Opinion article
Acne: why it happens and how to treat it at every age
Acne results from four factors coming together: excess sebum production, pore blockage by dead skin cells, overgrowth of the bacterium Cutibacterium acnes, and inflammation. Hormones, especially androgens, drive sebum production, which is why acne tends to worsen during puberty, before menstruation, or in conditions such as polycystic ovary syndrome.
Types of lesions
- Comedones: blackheads (open) and whiteheads (closed), the mildest form.
- Papules and pustules: inflamed, red lesions, sometimes with pus.
- Nodules and cysts: deep, painful lesions, with a higher risk of scarring.
Treatment, in order of complexity
- Topical retinoids (adapalene, tretinoin): normalise pore shedding, the backbone of treatment in most cases.
- Benzoyl peroxide: reduces bacteria and inflammation, available over the counter.
- Topical or oral antibiotics: reserved for moderate inflammatory acne, always combined with a retinoid or benzoyl peroxide to limit bacterial resistance.
- Hormonal treatment: combined contraceptives or anti-androgens, useful for women with a clear hormonal pattern.
- Oral isotretinoin: for severe, nodular, or treatment-resistant acne, with close medical follow-up because of its side effects.
Any acne treatment takes, on average, six to eight weeks to show visible improvement. Switching products every week delays results rather than speeding them up.
Squeezing lesions increases the risk of infection and permanent scarring. Daily sun protection matters during treatment, since several of these medications make skin more sensitive to sunlight.
This article is for information only and does not replace a medical consultation.
Sources
- Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of Care for the Management of Acne Vulgaris. Journal of the American Academy of Dermatology. 2016
- American Academy of Dermatology Association, Acne