The Ultimate Guide to Acne an Inflammatory Skin Condition

Updated: 10th March, 2021

Evidence Based

This article has 14 references.

Is Acne?

No doubt you have seen someone with acne before or even have had it yourself. Acne is one of the most common inflammatory skin disorders globally. It affects approximately 9.4% of the world’s population! (1)

The problem is that acne can negatively impact one’s life. Many teenagers just feel less-confident, unattractive, or even embarrassed of their appearance because of acne. So why acne seems to affect teenagers specifically? What effects can it have, and how can we deal with them physically and psychologically?

Lady with pimples
Acne is usually accompanied by whiteheads.



Well, that’s pretty straightforward. During puberty, many changes happen to the male body as well as the female. For example, males can become taller, muscular, develop broad shoulders, and other changes, right? These significant changes are regulated by your hormones, specifically a family of hormones called androgens.

Androgens come from two places in males: the testis and an organ called the adrenal cortex, which sits exactly on top of your kidney. However, it comes from only one place in females: the adrenal cortex, not from two locations as in men for obvious reasons.

Unfortunately, these androgens also target sebaceous glands in your skin and make them produce more sebum, making your skin oily. Sometimes, too much sebum can lead to blockage of the duct of these glands. If these glands are blocked, they won’t be able to secrete their sebum, resulting in sebum accumulation. When there is excessive sebum accumulation, this leads to inflammation and bacterial growth. Congratulations, you got acne! (2)

Behind Acne Vulgaris

Who is at risk for developing Acne Symptoms?

  • Being a male: Acne develops because of excess androgens in the body that causes increased sebum production leading to blockage and inflammation of sebaceous glands. Men have more androgens than females, so they are at higher risk. Androgens are responsible for making a male looks like a male.
  • Genetic factors: Genetics plays a huge role. The amount of androgens produced is determined by the genes you receive from your parents. This explains why some people develop acne, and others don’t.
  • Environmental factors: These things include food and other environmental exposures we have in our daily life. They can either aggravate or calm your acne. For instance, studies showed that eating sugary foods and foods with a high glycemic index like white bread and potatoes is associated with more acne lesions. Additionally, dairy products have been implicated in the pathogenesis of acne. Also, stress, smoking, and squeezing your pimples can worsen acne. (3)

Acne is not restricted to any age group. In fact, acne affects 20% of adults between the ages of 25 and 44.

Blackheads vs Whiteheads, the
Pimple Showdown

You have met someone with blackheads on their face; now you think this dirt because they don’t wash well. That’s not correct. Blackheads have nothing to do with dirt. Blackheads are considered to be very similar to whiteheads, but there is a slight difference.

What makes blackheads black is that they are open to the air. The tissue reacts with oxygen in the atmosphere leading to the formation of that black color. In contrast, in whiteheads, the air can’t react with the skin tissue inside, and, thus, black color doesn’t appear.

Blocked Skin Pores

How Do I Determine The
Of My Acne?

There are many ways we can categorize acne based on severity.

Mild acne: Acne is mild if you only have a few blackheads, whiteheads, or even a mixture of them.

Moderate acne: People with moderate acne have more noticeable acne pimples. Furthermore, inflamed pimples called “papules” (small bumps) or “pustules” (sacs filled with yellow pus) tend to be present.

Acne Scarring
Post Scarring from Severe Acne.

Severe acne: People with severe acne tend to have a lot of papules, pustules, and even nodules on their skin. These nodules are often reddish and painful. This type of acne may lead to scarring. (4)

Should I worry so much about acne?

There is no specific answer to this question. If the acne is mild or even moderate, you don’t need to worry too much about it. Just take care of it, and it will go away with time.

On the other side, severe acne can have more effects than mild or moderate acne. Besides having more psychological issues related to how teenagers can perceive their image, it can lead to atrophic scars. Atrophic scars leave skin dents when inflammation is severe or if the skin didn’t heal properly.

Doctor, I am female with acne and signs of hirsutism; is it a bad sign?

If you are a female and suddenly start developing symptoms like acne, excessive facial hair growth, deepening of your voice, and irregular periods, you should seek medical help.

These are the classic signs of a disease called polycystic ovarian syndrome (PCOS). PCOS is a poorly understood disease characterized by increased testosterone hormone levels (a major androgen) in females, leading to irregular periods and signs of hirsutism like acne and facial hair growth. (5)

Your Way To Clearer Skin

A great example of this relation is acne development in some populations after adopting a western diet. Some of these populations, like Canadian Inuit and South African Zulus, didn’t historically have acne but accepted the western diet, including processed foods, dairy, and refined sugars, which may play a role!

Acne Diet
Sugary Foods are associated with Acne.

Although there are many debates, scientists have discovered that increased consumption of sugary food is associated with more skin inflammation and increased acne. A clinical study that included 31 adult males who consumed less low glycemic index food for 12 weeks showed a reduction in their acne lesions.

Sugar, chocolates, milk, and more!

Dairy and Acne Diets

Recent studies have shown that consumption of milk may worsen acne. This is because milk has a high glycemic index. A study showed that consumption of milk chocolate and sugary beverages is positively associated with current acne.

Ketogenic Diet
There is no available evidence about the relation between the ketogenic diet and acne. However, studies have shown that it may help reduce inflammatory markers in the body, impacting acne lesions.

Vegetarian and Vegan
Many people claim that a vegan diet may help in reducing acne. A recent study found the prevalence of vegan diets to not be significantly different between 453 patients with acne and 150 without acne. However, there are limited studies on the relationship between a vegetarian diet and acne. More research is needed to expand our knowledge. (6)

What Treatments Are Available And
Do They Work?

Chemical Peel Treatment

Treatment can vary from person to person, depending on the severity of their acne and their goals. We can generally divide acne treatment into three categories: Topical medications, oral medications, and therapies.

Topical medications: They are the most common. The goal of topical medications is to decrease inflammation in your skin and kill any bacteria. This is achieved by applications of medicines that contain anti-bacterial and anti-inflammatory compounds like dapsone, salicylic acid, and antibiotics. Physicians prescribe topical medications in mild to moderate cases.

Oral Supplements: The most common oral medications include antibiotics and antiandrogens. Oral antibiotics tend to be more robust; this is why people use them in moderate to severe acne cases. Antiandrogens are drugs that decrease androgen levels. These drugs aren’t used in males because they can lead to feminization. They are also not recommended for pregnant females because this can lead to the feminization of their male baby! Lamelle’s Acnevelle has shown a 88% reduction in the number of lesions within 8 weeks of use when treating mild to moderate inflammatory acne.

Therapies: Chemical peel is a great example. This procedure uses repeated applications of anti-inflammatory compounds. This may improve the skin’s appearance, but the change is not long-lasting, and repeat treatments are usually needed. Other therapies include light therapy and steroid injections. (7)

Always remember that imperfection is the real perfection! Don’t make these pimples let you down. Enjoy your teenage years because acne is just the result of the hormonal changes happening during puberty. Diet modifications and available medications can help in reducing acne. Keep calm; acne will have to go away someday!

Acne Oily Skin Free

Resources and References

Want to learn more about Acne or just take a look at our sources? Here they are:

Acne: Overview – Cologne, Germany: Institute for Quality and Efficiency in Health Care.

Acne Vulgaris – Treasure Island (FL): StatPearls Publishing

Acne – David A. Whiting, MD, M Med, FRCP

Polycystic Ovary Syndrome – A Review of Treatment Options With a Focus on Pharmacological Approaches.

Diet and acne – Journal of the American Academy of Dermatology.

Effects of Diet on Acne and Its Response to Treatment – Baldwin, H., Tan, J. Effects of Diet on Acne and Its Response to Treatment. Am J Clin Dermatol 22, 55–65 (2021).

Management of acne – Kraft J, Freiman A. Management of acne. CMAJ.