When most people talk about acne-prone skin, a complexion covered in bright red bumps probably comes to mind, but there are several other ways acne can manifest. Although it’s the most common skin condition in the U.S., many people aren’t quite sure what acne really is, which can make treating and preventing breakouts feel frustrating, if not, impossible. The good news, however, is that with a consistent treatment plan, you can be on the path to clearer skin.
We spoke with three dermatologists to learn what acne is, how it forms, and what you can do to manage it.
Meet the Expert
- Dr. Marisa Garshick, MD, FAAD is a Board-certified dermatologist at MDCS: Medical Dermatology and Cosmetic Surgery Centers, and Clinical Assistant Professor of Dermatology, at Cornell University.
- Dr. Brendan Camp, MD, FAAD is a double board-certified dermatologist at MDCS Dermatology in Manhattan.
- Dr. Craig A. Kraffert, MD is a board certified dermatologist and founder of Amarte Skin Care and DermStore.
The Different Types of Acne
Although acne is technically the name of the skin condition that can result in breakouts, pimples of all types have become synonymous with the term. While acne symptoms do all start out the same way, some may progress to form different types of breakouts. “All acne lesions have the same starting point, the microcomedone, a microscopic blockage of the narrow duct extending around a fine hair follicle unit from the deeper dermis to the skin surface,” says Kraffert. “As the microcomedone persists, it can become a normal open comedone (blackhead) or a closed comedone which resembles a tiny whitehead at the skin surface. Inflamed comedones are sometimes raised with surrounding redness. Some microcomedones do not progress into typical comedones, but instead develop underlying inflammation. Depending on the degree of inflammation and its depth within the skin, these red and tender bumps are called papules and, when there are pus points centrally, pustules. Deeper painful papules are called cysts. Larger cysts are sometimes referred to as nodular cysts.”
- Comedones: "Generally, comedonal acne—which are considered whiteheads and blackheads—commonly show up in oily prone areas of the skin such as the T-zone, but can occur anywhere," says Garshick.
- Papules and pustules: These are the "classic" symptoms you probably think of when you picture a pimple. "Red papules and pustules are considered more inflammatory acne, and as such, can also be attributed to bacteria and inflammation," Garshick says. The main difference? papules are raised bumps, while pustules contain pus.
- Cysts: "Hormonal breakouts, while they can occur anywhere, tend to show up as deeper cystic breakouts [Ed. note: those "invisible" breakouts that feel tender to the touch.] involving the lower one-third of the face or the jawline area," says Garshick. "For many people, these breakouts can be cyclical and occur around their menses."
"The development of acne is multifactorial," says Camp. "It involves follicular hyperkeratinization (exfoliating or shedding skin cells form a plug within a pore,) hormonal influences (androgens or sex hormones that signal sebum or oil production,) and inflammation related to bacteria." To put it simply, acne symptoms, like red, raised lesions, occur when too much oil and dead skin cells clog a pore and form bacteria, which initiates an inflammatory response from the body, resulting in breakouts. More detail, below:
- Excess sebum: Sebaceous glands, which are located at the end of a hair follicle, or pore, produce sebum, which is an oily substance designed to keep the skin healthy by hydrating it, and protecting it from external stressors. Sometimes, these glands can go into overdrive and produce too much oil, which can result in clogged pores, and eventually, breakouts.
- Hormones: Those sebaceous glands become triggered mainly by hormones. “Acne tends to be hormonally driven,” says Kraffert. "The same hormones that drive acne also tend to promote more oily skin." Which hormones are mostly responsible for increased oil production? “Androgens are the main drivers of acne," Kraffert adds. "Androgen levels tend to rise in adolescence and, especially in women, early adulthood."
- Dead skin cells: It’s not just oily skin that leads to acne symptoms—debris like dead skin cells can contribute to clogged pores, and when they mix with too much oil, bacteria called Cutibacterium acnes forms within the pore, causing breakouts.
- Diet: While highly disputed as an official cause, many believe that what they eat has a direct impact on the condition of their skin. "A high glycemic index diet is thought to be related to acne," says Camp. "These types of foods cause large increases in blood sugar levels, which leads to the release of hormones that may promote acne formation." Some examples of high glycemic foods include starches, sugars, and dairy.
The Best Skincare Routine for Acne
While acne symptoms themselves will fade over time, the condition of acne should be treated if you want your skin to be free of bumps more often than not.
- Cleanse your skin. A regular cleansing routine will go a long way in keeping your complexion healthy, just be sure to keep the severity of your acne symptoms in mind when applying a cleanser. “A skincare routine can vary based on the type and severity of breakouts," says Garshick. "For most people with acne, it is best to wash the face 1-2 times per day." For those with mild breakouts or oily skin, it can be helpful to use a salicylic acid based cleanser, such as Neutrogena Oil-Free Acne Wash, which helps to unclog the pores. "In addition to your breakouts, be sure to consider your skin type when cleansing, and adjust as needed with the change in seasons. "Those with dry skin do not want a cleanser or treatment that will remove all the oil from their face, while those with oily skin may tolerate something stronger," says Camp. "For oily skin, I recommend Cetaphil DermaControl Foam Cleanser. For dry skin, I recommend CeraVe Hydrating Facial Cleanser."
- Exfoliate. Cleansing can remove excess oil and dirt from your skin, but you’ll want to scrub away those dead skin cells as well, as gently as possible. Kraffert recommends the Amarte Daily ExfoliPowder for cleansing and exfoliating, which is gentle enough for daily use.
- Tone. This step is not required, but toning can help balance the skin or treat it, depending on the ingredients, such as sulfur or tea tree oil, both of which reduce acne symptoms. "Toners are wonderful products to use, and while not everyone needs to use them, everyone can use them," Kraffert explains. "Those with true acne-prone skin and oily skin tend to reap the most benefits from toner, because they’re formulated to remove sebum, oil, and dirt from the pores."
- Implement active ingredients. Specific treatments will vary from person to person, but according to dermatologists, the top products for acne-prone skin include retinol and a spot treatment. Camp recommends Differin gel, which “helps regulate cell turnover and prevent clogged pores to use at night," along with a 5% benzoyl peroxide to kill acne-causing bacteria, like Clear Skin Spot Treatment from Glo Skin Beauty. However, don't use them together—instead, apply the benzoyl peroxide in the morning and the retinol at night a few times a week once you've built up a tolerance. When you're first starting out, introduce these ingredients slowly. If excessive redness or peeling occurs, consult with a dermatologist.
- Moisturize. It may feel counterintuitive to add more moisture to already oily skin, but because acne treatments can be drying, it’s important to hydrate. Why? The body can actually signal for the sebaceous glands to produce more oil if it senses that the skin is dry, which can result in more clogged pores or breakouts. "For moisturizer, I recommend CeraVe Facial Lotion as it provides hydration and contains ceramides to help support the natural skin barrier without clogging the pores or La Roche Posay Toleriane Double Repair which contains ceramides and niacinamide to help reduce inflammation."
- Always use SPF. "As many anti-acne products can make you more sensitive to the sun, it is important to also commit to sunscreen daily," says Garshick. “Elta MD UV Clear is a great option for sunscreen for those with acne-prone skin as it is a zinc-based sunscreen with niacinamide and hyaluronic acid to help calm and hydrate the skin.”
- Treat the body if needed. "For those with back and chest breakouts that are red and inflamed, a benzoyl peroxide cleanser, such as Panoxyl 4%, is a great option,” says Garshick. "As it is important to be gentle on the skin, especially if you are using any prescription products or chemical exfoliants such as salicylic or glycolic acid, it is best to stick with a gentle body wash such as Dove Sensitive Skin Body Wash, which is non comedogenic and won’t clog the pores."
Everything in Moderation
If you have acne, you may be tempted to pile on an array of products designed to fight it, but doing so can strip the skin of necessary oils, and possibly lead to irritation and dry skin. "My general rule of thumb when treating acne is ‘less is more,'" says Camp. "The more products you have in your routine, the more cumbersome it becomes, and the less likely you are to follow through with it. Also, using multiple products is more likely to disrupt the acid mantle and microbiome." Garshick recommends doing the same with your haircare products as well, as build-up can lead to breakouts, both along the hairline and elsewhere on the face and torso.
Acne breakouts don’t form over night, and they won’t go away so quickly either. "Don’t give up on acne products too soon," advises Camp. "I tell patients that topical acne medications should be used for 8-12 weeks before they 'declare' themselves as effective or not. It doesn’t help to cycle through products rapidly." And while you’re waiting, do your best to keep your hands off of your skin. "While tempting, it is not a good idea to pick or pop acne," he adds. "Doing so ruptures the follicle and widens the area of inflammation. This could lead to a larger area of discolored skin. It also increases the risk of scarring and may lead to a bacterial infection."
Know When to Consult a Professional
For stubborn acne symptoms, over-the-counter remedies may not provide relief, in which case, a medical professional may be your best bet for finding a solution that works. With any prescription, apply right after cleansing and exfoliating to allow for maximum absorption. In addition to topicals, specialized treatments can help address issues and repair the skin. “In-office treatments that can help address acne include steroid injections, acne surgery, peels, blue light and red light therapy, photodynamic therapy, microneedling, and lasers,” says Camp.
To sum it all up, acne breakouts occur when extra oil and dead skin cells form within a pore to create bacteria, which causes the body to react as it would when any infection disrupts its system. A skincare regimen can absolutely reduce symptoms, or even prevent new ones from forming, but the exact routine will depend on you, your skin type, and the severity of your acne symptoms. For the most part, however, dermatologists recommend cleansing, regular exfoliation, moisturizing, and spot treating as needed, along with practices that contribute to overall skin health, like using retinol in the evening, and SPF every day.