Symptoms and causes of acne
In this blog series, I want to explain several common skin conditions. I try to do this in the same way I do every day in my practice: by using simple, clear language to make sometimes complex topics understandable for everyone. Clear explanations about the condition, its expected course, the causes, and treatment options.
When people understand these things better, treatment is more effective, and they may also be more resilient against misinformation.
We start this series with a blog about acne.
Teenage pimples appear during puberty, when hormones become active. These hormones trigger growth spurts and sexual development. But they also affect the skin: sweat glands and sebaceous glands become more active. Sebaceous glands produce sebum, which keeps the skin supple and protects against dehydration, bacteria, fungi, and viruses.
During puberty, the increased production of sebum makes the skin oilier. This is completely normal. However, excess sebum can clog skin pores, leading to blackheads, which may become inflamed and turn into pimples. When bacteria are also involved, pustules may develop.
Acne is more than that: in addition to increased sebum production, acne also involves reduced drainage of sebum from the sebaceous glands to the skin surface. This causes sebum to build up deeper in the skin. Like teenage pimples, this can result in blackheads, pimples, and pustules. But with acne, this happens more often, deeper, and more severely, which increases the risk of (permanent) acne scars.
The tendency to develop acne is often genetic. If your parents suffered from acne, your risk is higher.
Sebaceous glands are most concentrated on the face, shoulders, and chest, which is why pimples and acne appear there most often.
Teenage pimples usually go away within a few years once the epidermis and sebum production are balanced. They typically do not leave scars.
Acne, on the other hand, is a serious condition that may last 5–15 years, cause deeper inflammation, and lead to permanent acne scars.
Acne can disrupt life during puberty and young adulthood. Scars remain as a daily reminder every time you look in the mirror. Today, acne scars can be treated and made less visible (for example, with fractional CO₂ laser therapy), but they never disappear completely. Unfortunately, many young people only visit a dermatologist when their skin has already been significantly damaged by acne. That is why it is so important to distinguish teenage pimples from acne, to recognize acne early, and to start treatment in time to prevent scars.
Treatment options for acne and teenage pimples
For teenage pimples, many over-the-counter products from the drugstore or pharmacy may help. Treatments by beauticians or skin therapists can also be effective. A general practitioner may prescribe creams or antibiotics for more severe symptoms.
For true acne, more is needed. Treatment should start early to prevent scarring and must focus on reducing sebum production and improving drainage to the skin surface. Retinoids (strong derivatives of vitamin A) reduce sebum production and improve drainage. This tackles the root cause of acne. Retinoids must be used long-term to achieve lasting results. A typical treatment course lasts around 9 months.
Retinoids are available as creams for mild acne. For more severe acne, oral isotretinoin (previously known as Roaccutane or Accutane) is often prescribed. There are many myths about terrible side effects, but it is in fact one of the most effective treatments for acne. In more than 30 years of experience, I have rarely seen patients stop treatment because of side effects. With proper supervision, it is a safe medicine.
All medicines that enter the body are broken down by the liver and kidneys. Some people genetically lack an enzyme in the liver that is needed to process isotretinoin. In such cases, the medicine can build up in the liver. Therefore, blood tests are required: once before treatment starts and again 4–6 weeks after. This shows whether the medicine is broken down properly and can be continued safely.
The most common side effect is dry lips, because isotretinoin also affects glands in the mucous membranes. Lips dry out and painful cracks can appear. This can easily be prevented by applying a rich lip balm or pure white Vaseline several times a day. I always advise patients to have multiple tubes available (at home, at school, in your bag or jacket), so there is always one nearby. If you forget for a few hours, cracks can form quickly. Other side effects include dry skin (body lotion helps) and sometimes muscle or back pain. Very rarely does anyone have to stop treatment because of side effects, as long as a dermatologist supervises.
In the first 1–2 weeks after starting isotretinoin, acne symptoms may temporarily worsen: the skin becomes drier and pimples redder. This is no reason to stop. After that initial phase, recovery begins, and usually after 2–4 months acne calms down completely. The treatment must then be continued for several more months.
Stopping too early can cause acne to return. But if the course is completed (6–9 months on average), acne returns in fewer than 10% of cases. In other words, 90% of people are permanently acne-free after a full isotretinoin course.
Another important point: women must not become pregnant while taking isotretinoin. It can cause severe birth defects. In many countries, strict regulations require monthly pregnancy tests before a prescription is renewed.
What to do (and not do) with acne
Do not squeeze or scratch pimples. This worsens inflammation, delays healing, and increases the risk of scarring. Leave pimples alone so they heal faster. Only blackheads can be removed relatively safely, ideally by a professional. Avoid foundation or concealer. These products are often used to cover acne but can actually worsen it by clogging pores. If used, do so sparingly.
Diet and acne: there is no special diet proven to reduce acne. Some people notice flare-ups after eating chocolate or pork. In that case, the advice is simple: avoid those foods. If you don’t see a connection, no diet is needed. Naturally, healthy eating is better than junk food.
Conclusion: why timely acne treatment matters
Acne is not the same as teenage pimples. Teenage pimples are normal and disappear on their own. Acne is not normal, can last for many years, and may cause permanent scars if left untreated. Fortunately, acne can now be treated effectively and safely. With timely treatment, acne scars can be prevented.
