Acne

Acne affects millions of people in the United States every year. It is most common during adolescence because hormonal shifts stimulate oil production, but adults are frequently affected as well. Women often experience breakouts linked to menstrual cycles, pregnancy, or hormonal changes in midlife. Adult-onset acne, particularly along the jawline and lower face, is increasingly common.

Both men and women can develop acne, and it occurs across all skin tones. Genetics play a meaningful role. Individuals with a family history of acne are more likely to experience it themselves. Although acne is not dangerous, its emotional impact can be significant. Persistent breakouts and acne scarring can affect self-esteem, social confidence, and overall quality of life.

Acne develops from a combination of factors rather than a single cause. Excess oil production is one of the primary drivers. Hormones known as androgens stimulate sebaceous glands to produce more sebum. During puberty, androgen levels rise sharply, which explains why acne often begins in the teenage years. Hormonal fluctuations later in life can trigger similar changes.

Clogging of pores is another key factor. As skin cells naturally shed, they can accumulate within the follicle and mix with oil. When this material cannot exit the pore, it forms a plug. Bacteria that normally live on the skin may multiply inside the blocked follicle, leading to inflammation, redness, and swelling. This is why exfoliation is such an important part of a skincare routine.

Certain medications can contribute to acne, including corticosteroids, lithium, and drugs containing testosterone. External factors such as heavy makeup, oily skincare products, and repeated friction from helmets or tight clothing may worsen breakouts. Stress does not directly cause acne, but it can increase inflammation and hormone levels that aggravate existing lesions.

Diet has been studied extensively. While not the sole cause, high-glycemic foods and excessive dairy intake may worsen acne in some individuals. The relationship varies from person to person.

Acne lesions are divided into non-inflammatory and inflammatory types.

• Non-inflammatory acne includes blackheads and whiteheads. Blackheads form when a clogged pore remains open at the surface. The dark appearance results from oxidation when the contents are exposed to air, not from dirt. Whiteheads occur when the clogged pore remains closed, creating a small, flesh-colored or white bump under the skin.
• Inflammatory acne develops when bacteria and immune responses trigger swelling and redness. Papules are small, red, tender bumps without visible pus. Pustules are similar but contain a white or yellow center. Nodules are larger, firm, painful lumps that form deeper within the skin. Cysts are severe, pus-filled lesions that develop even deeper and often carry a high risk of scarring.

The most obvious symptom of acne is the presence of blemishes. Inflammatory lesions may feel tender to the touch and can persist for weeks.

In more severe cases, acne may leave behind dark marks after healing. These areas of discoloration, known as post-inflammatory hyperpigmentation, can last for months. Repeated inflammation increases the risk of permanent scarring. Acne scars may appear as shallow depressions, deeper pits, or raised thickened areas.

Beyond physical symptoms, acne can cause emotional distress. Many individuals feel embarrassed or frustrated by persistent breakouts. Adults may find acne particularly disruptive in professional settings. Early evaluation can help prevent both physical and psychological consequences.

Acne is diagnosed through a clinical skin examination. An experienced physician evaluates the type and number of lesions, their location, and the presence of inflammation or scarring. The severity is graded based on whether the acne is primarily non-inflammatory, moderately inflammatory, or severe with nodules and cysts.

Laboratory testing is usually not required. However, if acne is unusually severe, sudden in onset, or accompanied by other symptoms such as irregular menstrual cycles or signs of hormone imbalance, further evaluation may be recommended.