoin and erythromycin. Erythromycin is an antibiotic that can kill bacteria in the affected area. Tretinoin is a retinoid that accelerates the turnover of skin cells and gets rid of dirt and dead cells from the skin. You should use an applicator to apply the treatment and ensure you cover the whole affected area.

How to get rid of acne scars

Treatment for acne scarring is classed as a type of cosmetic surgery and is not normally available on the NHS. Exceptions have been made in the past if the acne scarring has been shown to cause serious psychological distress.

Typical treatments for getting rid of acne scars include steroid injections, micro needling, laser treatment, and subcision.

How to prevent acne

There are certain things you can do to try to prevent acne from flaring up, such as:

• not washing affected areas of skin more than twice each day (frequent washing can cause skin irritation and make symptoms worse)
• using a mild soap or cleanser to wash the affected area with lukewarm water (cold or very hot water can make your acne worse)
• not squeezing spots (this can make your acne worse and lead to permanent scarring)
• avoiding oil-based makeup products (they can block the pores in your skin which can lead to acne)

Sources

Acne (July 2019) NHS (Accessed 10 February 2022)

Acne – British Skin Foundation (2022) British Skin Foundation (Accessed 10 February 2022)

Acne | Patient (July 2021) Patient.Info (Accessed 10 February 2022)

A comparison of the efficacy and safety of lymecycline and minocycline in patients with moderately severe acne vulgaris (April-May 1998) National Library of Medicine (Accessed 10 February 2022)

A double-blind study of the effect of zinc and oxytetracycline in acne vulgaris (November 1997) National Library of Medicine (Accessed 10 February 2022)

A randomized, single-blind comparison of topical clindamycin + benzoyl peroxide (Duac) and erythromycin + zinc acetate (Zineryt) in the treatment of mild to moderate facial acne vulgaris (March 2017) National Library of Medicine (Accessed 10 February 2022)

A Review of Advancement on Influencing Factors of Acne: An Emphasis on Environment Characteristics (September 2020) Frontiers (Accessed 10 February 2022)

Multicenter study for efficacy and safety evaluation of a fixed dose combination gel with adapalene 0.1% and benzoyl peroxide 2.5% Epiduo for the treatment of acne vulgaris in Brazilian population (November-December 2015) PMC (Accessed 10 February 2022)

The Impact of Psychological Stress on Acne (July 2017) National Library of Medicine (Accessed 10 February 2022)