Frequently Asked Acne Questions

Frequently Asked Acne Questions

There are many claims about what causes acne and what treatments are effective for improving acne symptoms. Some of these claims are entirely true, some are partially true, and many are completely false. There is also a tremendous amount of contradictory information about acne available from lots of different sources.

In this FAQs section we address the most common acne-related questions on topics such as diet, hygiene, bacteria, hormones and more. For in-depth discussions the scientific aspects of acne, refer to our Acne Science page.

What is Acne?

Type 3 Acne on Forehead
Type 3 Acne on Forehead

Acne is a difficult to treat and often debilitating disease that affects the skin, usually the face. The most common form of acne (acne vulgaris) is an infection within a hair follicle. This infection causes varying degrees of inflammation, which manifest as pimples, nodules and cysts. When the inflammation is severe, it can cause permanent damage to the skin and create acne scars. This section covers the basics of what acne is and the different types of acne.

What Causes Acne?

Inflammatory Acne Papules Skin and Cellular View
Inflammatory Acne Papules Skin and Cellular View

Acne is a complex disease and many factors can contribute to the development of acne symptoms. Every case of acne is unique and the blend of factors that cause acne varies between individuals. This section contains a list and discussion about the factors that are major contributors to the development of acne symptoms.

What is the Best Acne Treatment for Me?

Over The Counter (OTC) Acne Products
Over The Counter (OTC) Acne Products

Choosing the best acne treatment(s) for each individual depends on many factors. The type and severity of your acne, your age, gender, treatment history and personal preferences are all important. If possible, you should work with your dermatologist or healthcare provider to develop a comprehensive acne treatment plan that is specifically tailored to your needs. Treatments for active acne and acne scars can be roughly divided into 6 different categories: Over The Counter (OTC) Treatments, Pharmaceutical (Rx) Treatments, Naturopathic/Homeopathic Treatments, Light & Laser Treatments, Surgical Treatments and Acne Scar Treatments. This section contains detailed information about all of the available acne treatments.

What are the Different Types of Acne Scars?

Rolling Acne Scars on Face (Woo)
Rolling Acne Scars on Face (Woo)

Acne scars come in many different shapes, sizes and even colors. Each type of acne scar has its own unique characteristics and features. Because of these differences, the available treatments for acne scars are not one size fits all. It is important to carefully choose the treatment that best matches your needs in order to achieve optimal results. Acne scars can be classified into three main groups: Depressed (pitted scars), Raised (keloid scars) and Discoloration scars. This section discusses the different types of acne scars and the features that define each group.

How Do Acne Scars Form?

Ice Pick Acne Scars on Cheek
Icepick Acne Scars on Cheek

Acne scars are the result of tissue damage caused by inflammatory acne. The vast majority of acne scars are caused by from persistent cases of inflammatory acne affecting the same area of skin. Individuals who suffer from frequent nodular and cystic acne outbreaks (Acne Types: 3-4) are at a very high risk of developing permanent acne scarring. This is particularly true when a region is affected by overlapping acne outbreaks, with no opportunity for the skin to completely heal between outbreaks. This section discusses the different factors that contribute to the development of acne scars.

Is acne caused by dirt or not washing my face enough?

Facial Cleansers are Popular OTC Acne Products
Facial Cleansers are Popular OTC Acne Products

The answer is usually NO. In most acne lesions (pimples, nodules, cysts, etc.), the site where the infection and inflammation is centered is not near the surface of the skin. Instead, it is near the base of the hair follicle where the sebaceous gland attaches. This is a region of the follicle that is not readily accessible from the surface. Therefore, cleansers and their active ingredients are unlikely to impact the inflammatory processes that drive moderate to severe acne symptoms (Acne Types: 2-4). This section discusses the benefits, risks and uses of acne facial cleansers.

Is Popping a Pimple a Bad Idea?

Popping a Pimple
Popping a Pimple

The answer is that it can be, especially if done improperly. Some pimples and other acne lesions benefit from being drained or popped in order to remove pus and accelerate healing, but other pimples should be left alone to heal on their own. The nodules and cysts of those patients who suffer from severe inflammatory acne (Acne Type: 4) are often lanced and drained by a dermatologist. This can prevent further damage and limit post-acne scarring. The important thing is to identify those zits and pimples which can be effectively popped (and which ones can not), and to do that properly and in a sterile fashion. This section discusses the risks, benefits and techniques for draining acne lesions.

Does Greasy Food, Milk or Chocolate Cause Acne?

Does Pizza Cause Acne?
Does Pizza Cause Acne?

The answer is probably not. Anecdotal associations between acne and particular foods like chocolate, ice cream and pizza have largely been discredited by scientific research. But research does point to a connection between overall diet and the development of acne symptoms. Researchers have shown that people whose diets include lots of high glycemic index foods (foods that are high in sugar and simple carbohydrates) tend to experience acne at a greater frequency than those who have low glycemic index diets. However, there is no clear scientific consensus on why this connection exists. This section discusses several of common claims about the association of specific types of food and acne symptoms.

What Does Non-Comedogenic Mean?

Acne Patients Should Avoid Comedogenic Substances
Acne Patients Should Avoid Comedogenic Substances

Comedogenicity refers to the potential of a substance to cause a comedo, a plugged or inflamed pore. Non-comedogenic means that in testing, the substance or product has not been shown to cause comedos (clogged or inflamed hair follicle). Some substances (eg. coal tar) are highly comedogenic and produce a type of allergic, acne-like reaction. There is not a clear consensus when it comes to the comedogenicity of many substances, with different tests yielding different results. This section discusses what comedogenicity is, how it is tested and which products and substances are likely to be comedogenic.

Can Stress Cause Acne?

Stressed Out
Stress

Stress can inhibit the function of the immune system and trigger or worsen acne symptoms It is well known that putting an organism under stress makes it more susceptible to infection. This is true for humans, animals and even plants. The same neural and biochemical pathways that make stress feel uncomfortable can also disrupt the delicate balance of a properly functioning immune system. This section discusses the relationship between stress and the development of acne symptoms.

What is the Relationship Between Acne, Depression and Suicide

Diagram of Psychological Impact of Acne (Magin)
Diagram of Psychological Impact of Acne (Magin)

Acne can have a profound negative impact on the psychological well-being of acne sufferers. Acne can increase the risk of bullying, depression and suicide.
For the millions of people who have suffered with acne, the psychological toll of the disease is well understood. The face is the window that connects one’s consciousness with the outside world. The face is also an essential factor in how the outside world perceives an individual. More than any other part of the body, diseases that affect the appearance of the face can have severe emotional and psychological consequences. This section discusses the connections between acne, stress, depression and suicide.

Is Acne Different Between Men and Women?

Acne Tends to be Different Between Men and Women
Acne Tends to be Different Between Men and Women

Yes, and it mostly comes down to hormones. Men and women tend to experience acne differently. Men are more likely to develop acne during puberty and are more likely to develop severe and inflammatory forms of the disease. Acne symptoms tend to peak during adolescence and recede during a male’s mid 20’s. In contrast, women tend to experience less acne and less severe acne than men, but rates of acne actually increase for women in the 20-40 age range. This section discusses key differences in acne symptoms between men and women, and why these differences exist.

What is the Relationship Between Pregnancy and Acne?

Pregnancy can Trigger Acne Symptoms in Some Women
Pregnancy can Trigger Acne Symptoms in Some Women

There are a tremendous number of changes that take place in the female body during pregnancy and these changes can have both positive and negative effects on acne symptoms.
Many women experience dramatic changes in their acne both during and after pregnancy. Hormones that control the natural processes of menstruation and pregnancy have wide ranging effects throughout the body. Onset of acne or a worsening of acne symptoms is very common during pregnancy. At the same time, a smaller percentage of women report an improvement in their acne symptoms during pregnancy. This section discusses the effects that pregnancy can have on acne symptoms.

Anabolic Steroids and Acne

Arnold Used Lots of Anabolic Steroids
Arnold Used Lots of Anabolic Steroids

Anabolic Steroids (aka Roids, Juice, AAS, etc) are molecules that mimic the shape and function of androgen hormones (eg. Testosterone). Anabolic Steroids are generally used to stimulate protein synthesis and muscle growth. They are widely used as performance enhancing drugs (PEDs) in athletics. Anabolic steroids should not be confused with corticosteroids, which are immune suppressants and can actually inhibit muscle growth. Corticosteroid injections are sometimes used to treat acute inflammation in severe acne lesions. Anabolic Steroids are never used as an acne treatment, and their use can cause or worsen acne symptoms. This section discusses the biology of anabolic steroids and their role in the development of acne symptoms.

What is Propionibacterium acnes?

Propionibacterium acnes (Toyoda, et al)
Propionibacterium acnes (Toyoda, et al)

Propionibacterium acnes (P.acnes) is a bacteria that can colonize the the skin and hair follicles. Excessive growth of this bacteria in the skin contributes to acne vulgaris. Propionibacterium acnes (P. acnes) is a bacteria that grows deep inside of pores, where it feeds on the sebum that is produced by the sebaceous glands that surround the base of the hair shaft. Most individuals with acne symptoms have an overgrowth of P. acnes bacteria in their skin. Several research studies have indicated that specific strains of P. acnes bacteria are commonly associated with acne vulgaris. This section details what P. acnes bacteria are and how it contributes to acne symptoms.