Causes and Treatments of Acne

Acne is a troublesome condition. Not only is it painful to the touch, but it also affects appearance. When acne becomes severe, it can undermine self-confidence and have a major impact on daily life and work. So how exactly does acne form, and what treatments are currently available?

Beneath the skin, the sebaceous glands continuously secrete oil to moisturize the skin and hair, keeping them healthy. In the basal layer of the skin, cells are constantly dividing and moving outward until they reach the outermost stratum corneum. Eventually, these cells become dead keratin and naturally shed.

However, dead keratin can easily mix with the oil secreted by sebaceous glands, forming plugs that block pores. Once pores are clogged, bacteria multiply rapidly, triggering inflammation—this is how acne develops. Any factor that increases oil secretion or disrupts normal keratin metabolism raises the risk of plug formation and pore blockage, thereby increasing the likelihood of acne:

• During adolescence, hormonal changes stimulate excessive oil production.
• Diets high in sugar and fat may stimulate sebaceous glands and promote keratin buildup.
• Stress and lack of sleep elevate cortisol levels, increasing oil secretion.
• Hot and humid environments stimulate oil production, while humidity provides an ideal breeding ground for bacteria.
• Improper skincare, such as over-cleansing, can cause the skin to produce more oil for protection, while using overly rich products can clog pores.
• Genetic factors may predispose individuals to excessive oil secretion or abnormal keratin metabolism. It is important to note that sebum plays a vital role in human skin. It moisturizes the skin, locks in hydration, and has antibacterial and protective functions. Sebum also nourishes hair, keeping it soft, smooth, and less prone to tangling or breakage. Problems arise only when oil secretion becomes excessive. Similarly, the basal layer of the skin constantly produces new keratin cells to renew and repair the skin. Issues occur when keratin metabolism is disrupted, causing the stratum corneum to thicken abnormally, which in turn contributes to acne.

Acne also comes in different types and levels of severity, generally classified as:

• Comedones (blackheads and whiteheads): Non-inflammatory. Whiteheads are keratin plugs blocking pores, while blackheads form when these plugs oxidize upon contact with air. Comedones may later become infected and inflamed, turning into papules, or remain non-inflammatory.
• Papules: Inflamed, slightly red, raised bumps that may be mildly painful.
• Pustules: More advanced inflammation, with a visible pus-filled center and greater redness and swelling.
• Nodules: Deep inflammation, forming hard lumps under the skin, usually without pus but painful.
• Cysts: Severe deep inflammation, with large amounts of pus and significant pain. The degree of inflammation determines the likelihood of post-acne marks and scarring, while the skin’s ability to repair itself also plays a role. During recovery, proper skincare, correct use of scar-fading products, and adequate sun protection to prevent UV-induced pigmentation all influence how acne marks and scars heal

When pus forms inside acne, the body can naturally absorb and expel it over time, depending on the size of the pus pocket and the severity of inflammation. Manually squeezing a pimple to release the white pus can indeed speed up healing, since removing the pus clears much of the source of inflammation and reduces swelling. However, improper handling during squeezing can worsen inflammation, spread infection if hygiene is poor, or damage the dermis if too much force is applied—leading to more difficult scars. In other words, if done correctly, such as with the aid of a sterile acne needle, pus can be released safely, followed by proper disinfection, which may help resolve acne more quickly. Yet in practice, most people cannot reliably meet these conditions, which is why patients are generally advised not to squeeze pimples themselves.

There are many ways to treat acne. For mild cases, where inflammation is minimal, simply keeping the skin clean is often enough for the body to repair itself. Over-the-counter acne creams, available in supermarkets or pharmacies, can also help. These products generally work by reducing inflammation, killing bacteria, and softening keratin, and they can be effective for treating mild acne. For moderate to severe acne, however, medical assistance may be necessary. Dermatologists may prescribe different treatments depending on the condition, such as antibiotics, specialized anti-inflammatory medications, corticosteroids, or hormonal therapies. These prescription drugs can have side effects, so they must be used under a doctor’s supervision.

When discussing acne treatment, retinoic acid (commonly referred to as Vitamin A acid) must be mentioned. It is considered a highly effective medication for acne and is often regarded as the most powerful treatment available. However, due to its significant side effects, it must only be used under medical prescription and supervision. Retinoic acid can be divided into two forms:

• Topical retinoic acid: Trifarotene is a fourth-generation topical retinoid with fewer side effects compared to earlier versions. It regulates keratinocyte metabolism, reduces sebum production, and suppresses inflammation. Common side effects include localized redness, skin dryness and peeling, and stinging sensations.
• Oral retinoic acid: Also known as isotretinoin, this treatment is highly effective, especially for severe acne. It works by shrinking sebaceous glands, drastically reducing sebum production, and providing strong anti-inflammatory effects. However, its side effects are considerable. Common ones include dryness and peeling of the skin and lips, dry eyes, nasal dryness with nosebleeds, while more serious risks include elevated blood lipids, liver dysfunction, bone problems, mood instability, and teratogenic effects. Because of these risks, oral isotretinoin must be taken strictly under medical supervision.

If acne is severe, even after healing it may leave scars or marks that affect appearance. Post-inflammatory red or brown marks usually fade gradually over time, as long as the skin is kept well-hydrated and protected from the sun to prevent UV-induced pigmentation. In these cases, the skin can repair itself naturally. However, acne can also leave behind pitted or uneven scars. These require professional advice, and depending on their depth, different treatments may be used to improve or reduce their appearance. Common options include:

• Chemical peels: These involve applying different acid-based solutions to the affected skin, promoting exfoliation and stimulating collagen production. They can improve scars, fine lines, uneven skin tone, and pigmentation. Side effects may include redness, peeling, stinging, and photosensitivity. The depth of the peel determines both the effectiveness and the side effects: superficial peels produce milder results with fewer side effects and faster recovery, while deeper peels deliver more dramatic improvements but carry greater risks and longer downtime.
• Microneedling: This technique uses numerous tiny needles to puncture the skin surface, creating micro-injuries that trigger the skin’s natural repair process and stimulate collagen production. It can improve scars, fine lines, and enlarged pores. Side effects may include redness, minor bleeding, and stinging. The length of the needles also influences the effectiveness, side effects, and recovery time.
• Laser therapy: This method uses high-energy light beams targeting different layers of the skin to stimulate renewal and repair. It can improve scars, fine lines, pigmentation, and uneven texture. Side effects include redness, peeling, hyperpigmentation, and photosensitivity. Different laser intensities are suited to different scar depths. Laser therapy is generally more effective than chemical peels or microneedling, especially for deep pitted scars, but it involves longer recovery and higher risk of side effects

There are many different treatments for acne and acne scars. With the rapid advancement of medical and aesthetic technologies, new generations of medications and treatment approaches continue to emerge, offering greater effectiveness with fewer side effects. However, not every method is suitable for every condition. The most important step is to seek medical advice early, so that a doctor can recommend the treatment best suited to each individual case.