Acne: What it is, Causes, Treatment & More

What is Acne?

Acne, or acne vulgaris, is a general term used to describe blemishes that appear on the skin when the hair follicles and pores become clogged. The skin naturally produces sebum, an oil that keeps it hydrated. Excess production of dead skin cells and sebum can clog pores, leading to various types of acne, including blackheads, whiteheads, and cysts. It can be itchy and painful, depending on the type and severity.

What are the Types of Acne?

Acne breakouts are classified into different types based on their size, colour, appearance, and underlying cause. Here is a look at the most common types:

How Common is Acne in India?

Acne is one of the most common skin diseases in India, affecting millions of adolescents and young adults. Studies show that the prevalence of acne vulgaris in Indian youth is about 40-50%. In fact, acne is estimated to affect up to 85% of people aged 12 to 24. Dermatologists across the country are also reporting a steady increase in acne cases, particularly among young adults.

While people aged 18–25 years continue to account for the largest share of acne patients, clinics are increasingly seeing adults who get acne for the first time in their 20s and 30s. Research further indicates that acne is especially common among women, with a high prevalence rate of 81.7%.

The growing burden of acne is evident in urban areas across the country. Chronic stress, hormonal changes, air pollution, long commutes, and too many beauty products are all thought to contribute to recurring breakouts.

What are the Symptoms of Acne?

The symptoms of acne are different, depending on the type and severity of the breakout. The colour, size, shape, location on the body, and whether they cause pain, tenderness, or inflammation can vary.

What Causes Acne?

Acne occurs when hair follicles (pores) get plugged up with oil, dead skin cells, and other substances. When a pore becomes clogged, it creates an ideal environment for bacteria to grow, which can cause inflammation and pimples.

The main factors that contribute to acne include:

• Excess Production of Sebum: The body has glands that naturally produce an oil-like substance called sebum to keep the skin hydrated. However, when these glands produce too much sebum, it can accumulate inside pores and contribute to blockages, causing pimples.

• Clogged Hair Follicles: Dead skin cells normally shed from the skin's surface, but occasionally they mix with excess oil and become trapped inside hair follicles. Such blockages can lead to the formation of acne.

• Bacterial Growth: Certain bacteria naturally live on the skin. When a pore becomes blocked, these bacteria can multiply inside the follicle, increasing the risk of infection and acne breakouts.

Risk Factors of Acne

While acne can affect anyone, certain factors can increase the likelihood of developing breakouts or make existing acne worse:

• Age: Acne is most common during the teenage years when hormonal activity is at its peak. However, people can develop acne at any age.

• Hormonal Changes: Fluctuations in hormone levels stimulate the skin's oil glands, leading to excess sebum production and acne breakouts. This particularly affects pregnant women and teenagers.

• Family History: If one or both of your parents had acne, you may be more likely to experience it as well.

• Certain Medications: Medicines containing corticosteroids, testosterone, lithium, and other ingredients can cause acne or worsen acne in some people.

• Oily or Greasy Products: Regular use of heavy creams, oily cosmetics, or skin care products can clog pores and contribute to acne formation.

• Contact with Grease or Oils: Working in environments where the skin is frequently exposed to oil, grease, or similar substances may increase the risk of breakouts.

• Friction and Pressure on the Skin: Constant rubbing or pressure from helmets, backpacks, tight collars, hats, face masks, or mobile phones can irritate the skin and contribute to acne.

• Stress: Stress does not directly cause acne. But if you already have breakouts, they can become more difficult to manage if you are stressed.

• Environmental Factors: Exposure to pollution, airborne irritants, and high humidity levels may increase the likelihood of acne flare-ups in some individuals.

What are the Complications of Acne?

While acne is not life-threatening, it can sometimes lead to the following complications:

• Scars: Acne can affect deeper skin layers, especially when severe lesions (nodules and cysts) become inflamed or rupture. This can lead to permanent scarring, such as pitted scars or raised thick scars called keloids.

• Changes in Skin Pigmentation: Acne can leave dark spots (hyperpigmentation) or lighter patches (hypopigmentation) in the affected areas after healing. These pigmentation changes can last for weeks, months, or even longer.

• Mental Distress: Severe or long-lasting acne breakouts can affect a person's confidence and self-image. Many people experience frustration, embarrassment, anxiety, or stress because of the visible nature of acne.

When Should I See My Healthcare Provider?

While acne can be treated with over-the-counter medicines or home remedies, it is better to see a dermatologist as soon as acne appears. Early treatment can prevent scarring, which can be difficult to reverse once it sets in.

It is also worth being aware that certain non-prescription acne products can, in rare cases, cause a serious allergic reaction. If you experience faintness, difficulty breathing, swelling of the eyes, face, lips or tongue, or tightness of the throat after using a skincare product, seek emergency medical help immediately.

How is Acne Diagnosed?

Diagnosing acne is usually a simple process that involves a physical examination and a few questions about your health and lifestyle. Sometimes, the doctor may recommend tests to find the underlying cause.

How is Acne Treated?

Doctors often treat acne with a combination of topical creams, oral medications, and other therapies. Here are some commonly used treatments:

• Creams and Lotions: For moderate acne, retinoid-based creams and gels such as tretinoin, adapalene or tazarotene are commonly prescribed. They work by increasing the rate at which skin cells shed, keeping the pores clear, and helping prevent new breakouts.

• Antibiotics: These medicines are prescribed if the breakouts are moderate to severe. They help reduce the bacteria growing on the skin and lessen inflammation. These are often given along with cream-based treatments such as benzoyl peroxide to enhance effectiveness and reduce the risk of antibiotic resistance.

• Hormonal Therapy: Oral contraceptives or anti-androgen medications may be prescribed to women for acne caused by hormonal imbalances.

• Light and Laser Therapy: Various light-based treatments and laser procedures can target bacteria, reduce inflammation, and reduce breakouts and acne scars. Research into the most effective types and dosages is ongoing.

• Chemical Peels: Doctors often recommend salicylic acid, glycolic acid, or retinoic acid peels to exfoliate the skin, open the pores, and improve overall skin texture.

• Scar Treatments: If the skin has significant acne scarring, additional options like corticosteroid injections, dermal fillers, microneedling, and surgical procedures are recommended.

• Extraction: If blackheads and whiteheads are not responding to creams or lotions, they can be manually removed by a dermatologist.

Can Acne be Prevented?

Since acne can stem from a variety of causes, it is not always possible to prevent it entirely. Especially, hormonal acne cannot be fully prevented. However, certain habits can help prevent breakouts from getting worse or coming back:

• Wash your face daily with warm water and a gentle facial cleanser.

• Use an oil-free, non-comedogenic moisturiser to avoid clogging pores.

• Choose non-comedogenic makeup products and always remove makeup before going to bed.

• Avoid touching your face unnecessarily, as hands carry bacteria and oils that can aggravate the skin.

• Do not scrub your face with harsh tools or apply excessive pressure while cleansing, as this can irritate the skin and worsen acne.

• Change pillowcases regularly and keep your phone screen clean, as both come into frequent contact with your face.

• Keep your hair clean and away from your face, as oils from the hair can transfer to the skin.

• Pay close attention to the ingredients in your skincare products and avoid anything that may be irritating or pore-clogging for your skin type.

What is the Prognosis of Acne?

There are many treatment options available for acne, but how well and how quickly a person responds depends largely on the underlying cause. For many people, acne is most prevalent during the teenage years and tends to improve naturally as they move into adulthood. For others, particularly those who develop acne due to hormonal, dietary, or other factors, the journey to clear skin can take longer and may require trying several different treatments before finding the right one.

Scarring can be a problem. This is particularly true when acne penetrates beyond the surface layer of the skin and damages deeper tissue. These scars can be stubborn and may take a considerable amount of time to fade, which is why early treatment and avoiding picking or squeezing breakouts is always recommended.

Does Health Insurance Cover Acne?

Health insurance generally does not cover acne treatment if it is done for aesthetic or cosmetic purposes. If acne is diagnosed as a medical condition, such as severe cystic or nodulocystic acne that causes significant pain, infection, or scarring, some policies may cover it under the OPD benefits.

It is worth noting that most standard health insurance plans cover treatments requiring hospitalisation for a minimum of 24 hours, so OPD cover may need to be purchased separately to access outpatient acne-related care.

Purely cosmetic procedures such as chemical peels, laser treatments for scars or pigmentation, microdermabrasion, acne facials, and elective scar revision surgery are generally not covered. As always, reviewing your policy documents carefully or speaking directly with your insurer is the best way to understand what applies to your specific plan.