Acne: What You Need to Know

What is acne?

Acne is a disorder that causes your skin to break out in pimples (also called zits) and other kinds of bumps. Acne is most often on the face but can be found on other parts of the body.

Most people get at least some acne, especially during their teenage years. Acne can begin at age 8 or 9 and usually gets better by the mid-20s. Acne can be mild, moderate or severe.

What causes acne?

To keep your skin from getting dry, your skin makes oil in little wells called sebaceous glands that are found in the deeper layers of the skin. People with acne have glands that make more oil and are more easily plugged. This causes the sebaceous glands to swell. Hormones, bacteria (called C. acnes) and your family’s likelihood to have acne also play a role.

What does mild acne look like?

With mild acne, you can see small bumps on your skin called blackheads and small pimples called whiteheads. These are caused by dead skin cells and oil in the pores and hair follicles. Mild acne does not leave scars.

Did you know…?

Blackheads and whiteheads are not caused by dirt. That’s why rubbing and heavy washing of the skin does not help acne to go away. In fact, rubbing the skin or using harsh or rough soap can make your skin more irritated.

What does moderate to severe acne look like?

With moderate to severe acne, you see larger pimples on the skin. These have pus (a gluey white liquid) inside that you can see. There may also be bumps that are about the same size as the pimples, but without pus inside. These are signs of a kind of acne that goes deeper into the skin. Severe acne is more likely if your skin is very oily. This can be caused by your body changing during puberty (growing physically from a child to an adult).

Moderate to severe acne is more likely to leave scars on your skin. If you get treatment early follow your treatment plan, you can keep acne from scarring your skin.

What can make acne worse?

• Repeatedly pushing, touching or scrubbing areas where you have acne. This can happen if you wear headbands or helmets a lot.
• Oil and grease in moisturizers and/or makeup. Try to use these as little as possible.
• Oils in the hair. Try to pull your hair back from your face as much as possible.
• Being around grease-filled air in restaurant kitchens.
• Squeezing pimples and scratching the skin with fingernails. This can lead to scarring.
• Emotional stress can make acne flare up because this causes changes in your hormone levels.
• Some medicines taken for other problems can cause acne or breakouts that look like acne. Some of these medicines are lithium, steroids and bromides or iodides, which are in some sedatives and cough medicines. Make sure you tell your doctor about all the medicines you are taking.

Do certain foods make acne go away?

There is no specific diet that will make your acne go away. Some foods can make acne worse, such as sugary foods or high-fat foods.

How can doctorcs treat acne?

Acne cannot be cured. You can help control it with a good skin care routine and different kinds of medicine. There are several options for medicines. Your doctor will help you choose the best one for you based on the kind of acne you have.

What can I expect from treatment?

How often you see your doctor for acne treatment depends on the type of acne you have and which treatment you use. For any type of treatment, it may take 2-3 months to see an improvement in your acne. You may need to continue treatment in some way for several years.

If your doctor prescribes oral antibiotics (medicine that you swallow), you may have appointments every 3-4 months.

If your doctor only prescribes topical therapy (medicine that you put directly on your face), your visits may be 1-2 times a year.

Skin care

• Wash your face twice a day, once in the morning and once in the evening (including any showers you take) with a gentle, alcohol-free soap or over-the counter acne wash.
• Use over-the-counter (a medication or product you can get without a prescription) acne washes with salicylic acid or benzoyl peroxide a few times a week. These washes fight oil and bacteria but can be drying and irritating. Start using them a few times per week and build up to more frequent use as your skin gets used to them.
• Avoid over-washing or over-scrubbing your face. This will not improve your acne. It may also lead to dryness and irritation, which can affect how well your acne medication works.
• Try not to pop pimples or pick at your acne. This is easier said than done. Picking or popping can delay healing and lead to scarring or dark spots. It can also cause a serious infection.
• If you play sports, try to wash your skin and sports equipment or uniform right away when you are done. Also, pay attention to how your sports equipment (shoulder pads, helmet strap, swim cap, etc.) might rub against your skin, which can make your acne worse.
• Do not use moisturizers and cosmetics if you do not need to. If you use them, choose products that are labeled oil-free and non-comedogenic (will not block your pores).
• Be patient. Do not stop using the medications your doctor gave you if you do not see results right away. It can take up to 3 months for your skin to start getting better.
• Apply sunscreen (SPF 30 or above) every day after applying your acne medication. Sunscreen is important not only for protecting your skin in general, but also because acne medications can make your skin more sensitive. It can also help lessen the appearance of dark spots.

Medications

• There are many types of medication to treat acne, including prescriptions from your doctor or over-the-counter. When used properly, acne treatment works well. If you have acne and over-the-counter products are not working, you may need a prescription to help. Your doctor will help you find a prescription that works for you.
• You may need a combination of medicines to treat acne. If one medication did not work on its own, it may work better in combination with another. Your doctor can help find a combination that works for you.
• Keep using the medication even if your acne is better. This will help prevent new or more acne from forming in the future.

Rev. 3/2022. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.