A Guide to Acne

Everything you need to know about acne vulgaris

Almost 85% of Australians experience acne. What causes acne? How can we get rid of it? And what does ‘vulgaris’ mean, anyway?

We set out to explain everything you need to know about acne, and bust some common acne myths along the way.


What does acne vulgaris mean?

Acne vulgaris is the medical name for 'common acne'1. It has acquired the name because almost 90% of adolescents develop acne2, and it is commonly seen in adults  (particularly women) too.


What’s the difference between pimples and acne?

Pimples are individual acne lesions. Everyone gets them once in a while, but when there are a lot of pimples on the face or body that don’t go away easily, it’s considered acne.


There are a few different kinds of pimple3:

  • Comedones: blackheads (open comedones) or whiteheads (closed comedones)
  • Papules: small red bumps
  • Pustules: larger red bumps with white or yellow ‘heads’
  • Nodules: solid red bumps that do not contain pus
  • Pseudocysts: solid red bumps that contain pus

Papules, pustules, nodules, and pseudocysts are considered ‘inflammatory’ acne because of the redness and swelling that accompanies them.


What’s considered ‘severe’ acne?

Acne is graded - from mild to severe. The severity of acne depends on two things: the number of lesions you have, and the type of lesions. The following information, from DermNet New Zealand, explains it well1:

Mild acne:

  • Less than 20 comedones (blackheads or whiteheads)
  • Less than 15 inflammatory lesions
  • Less than 30 lesions overall


Moderate acne:

  • 20—100 comedones
  • 15—50 inflammatory lesions
  • Between 30—125 lesions overall


Severe acne:

  • More than 5 pseudocysts
  • More than 100 comedones
  • More than 50 inflammatory lesions
  • More than 125 lesions overall


If you see a doctor or dermatologist for help with your acne, the severity of your acne will be taken into account when deciding on the best possible treatment for it.


How do pimples form?

Pimples form when skin oils and bacteria get caught inside our hair follicles. Our follicles are usually pretty good at self-cleaning thanks to something called the sebaceous gland, which exists in each follicle and produces an oily substance called sebum. Sebum carries out any impurities or foreign matter and expels it through the pore, at the top of the hair follicle4.


This process occurs over and over again on our bodies every day, and it usually happens without any problems—but sometimes the follicle gets clogged. The sebaceous gland continues producing sebum, which builds up inside the follicle and creates a breeding ground for a skin bacteria called propionibacterium acnes5. As this bacteria multiplies, the body’s immune system is triggered and the skin around the area becomes inflamed as the body tries to heal the new pimple6. White blood cells can sometimes be used by the body to help heal the pimple, and these are later expelled as pus7.


What causes acne vulgaris?

There are a few things that can cause acne, but the biggest cause is hormones. Increases in some hormones can cause a surge in our body’s production of sebum, which can create acne. 


The relationship between hormones and acne explains why many teenagers get acne as they start puberty, and it also explains why acne is so common for people on hormone therapy, people taking prescribed steroids, women going through menopause, and women with poly-cystic ovary syndrome8. Some women may also notice an increase in acne during certain stages of their menstrual cycle, and this too is related to hormones9.


Aside from hormones, acne can also be caused by certain kinds of cosmetics and some facial or head coverings. There have been some studies done that have revealed tenuous links between diet and acne, and stress and acne, but we believe more research needs to be done in this area before any conclusions can be drawn from it.


Why do some people get severe acne and some don’t?

We all have that one friend who never gets acne, and it can be frustrating to think that they’ve found some secret to good skin that we don’t know about. But unfortunately, we don’t yet know why some people get severe acne, some only get a mild case, and some get none at all.


One research paper has suggested that there are different strains of the p. acnes bacteria that could play a role in how severe an individual’s case of acne is, but even though this idea is interesting, it needs more research before we can know for sure whether it makes a difference10.


In the meantime, it’s important to know that your likelihood of getting acne isn’t something you can control initially. No matter how severe your acne may be, it’s not your fault that you have it. However, with doctor’s advice (and a few clinically proven ingredients) you can work towards giving your skin the best opportunity to combat this annoyingly common condition.


Is acne unhygienic?

Acne is definitely not unhygienic. While skin bacteria does play a role in acne, this bacteria is found on everyone’s faces and is natural to our bodies. Having acne is not a sign that someone needs to bathe or shower more, or that they are ‘dirty’ or unclean in any way. In fact, showering or washing our face too much can cause acne to get worse, rather than better11.


Acne is also not contagious, either.


Are there treatments available?

The good news is that there are treatments available for acne. Even the most severe acne can be treated and managed. 


We believe it’s important to seek treatment for acne once you believe it’s becoming a problem. If you’ve tried some over-the-counter acne treatments and they’re not working, or if acne is making you feel bad about yourself and your appearance, speak to a doctor. They can prescribe a strong, effective treatment that’s proven to work.


Will acne go away on its own?

Acne can go away on its own but it can take years, so treating acne is worth it. A really successful acne treatment won’t just target the pimples themselves, it will also improve the quality of your skin in general and make it so that pimples are highly unlikely to return. If your acne has an underlying cause—for example, a hormonal imbalance—a doctor may be able to diagnose and manage that as part of your acne treatment.


It’s important to know that leaving more severe cases of acne to heal on their own can cause scarring, which can damage the condition of your skin. Acne scars can be treated, but as with acne itself, the sooner you access treatment, the better.


What’s the best treatment for me?

The best acne treatment for you is the one that works!


There are several things a doctor will take into account when prescribing you an acne treatment: which skincare products you have used before, any allergies you may have, any other skin conditions you would like to treat, and the sensitivity of your skin. Because of this, there’s no one single acne treatment that works for everyone: a good acne treatment will be tailor-made just for you and your skin.

What does a successful treatment do?

A successful acne treatment may take weeks or even months to start visibly working, but once it does, it should reduce the amount of visible acne lesions on your skin, along with any swelling, inflammation, and redness that comes with them.


After most acne lesions have healed, you might begin treatments that help restore your skin’s health and appearance, and reduce any scars that are left over from having acne. 


No treatment will work overnight, and treating acne does require time, patience, and the faith that it will work. But it’s important to know that it is possible: acne can be treated, and acne-free skin is achievable.

References

  1. DermNet NZ, ‘Acne vulgaris’, <https://dermnetnz.org/topics/acne-vulgaris/>, accessed 23rd June 2020.
  2. Gebauer, Kurt 2017, ‘Acne in adolescents’, Australian Family Physician, vol. 46, no. 12, pp. 892—895. <https://www.racgp.org.au/afp/2017/december/acne-in-adolescents/>, accessed 23rd June 2020.
  3. DermNet NZ, Acne, <https://dermnetnz.org/topics/acne/>, accessed 9th June 2020.
  4. Drugs.com, Acne guide: causes, symptoms, and treatment options, <https://www.drugs.com/health-guide/acne.html>, accessed 4th June 2020.
  5. Health Direct, Acne, <https://www.healthdirect.gov.au/acne>, accessed 4th June 2020.
  6. British Association of Dermatologists 2007, Acne, brochure, British Association of Dermatologists.
  7. Medical News Today, What is pus?, <https://www.medicalnewstoday.com/articles/249182#causes>, accessed 9th June 2020.
  8. Elsaie, Mohamed L. 2016, ‘Hormonal treatment of acne vulgaris: an update’, Clinical, Cosmetic, and Investigational Dermatology, vol. 9, pp. 241—248. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015761/>, accessed 4th June 2020.
  9. WebMD,  How your period affects acne, <https://www.webmd.com/skin-problems-and-treatments/acne/features/period#1>, accessed 4th June 2020.
  10. Fitz-Gibbon, Sorel, Tomida, Shuta, Chiu, Bor-Han, Nguyen, Liu, Du, Christine, Liu, Minghsun, Elashoff, David, Erfe, Marie C., Loncaric, Anya, Kim, Jenny, Modlin, Robert L., Miller, Jeff F., Sodergren, Erica, Craft, Noah, Weinstock, George M., and Li, Huiying 2013, ‘Propionibacterium acnes strain populations in the human skin microbiome associated with acne’, Journal of Investigative Dermatology, vol. 133, no. 9, pp. 2152—2160. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745799/>, accessed 24th July 2020.
  11. Harvard Health Publishing, ‘Acne’, <https://www.health.harvard.edu/a_to_z/acne-a-to-z>, accessed 24th July 2020.
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