Acne Treatment: Causes and Options by Severity

What causes acne?

Acne starts when pores become clogged with a mix of dead skin cells and the oil produced by sebaceous glands. Bacteria that normally live on the skin multiply inside the blocked pore and cause inflammation. That is why breakouts tend to appear on the face, chest and back, where oil glands are most numerous.

Several factors make acne more likely: hormonal changes during the teenage years and before periods, genetics, some medicines, and heavy cosmetics that block pores. Diet plays a smaller role than many people think; some research suggests high-sugar foods and certain dairy products may worsen acne in some people only, and this varies from person to person.

How severe is your acne?

Dermatologists usually grade acne into three levels, and knowing the level is the first step in choosing treatment:

One person can have several types of spots at the same time, and an accurate grade is made during an examination.

• Mild: blackheads and whiteheads with a few small red spots.
• Moderate: more red spots and pus-filled pimples, sometimes spreading to the chest or back.
• Severe: deep, painful nodules or cysts under the skin, widespread acne, or spots that are starting to leave scars.

Which products are available without a prescription?

For mild acne, you can start with products that contain well-studied active ingredients, such as:

Start with one product and apply a thin layer to the whole area, not just to individual spots. Expect mild redness or flaking in the first weeks, which usually settles. If you are pregnant or breastfeeding, check with your doctor before using any acne treatment, especially vitamin A derivatives.

• Benzoyl peroxide: reduces bacteria and inflammation. Start with a low strength, as it can dry the skin and bleach towels and pillowcases.
• Salicylic acid: helps unclog pores and exfoliate dead cells, and suits blackheads and whiteheads.
• Adapalene: a retinoid (vitamin A derivative) that prevents clogged pores. It is sold over the counter in some countries and by prescription in others, so ask your pharmacist what is available.

When do you need prescription treatment?

If your skin has not improved after about 2 to 3 months of regular use, or if your acne is moderate or severe from the start, it is time to see a dermatologist. Depending on your case, options may include:

Isotretinoin is very effective for severe acne, but it requires close medical supervision and regular blood tests, and it causes serious birth defects, so pregnancy must be avoided during treatment and for a period afterwards set by the doctor. All of these medicines need a doctor's prescription, and the doctor decides the type and duration. Never use medicine prescribed for someone else.

• Topical antibiotics, usually combined with benzoyl peroxide to reduce bacterial resistance.
• Stronger prescription topical retinoids.
• Oral antibiotics for a limited period in widespread inflammatory acne.
• Hormonal treatments for some women when hormones clearly play a role.
• Isotretinoin for severe acne or acne that has not responded to other treatments.

Which daily habits help your skin?

Treatment works best alongside habits that protect the skin from irritation and keep pores clear. Hot, humid weather increases sweating and oil, so wash your face after being outdoors or exercising, and choose light, gel-based products.

• Wash your face twice a day with a gentle cleanser and lukewarm water, without harsh scrubbing.
• Do not squeeze or pick spots; it increases inflammation and leaves marks and scars.
• Choose a moisturiser and sunscreen labelled non-comedogenic.
• Clean your phone screen and change your pillowcase regularly.
• Avoid harsh scrubs and layering many products at once.