A blemish is a broad term that refers to any type of skin mark. Acne can appear as pimples, blackheads, whiteheads, etc. Sometimes acne can leave dark spots, pockmarks, or scarring on the skin. These are all types of skin blemishes. Acne occurs when hair follicles become clogged with oil and dead skin cells. This is called “common acne” because almost everyone suffers from a pimple outbreak at some point in their life.
Acne begins when greasy secretions from the skin's sebaceous glands (oil glands) plug the tiny openings of hair follicles creating clogged pores. If the openings are large, the clogs take the form of blackheads: small, flat spots with dark centers. If the openings stay small, the clogs take the form of whiteheads: small, flesh-colored bumps. Both types of clogged pores can develop into swollen, tender inflammations or pimples or deeper lumps or nodules. Nodules associated with severe cases of acne (cystic acne) are firm swellings below the skin's surface that become inflamed, tender, and sometimes infected.
Though it affects people of all ages, acne is most common among teenagers. Acne commonly starts during puberty between the ages of 10 and 13 and tends to be worse in people with oily skin. Teenage acne usually lasts for five to 10 years, normally going away during the early 20s. It occurs in both sexes, although teenage boys tend to have the most severe cases. About 20% of all cases of acne occur in adults. Women are more likely than men to have mild to moderate forms into their 30s and beyond.
Acne usually appears on the face, forehead, upper back and chest. The signs of acne vary based on how severe your condition is.
- Whiteheads: clogged pores, under the skin’s surface, closed
- Blackheads: clogged pores on the skin’s surface, open
- Papules: small red, tender bumps
- Pimples (pustules): papules with pus at their tips
- Nodules: large, solid, painful lumps under the skin
- Cystic lesions: painful, pus-filled lumps under the skin
The factors that lead to acne are complex. There are several main factors that cause acne:
- Excess oil (sebum) production
- Hair follicles clogged by oil and dead skin cells
Acne typically appears on areas of skin that have the most oil (sebaceous) glands, including your face, forehead, chest, upper back and shoulders.
Hair follicles are connected to oil glands on the skin's surface and when excess sebum clogs the openings to hair follicles, the follicle wall may bulge and produce a whitehead. The plug may also be open to the surface and darken, causing a blackhead. A blackhead is a pore congested with bacteria and oil, which turns brown when it is exposed to the air.
Sometimes when this clogging causes the follicle wall to break under the pressure of oil buildup, sebum leaks into nearby tissues and forms a pustule or a papule, also known as inflammatory acne. Larger and tender pustules are called nodules. Pimples are raised red spots with a white center and also appear when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation deep inside the follicles produce cyst-like lumps beneath the surface of the skin, commonly known as cystic acne.
Hormones are also an important factor that give rise to acne among teenagers. Common acne in teenagers starts with an increase in hormone production. During puberty both males and females produce high levels of androgens, male sex hormones that include testosterone. Testosterone then signals the body to make more sebum, or oil produced in the skin's oil glands.
While some people escaped their teenage years almost pimple-free, some may develop persistent adult-onset acne as they age. Some doctors believe that flare-ups of acne are more related to how a person’s skin responds to an increase in sebum production or to the bacteria that causes acne. The bacteria Propionibacterium acnes occurs naturally in healthy hair follicles. If too many of them accumulate in plugged follicles, they may secrete enzymes that break down sebum and cause inflammation.
Dermatologists typically prescribe a topical retinoid for your acne, such as topical tretinoin or adapalene. Other prescriptions or recommendations may depend on the type of acne being treated. Sometimes, over-the-counter (OTC) medications are recommended as well.
Recommended OTC acne medications commonly include active ingredients, including:
- differin (adapalene 0.1 percent), which is an OTC topical retinol
- benzoyl peroxide
- salicylic acid, though this isn’t commonly recommended in an acne regimen
In addition to topical retinoids, prescription topical medications commonly used to treat acne include:
Oral prescription medications commonly used to treat acne include:
- anti-androgen agents, such as off-label use of spironolactone
- antibiotics, such as off-label use of doxycycline
- combined oral contraceptives
Therapies that can be used in combination with medication or on their own:
- chemical peel
- light therapy, such as photodynamic therapy or intense pulsed light (IPL) therapy
Improving Dietary Habits
There is also strong evidence that some dietary changes make a significant difference in acne treatment. Research has shown that certain dietary habits can help reduce acne symptoms.
Here are some recommended diet tips to control acne:
Healthy Eating for Blood Sugar Control:
Eliminating sugary foods and beverages, as well as refined carbs, such as white pasta, pastries, and white bread, may improve your acne symptoms. Follow a low GI (glycemic-index) diet to avoid blood sugar fluctuations.
The glycemic index (GI) is a measure of how slowly or quickly a food spikes your blood sugar levels. Eating sugary foods increases levels of insulin, which is a hormone that shuttles sugar out of your blood and into your cells where it can be used for energy. This stimulates the release of other hormones, such as insulin-like growth factor 1 (IGF-1). This increase in hormones leads to hyperkeratinization and excess sebum production, which can worsen acne. Some studies have shown significant improvements in acne in people following a low-GI, high-protein diet.
Eliminate Dairy and Whey Protein:
Milk and dairy products promote insulin secretion and the production of hormones, such as IGF-1, which is known to be a major contributor to acne development. Studies have shown that intake of dairy products , including milk, cheese, and yogurt, was associated with a greater risk of acne. Similarly, consuming whey protein, which is a milk-derived protein, was also linked to the onset of acne.
Eat Whole, Nutrient-dense Foods:
Inflammation is one reason that causes acne. Following a nutrient-dense, anti-inflammatory diet is one of the best ways to treat and prevent acne naturally.
Opting for anti-inflammatory omega-3 fat sources, such as fatty fish and chia seeds, over potentially inflammatory omega-6-rich fat sources like canola and soybean oils may decrease acne symptoms. Colorful vegetables and fruits are another way to tame inflammation and reduce acne symptoms. These foods deliver anti-inflammatory antioxidants to your body along with other vital skin-supportive nutrients such as vitamin C.