Skip to content

The Ultimate Guide To Acne: Types, Triggers And Treatments

Dr. Amy Yuan
| September 9, 2020
Fact-checked by:
Marisa Garshick MD
, Board Certified Dermatologist
The Ultimate Guide To Acne: Types, Triggers And Treatments

Acne. This just affects teenagers, right? Wrong.

While acne and breakouts are principally seen in pre-adolescents and teenagers, it is increasingly seen in adults through age 40. While hormonal changes are usually the main cause of teen acne, there are a number of other factors than can cause acne including both internal and external issues including how you care for your skin, diet, where you live and more. Don't reach for those over-the-counter products until you educate yourself.

What causes acne?

There are the three main causes of acne.

Follicle plugging causing clogged pores. Dead skin cells and debris accumulate in the hair follicle, which causes a traffic jam of sorts, resulting in the formation of comedones, different types of pimples more commonly known as and appear as blackheads and white heads.

Hormonal changes. As already mentioned, during our teen years, we experience increased sebum or oil production from sebaceous glands which makes skin look and feel oilier. Androgens (natural hormones in the body) including testosterone and its derivatives, skyrocket during adolescence. Boys’ voices change, facial hair appears, so does acne and excess oil.

P.acnes is a bacteria that we all have on our skin. It becomes more abundant with excess sebum and dirt and leads to inflammation of acne prone skin.

Are there different levels or types of acne? Yes. Acne can be mild, moderate and severe. Some will have just comedones (blackheads and white heads), others will suffer with acne with pustules (puss bumps) and others can experience cystic acne, which can be painful. Hormonal acne, caused by just that; hormones, adult acne caused by a reaction to a specific medication and acne caused by environmental factors such as makeup, hair oils or even diet.

Hormonal acneIf you notice your acne flares up with your menstrual cycle, consider speaking with a dermatologist or your primary care provider about how birth control pills, with both estrogen and progestin, as well as a safe oral medication called spironolactone, can help your acne. Topical Tretinoin or Adapalene (both retinoids) also treat hormonal acne. These must be prescribed by medical professionals.

Forehead acneForehead acne is different from other forms of acne because it is often caused by personal care products (hair oils or gels) or sports helmets or baseball caps. (Remember that line of zits over your brows?)

If you wear a helmet or baseball cap regularly, clean the inside of the helmet as through that cap in the wash. Cleanse your face with a benzoyl peroxide or salicylic acid-based cleanser before and after wearing sports head gear, hats or caps.

Avoid using oil-based treatment or styling products in the hair. Try glycerin-based products instead.

If you want to continue using oil, apply only to ends of hair and the middle of the scalp away from the forehead.

Acne of the chest and back (sometimes known as “Backne”).

Acne of the chest and back can be especially difficult to treat. Products containing benzoyl peroxide, salicylic acid, and sulfur are critical for these areas. You will likely need someone to help you apply these products as the affected areas are usually difficult to reach. Invest in a lotion applicator for the hard to reach areas of your back. You should also discuss treatment options with your primary care doctor or Board-certified dermatologist such as using oral antibiotics like Doxycycline, topical antibiotics such as Clindamycin, Isotretinoin or Accutane. Definitely discuss any possible side effects.

Here are a few other treatment tips for acne in this area.

  • Resist the temptation to pick at, squeeze or pop acne spots. This can cause an infection, spread the acne and leave scarring.
  • Avoid friction on your back, such as weight from a heavy backpack. This will further irritate the area.
  • Wash workout clothes after every use.
  • Shower immediately after exercise.
  • Wear loose-fitting shirts.

Nodulocystic acne

Nodulocystic acne is the most severe type of acne and the type that is most likely to scar. Consider speaking to a dermatologist about starting a treatment regimen of Accutane or Isotretinoin. If this is not an option for you, a strict everyday routine including topical Tretinoin, topical antibiotics, and oral antibiotics is necessary to prevent permanent acne scarring. Always avoid picking or popping acne lesions as this can lead to scarring.

Adult female acne

Acne in adult women is becoming more and more common. Usual locations for this acne include the jaw line and chin. It is especially important, with this type of acne, to avoid harsh scrubbing and manipulation or picking of acne lesions, as these factors will worsen acne. Try to keep cell phones, office phones and hands away from your face as much as possible. Use earphones and pods instead.

Comedonal acne (blackheads/white heads)

If your acne consists of mostly black heads and white heads, a topical retinoid or retinol cream such as Adapalene gel or Tretinoin cream should be helpful. Avoid picking at these lesions as this may lead to more inflammation and acne scarring.

Medication-induced acne

There are several medications that are known to cause acne. If you are taking any of the following prescription medications, consider speaking to your physician about switching or stopping them. Never stop a prescription medication before speaking to your physician.

Common medications that cause acne: Anabolic steroids, Lithium, Isoniazid, Prednisone, and Phenytoin.

Acne Fulminans

This is the most severe type of acne, characterized by crusty, bleeding cystic acne lesions with associated fevers, malaise, bone, muscle and joint pains. Please see a dermatologist in person immediately to prevent severe scarring and bone lesions associated with this condition. You will likely require Accutane, along with a short course of oral steroids.

When Should I See A Dermatologist?

Acne can be frustrating and hard to treat, depending on the type you are dealing with. Your primary care provider can recommend a board-certified dermatologist. Schedule a consultation to discuss your particular issues, concerns and treatment options. Depending on several factors like the type of acne you are experiencing, your course of treatment could be a prescription, a personalized skincare routine or a combination of both.

If you have been to a dermatologist in the past and acne medications haven’t seemed to work for you, here are some things to consider:

Often people apply an acne treatment for less than a month before deciding it doesn’t work. Most acne treatments require 2 to 3 months (some even 6 to 10 months) of everyday use to show treatment benefits and effects.

Acne treatments are often mistakenly applied as “spot treatments” to active acne, when they should really be applied to all acne-prone areas.

Many acne sufferers stop their treatments because they irritate their skin. Please contact your dermatologist about alternative acne treatments that are safe to use on sensitive skin.

Once a course of treatment is completed there may be dark spots, or post inflammatory hyperpigmentation, on affected areas, apparent on the surface of the skin. These should fade over time which can be a period of months to years.

What Can I do At Home To Improve My Acne?

Practice some basic every day and at-home tips.

  • Don’t touch your face! Don’t pick, pop, or rub acne as this will make it worse.
  • Frequently wash pillowcases, hats, and other items that touch your acne.
  • Consider changing your sheets weekly and pillowcases two to three times weekly.
  • Now, during this Pandemic, wearing masks can further irritate and spread acne. If you are using paper masks, toss after a few uses. If you are using a fabric mask, wash them often.

Monitor your diet.

  • Avoid milk, especially skim milk, as it has been associated with acne.
  • Avoid whey protein supplements as these have been shown to fuel acne flareups.
  • Avoid processed foods. Look at your food labels. If there are several ingredients on it you don’t recognize, this is probably a processed food. Avoid the center aisles of the grocery store as this is where most processed food is found.
  • Consider shredding your own cheese. Shredded cheese contains many additives including cellulose, which is made from cotton and wood pulp.
  • Cook at home as much as possible but especially avoid chain restaurants as the ingredients are more likely to be heavily processed.
  • Visit your local farmer’s market weekly. There is nothing but whole and healthy foods there.
  • Consider a low glycemic index diet that limits foods that will raise your blood sugar. It is a healthy way to eat and will help control your acne.

Stop eating sugar. This includes soda, candy, chocolate, juices, breakfast pastries, cookies, cakes, and most cereals.

Avoid simple carbohydrates. This includes bread, bagels, pasta, cereal, pizza, and beer.

Eat more protein and fat along with plenty of vegetables, some fruits, and more complex carbohydrates such as whole grain breads, lentils, and beans.

Practice self-care. Take care of your mind and body.

When you take care of your physical and mental self, you are taking care of your skin and improving your acne without even knowing it.

  • Reduce stress in your life. This means something different to everyone. Take time out of your day just for you, spend time with friends, go for a calming walk, or consider meditation. If you are unable to deal with your stress on your own, consider speaking with a close friend, a psychiatrist, or a psychologist.
  • Eat right. Eat when you’re hungry and stop when you’re full. Avoid processed foods. Eat plenty of vegetables, especially leafy greens.
  • Getting enough sleep reduces stress. Try to go to bed and wake up at the same time every day.
  • Get rid of any lights that are on in your bedroom while sleeping, including lights from chargers, night lights, phones, television, and even your alarm clock. Try black out curtains and eye shades.
  • Limit noise in your bedroom. Put your phone on silent. Try a white noise machine, a fan, or ear plugs to block out noise you can’t control.
  • Limit daytime naps as much as possible so you are tired at bedtime.
  • Avoid stimulants including nicotine, caffeine (this includes coffee, tea, and chocolate), and soda within 8 hours of your bedtime.
  • Avoid eating two hours before bedtime to avoid symptoms of reflux.
  • Get outside during the day to exposure yourself to natural sunlight to maintain a healthy sleep-wake cycle.
  • Limit alcohol intake to 1 to 2 servings. However, even this amount can disrupt sleep.
  • Make your bed comfortable. Make sure you have the right kind of mattress with comfortable sheets. Keep your bedroom cool.
  • Don’t do anything in your bedroom except sleep and sex. If you work or study in your bedroom, you are more likely to think about these things when you are trying to fall asleep.
  • Read quietly for 10 minutes before going to bed to let your mind unwind.
  • If you can’t fall asleep because thoughts are running wild, try meditation to clear your mind.
  • If you absolutely cannot fall asleep, don’t stay in bed. Get up and read a book. Try not to get on your phone or watch TV.

Wear the appropriate makeup and personal care products

  • Avoid heavy lotions (Vaseline, cocoa or shea butter), makeup, or foundations as these can clog pores. Consider mineral-based makeup instead.
  • Only use lotions, sunscreens, and makeup that are non-comedogenic.
  • Shampoo regularly to prevent oils from your hair making your acne worse.
  • Avoid hair treatment oils, opting for glycerin-based products instead.
  • If you need to use hair oil, don’t apply it near your forehead and only apply at the ends of your hair.

Find a personalized skincare routine that is right for your specific skin type and needs

  • Wash your face twice daily and after sweating.
  • Remove all makeup before going to bed.
  • Avoid any harsh scrubs, toners, astringents, or exfoliants that can further irritate acne.

We each have a different genetic makeup, a different lifestyle, diet, sensitivities and living environment. There is no one size fits all approach. Identify your skin issues and educate yourself through research or speaking with a board-certified dermatologist as to what personalized regimen would be best for your individual skin type, skin condition, type of acne and concerns. Acne prone skin should follow a regimen that consists of:

A gentle daily cleanser to wash away dirt and oil, allowing pores to breathe, lessening redness and irritation. And, with our newest fashion accessory, facial masks, more sweat and dirt will get caught in pores.

Moisturizer. Skin is losing moisture from interior, dry air, facial masks or change in diets. Apply moisturizer after cleansing. If your skin tends to be oilier, a little less moisturizer might be helpful at this time to avoid an increase in clogged pores or acne flare ups. Use a day moisturizer with a Broad-Spectrum SPF and a bedtime moisturizer specifically formulated for nighttime use.

Products like PROVEN, that are formulated based on a person’s individual needs including living environment, lifestyle, diet, stress levels, frequency of travel, as well as skin sensitivities will be most effective on various types of acne prone skin. Go to provenskincare.com to take the complimentary skin quiz to discover your personalized skincare formulations.

For more information on Proven Skincare, please go to www.provenskincare.com and follow us on Instagram @provenskincare.

GET MY FORMULA

Scientific Citations