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Medically reviewed by Dr. A.M. van Coevorden, dermatologist
± 6 min read
Acnepimples and blackheads
Acne is an inflammation of the skin with pimples and blackheads, also known as spots. It is one of the most common skin conditions in the world. Almost everyone develops acne during puberty. For some it stays limited to a few pimples, for others it is more widespread and has more impact. Acne can continue after puberty or start in adulthood. It is a visible condition that can be quite distressing and may cause psychological complaints.
How does acne develop?
Acne is an inflammation around the hair follicles and sebaceous glands. Various factors cause a follicle to become blocked. This is how blackheads (comedones) form. A blocked follicle contains bacteria, and inflammation can follow. Sometimes this inflammation is severe. That is called acne conglobata, and it mainly affects men.
Acne can also come from outside factors. Think of follicles blocked by make-up and oil-based products. Medicines and supplements can cause or worsen acne too, for example vitamin B12.
Acne is not caused by poor hygiene or a vitamin deficiency. There is little evidence that a specific diet or supplements improve acne. The advice is to eat a varied and healthy diet.
What does acne look like?
Acne consists of blackheads (comedones), red bumps and pimples. A blackhead is a white or black bump on the follicle, a build-up of dead skin cells. Sometimes larger inflammations (abscesses) develop. Scars can remain after healing. The more severe and the longer the acne lasts, the greater the risk of scarring.
Is acne contagious?
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No. Acne is not contagious.
How does your doctor diagnose acne?
Your doctor usually recognises acne straight away from the skin. Extra tests are almost never needed. The severity is assessed from the number of bumps and pimples and how widespread it is: mild, moderate or severe. Whether there are scars also counts.
How is acne treated?
Acne almost always needs long-term treatment. There are several options. Depending on the cause, acne cannot always be cured. Usually it is possible to calm the acne and keep it calm until it clears on its own.
Treatment often starts with a cream, gel or lotion. This is often a combination of ingredients that exfoliate and work against bacteria and inflammation. Examples are benzoyl peroxide, retinoids (such as tretinoin and adapalene) and antibiotics (such as clindamycin). Sometimes a course of antibiotics is added. The most commonly used is doxycycline. This treatment is often given for 3 months.
For severe acne, a tablet treatment with isotretinoin is started. This medicine contains an ingredient derived from vitamin A. Isotretinoin reduces sebum production and reduces the hardening of the skin, so the ducts of the sebaceous gland and follicle are less likely to become blocked. It also suppresses inflammation. The most common side effect is dryness of the lips, the lining of the nose, the eyes and the skin. Liver values and blood fats can sometimes rise during treatment. Regular blood tests are therefore needed. Isotretinoin carries serious risks during pregnancy. Women and girls must therefore not become pregnant during treatment and, if of childbearing age, must take a monthly pregnancy test. This treatment lasts an average of 9 months, but this varies from person to person. See also the isotretinoin leaflet.
The contraceptive pill can also reduce sebum production and so have a beneficial effect on acne. It is recommended for women who already want to use the pill alongside their acne treatment. Your doctor will discuss this with you.
Your doctor can also refer you to a skin therapist for skincare advice and supportive treatments. Acne can affect your mood. Psychological support can help some people.
What can you do yourself?
- Do not squeeze pimples and blackheads. The pressure pushes sebum into the skin, which causes more inflammation and makes the acne worse.
- Wash your skin with lukewarm water, without scrubbing. Use a soap-free wash or syndet.
- Avoid oil-based products.
- Sunlight (UV) can temporarily improve acne, but be careful not to spend too much time in the sun. Too much sun thickens the skin, which actually creates more blackheads, and increases the risk of skin cancer. Take extra care with sunlight during some acne treatments, such as isotretinoin and certain antibiotics like doxycycline. These make your skin more sensitive to sun and UV.
- Do not use greasy, occlusive cream or make-up. It blocks the follicles and causes more blackheads and pimples. If you do wear make-up, choose oil-free products and remove them at the end of the day.
Acne-like rash during cancer treatment
Some cancer treatments cause a side effect that looks like acne. Yet it is slightly different: ordinary spots mainly appear during puberty and come with blackheads. This skin side effect can occur at any age and often has no blackheads. That is why it is called an 'acne-like rash'.
You can develop this side effect during treatment for cancer with certain medicines. This is mainly with newer cancer treatments such as eGFR, MEK and mTOR inhibitors. It can also result from supportive treatment with prednisolone. With chemotherapy, an acne-like rash is a rare side effect. The rash often appears in the first 4 weeks after the treatment starts, with red bumps and pimples on sun-exposed areas and on parts of the body with many sebaceous glands.
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Do not use standard 'acne treatments' such as benzoyl peroxide, tretinoin, adapalene or tazarotene for an acne-like rash caused by cancer treatment, because these dry out the skin even more. If in doubt, consult your doctor.
This is a Dutch translation of the EADV Dermatology for Cancer Patients Task Force, rendered here in English.
Frequently asked questions about acne
Is acne caused by poor hygiene?
No. Acne is not caused by poor hygiene or a vitamin deficiency. Washing too often or too hard can actually irritate the skin. Wash with lukewarm water and a soap-free cleanser.
Does diet help against acne?
There is little evidence that a specific diet or supplements improve acne. The advice is to eat a varied and healthy diet.
Can I squeeze pimples?
No. The pressure pushes sebum into the skin, which causes more inflammation and makes the acne worse. Squeezing also increases the risk of scarring.
How long does acne treatment take?
Acne almost always needs long-term treatment. A course of antibiotics such as doxycycline is often given for 3 months, and a tablet treatment with isotretinoin lasts an average of 9 months. This varies from person to person.
Can acne be cured?
Depending on the cause, acne cannot always be cured. Usually it is possible to calm the acne and keep it calm until it clears on its own.
Sources and more information
- NVDV patient leaflet Acne vulgaris, version 2022
- NVDV patient leaflet Acne-like rash during cancer treatment (EADV), version 2022
Source: Dutch Society of Dermatology and Venereology (NVDV).
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