Many people deal with pimples. What causes acne?

Delaney Nothaft
·4 min read

It’s the bane of many people’s existences – acne. It can feel like the only thing you see when you look at a photo or when you’re putting on makeup. Acne can cause not only skin discomfort and textural changes, like scarring, but it has also been shown to have significant psychological and social effects on people everywhere.

Acne can be complicated – with many different types, degrees of severity and treatments. To find out what you need to know about acne, we spoke with Dr. Maulik Dhandha, a board-certified dermatologist with Dignity Health Woodland Clinic in northern California, and Dr. Maya Thosani, MD a Scottsdale, Arizona-based board-certified fellowship-trained dermatologist and independent member of the HonorHealth Medical Staff.

What are the different types of acne?

Dhandha describes some of the different types of acne lesions as:

  • Whiteheads (clogged pores)

  • Blackheads (clogged pores with debris/dirt)

  • Papules (clogged pores with excess oil, dead skin or bacteria that gets inflamed)

  • Pustules (contain yellowish fluid)

  • Nodules and cysts (larger lesions)

Dhanda says these lesions can be further classified into different types. Here are a few examples:

  • Adolescent acne

  • Post-adolescent/hormonal acne

  • Acne conglobata/Acne fulminans (severe acne)

  • Acne excoriée (a disorder in which patients have a conscious, repetitive and uncontrollable desire to pick, scratch or rub acne lesions)

  • Neonatal/infantile acne

What causes acne?

Both Dhandha and Thosani explained that acne begins with a clogged pore. These pores get filled with sebum (oil) and excess keratin and bacteria called Cutibacterium acnes (formerly Propionibacterium acnes or P. acne).

There are a few causes of acne, and sometimes multiple factors are what result in acne. Thosani says that some of these factors include:

  • Genetics

  • Hormones

  • Inflammation

  • Environment

What foods cause acne?

Both Dhandha and Thosani emphasized external factors can exacerbate acne – particularly certain foods. Thosani says, “The role of diet affecting acne has been studied extensively. We know that there is an association between high glycemic index foods and dairy (specifically whey) causing a greater development of acne. Other studies show that eating a diet of fish and healthy oils (for more omega-3 and omega-6 fatty acids) can reduce acne. Restoring homeostasis (balance) with our gut and skin microbiome using probiotics has also shown promise, but more studies are needed to definitively guide therapy.”

Dhandha adds that smoking may also exacerbate acne.

What are some of the treatments for acne?

Dhanda says mild acne may be treated with over-the-counter remedies like benzoyl peroxide wash, salicylic acid wash and a topical retinoid called adapalene. Thosani adds, “As the mainstay of acne therapy, retinoids come in different strengths, and dryness can be a side effect that can make acne seem like it's worsening before getting better. Using a thicker non-comedogenic (meaning it won’t clog your pores) moisturizing cream can help mitigate these side effects and promote tolerability.”

But sometimes, more treatment is necessary, and that’s when you should talk to your primary care physician or dermatologist. “For mild to moderate acne with significant papules/pustules, treatments include topical antibiotics like clindamycin, erythromycin, minocycline, etc. There is also a topical anti-androgen called clascoterone,” Dhanda explains. Thosani also says, “Sometimes an oral antibiotic will be prescribed for a few months while starting the topical medication so that it can calm acne immediately until the topicals take effect (often after 2 months).”

For female patients, oral contraceptive pills and spironolactone can be good options for moderate to severe acne.

Isotretinoin (accutane) could also be an option. “Isotretinoin is the strongest medication for severe scarring acne,” says Dhandha. “Isotretinoin is a modified high dose vitamin A that is the closest to a 'cure' for acne that we currently have. It must be prescribed by a physician enrolled in the iPLEDGE PROGRAM, and supervised closely to monitor for side effects by checking bloodwork each month and screening for mood changes,” explains Thosani.

Acne can be painful and leave scars, but it can also be something that causes emotional distress – it’s not something that you have to suffer through without help.

Read more about acne, your skin here:

You may want to try: Banish pimples with these acne-busting products

Acne: It's not contagious and other things dermatologists want you to know

As summer approaches: Should you get screened for skin cancer?

Vitamin C: Is vitamin C serum all it's cracked up to be?

This article originally appeared on USA TODAY: What causes acne? Foods to avoid and how to treat pimples