One important method for keeping that outlook under control is to make reasonable efforts to combat the condition.

Not everyone can readily afford a professional dermatologist on an ongoing basis. But even one visit can provide tons of useful advice and a prescription for acne medication. That’s worth quite a lot. Even though there is a substantial amount of information available on the Internet today, it’s helpful to have someone experienced who can help interpret it.

The medicine itself is important, both to treat the disease and the psychological effects. As the patient lessens the number of lesions, and lengthens the period between outbreaks, the skin will clear. At the same time, even when acne is still present, knowing that one is doing everything possible to combat the condition promotes a better attitude.

Passivity in the face of acne creates a downward spiral. The person feels bad about having a skin disease. They look in the mirror and don’t want to face the day, which includes other people who will see them.

But passively accepting the situation only worsens it. It reinforces the mistaken belief that nothing can be done. It’s a self-fulfilling prophecy. If nothing is done, the condition doesn’t go away or at least lingers much longer, and more severely than need be. That provides false evidence that there’s nothing that can be done to make it go away.

Taking action tends to create a positive spiral. Severe acne won’t normally disappear in a day, even with the best treatment. But fighting it leads to greater confidence that it can be fought, especially when reality helps show it as the condition actually improves.

That attitude has another, perhaps greater, benefit. It builds up the inner resources that one can deal with the challenge. It helps create a mental outlook that focuses on achieving other values, not dwelling on one unfortunate – and usually short-lived – problem.

Over 85% of those between ages 12-24 will get acne at some time. It is usually mild and usually only lasts a couple of weeks or less, with proper treatment. Since it’s so common, one needn’t feel singled out. Since it occurs to nearly everyone at some point, it can be accepted as a normal, if regrettable, fact of life.

Facing that reality isn’t pleasant. But a realistic attitude that understands that bad things will happen, and that good things can be created, will help encourage us. Realizing that we don’t have to passively accept those bad things, but that despite our best efforts they may take time to solve, contributes to a positive outlook.

During the teen years, girls tend to develop acne sooner than boys. On average most girls will start to develop acne by about age 11, as contrasted with age 13 for boys. The reason isn’t hard to find. Girls mature sooner. They tend to enter puberty a few months to a couple of years before boys.

During those years the human hormone system sees rapid increases in levels of a number of well known hormones, such as estrogen or testosterone. But there’s a class of hormones that are less well known by name, but more relevant at this stage to acne onset: androgens.

As the name suggests, these hormones are shared by both males and females. But, as noted, the rise in females occurs sooner. Once they reach puberty, the androgen levels rise higher in males, so they tend to suffer more severe acne.

About 2/3 of all teens will develop acne, at least in mild form. But for females, the condition tends to last longer, at least cyclically. As a woman enters her 20s, her menstrual cycle tends to raise the likelihood of developing at least mild acne. Since that occurs approximately once per month, so does the acne. The week prior to the onset of flow is typically the worst for almost 62% of women.

The problem persists for women throughout the years of reproductive capacity. Over 50% of women (as opposed to only 42.5% of men) between ages 20-29 develop acne. The numbers dip radically for the years 30-39 to 35.2% and 20.1% respectively. By the time she’s reached her 40s, the number has lowered to 26.3% (12% for men). For those aged 50 and older the numbers are about 15% and 7% for women vs men.

The severity follows a similar pattern. Between the third and fourth weeks of the menstrual cycle, inflammations increase about 25%. Even blackheads and whiteheads rise about 20% during this time.

Pregnancy offers some relief, but it mostly shifts the pattern. It doesn’t eliminate acne entirely. During pregnancy, breakouts can occur at random. Skin changes, even for those who have never had acne, are a common occurrence when a woman is carrying.

Here again, significant hormonal changes are taking place. The largest number of cases tends to occur during the first trimester. That shouldn’t be surprising, since this is the interval during which hormone levels are changing most rapidly from their usual amount and distribution. Delivering the baby will often put an end to the outbreaks, but they tend to persist longer in women who breastfeed.

Though a woman has to always be more careful about what medications she takes, normal over the counter treatments are considered safe. Some studies have suggested, however, that isotretinoin (brand name: Accutane) and tetracycline (doxycycline), treatments for severe acne, should be avoided during pregnancy. They may cause birth defects or development problems in the fetus.

When in doubt, consult a dermatologist.

Acne is a condition in which a skin pore becomes clogged as a result of excess dead skin cells and sebum, a natural skin oil, being unable to exit the follicle. That can lead to bacterial growth, rupture of the follicle wall and other circumstances that promote acne. Hormones called androgens are thought to be a major driver of the increase in sebum production.

Since it is during our teen years that hormone levels increase dramatically, it’s not surprising that acne shows up most prominently during this period. Acne typically develops in girls around age 11 and 13 in boys, reflecting the average age at which the two genders start puberty.

Once it develops, the incidence and severity is greater for males. Boys produce considerably more androgen hormones than females, and so they tend to develop more (and more severe) acne. Around 40% of teen acne is severe enough to warrant treatment by a dermatologist.

But the scales tip later in life.

Young or even mature adults can get acne, women more often than men. Nearly 85% of the population of the U.S. between age 12 and 24 develop some form of acne. Males and females tend to suffer about equally during the period, but women have a higher incidence after that time.

One quarter of these people have acne on other parts of the body besides the face – most commonly the back and neck areas. 40% of acne sufferers seek medical attention because of the severity of their breakouts.

There are studies that suggest that the monthly hormonal cycle of women has an effect on the occurrence of acne. Nearly 44% of women between the ages of 20-32 experience premenstrual related acne. The odds are even higher for women aged 33 and older. This is according to one of the largest studies of the menstrual cycle’s effect on acne.

But acne can occur at any age.

Babies often get small whiteheads. It may take 3-6 weeks for baby acne to disappear, which it generally does, spontaneously. Acne can appear in those over 50 and even later in life. Often it is correlated with taking certain drugs, such as lithium, corticosteroids or phenobarbital. It’s not just a teen’s disease and it can have many causes.

Acne affects all races, too. Though more prevalent among Caucasians, blacks, Hispanics, Asians and others all get acne from time to time. Treatments are essentially the same for everyone.

Hormones and Sebum

It’s no accident that acne tends to be associated with teens. It strikes over 85% of us during those years. It’s at that stage of life when hormone levels rise sharply. Androgen levels increase in both males and females.

Among other effects, those stimulate the sebaceous glands that produce sebum, the natural oil found in hair follicles. The largest increases occur in the face, back and upper chest – right where acne tends to concentrate. The result can well be an outbreak of acne.

Increased oil or sebum isn’t generally a problem if it reaches the surface. It’s spread around, and often washed off with alcohol or soap and water by those who take good care of their skin. Still, blackheads may form as a result of the excess oil.

Worse, pores can close, causing them to become clogged with that excess oil. That encourages the growth of whiteheads. Also, the resulting pressure can cause follicles to rupture. The bacteria have a more ‘friendly’ environment in which to grow. At the same time, bacteria and the white blood cells that deal with it (normally without any problem) get trapped. The result is pus and inflammation. Acne.

Stress itself doesn’t produce acne, but it can make it worse by increasing hormones. It also contributes to weakening the immune system, thus leading a less effective defense against invading bacteria. But it’s not a major factor.

Drugs

Certain drugs can encourage the development of acne. Barbituates and tetracycline are known to be among the culprits. Anabolic steroids are widely recognized by professional dermatologists to be a major contributor among those who take them. Forgoing these, except for specific medical purposes, helps reduce the odds.

Heredity

Genetics plays a role, as well. How large, is still not yet quantified. The area is one of active research, and therefore the exact mechanism isn’t detailed. But, statistics show that acne does tend to run in families. That may be partly due to diet or other common family circumstances. But it’s more a factor of inheritance.

Diet & Skin Care

This is a much more minor cause than is commonly supposed. While certain foods are themselves greasy, that doesn’t translate directly into increased oil in the skin. Of course, poor eating habits often go hand in hand with poor skin care practices. And, any food that tends to increase the production of sebum (oil) or certain hormones will have an effect.

But no study suggests that the common culprits – soft drinks, chocolate and greasy cheeseburgers, among others – play a large role in producing acne.

Poor cleansing habits play some role, because bacteria that lie near the surface sometimes remain ‘unmolested’. Regular use of a good cleanser can help. Take care that the skin doesn’t become excessively dry, however. That causes other problems.

Also, heavy dirt or even makeup can contribute to a problem by blocking the pore, especially if they block oil ducts. But surface dirt itself isn’t responsible for acne. The dark head on blackheads is the result of exposure to air, not trapped dirt.

There’s little one can do about heredity, and passing through the teen years is a normal part of life. But good skin care, quick treatment at the onset of symptoms and other controllable choices will help keep acne at bay.

Knowledge is the first weapon. In order to know how best to treat acne, it’s essential to know what type one has. A professional diagnosis can be helped immensely when the patient takes careful notes about his or her condition. When it started, the type of blemishes and any treatments already tried are big aids to a correct diagnosis.

Knowledge also helps avoid many of the downsides associated with the disease. There are numerous myths surrounding the causes and treatments of acne. There are good reasons to avoid excess chocolate consumption and drinking too many soft drinks. Avoiding acne is not among them. Nor will a good suntan get rid of it.

Knowledge also helps reduce the prospect of useless guilt and depression. Acne affects nearly everyone at some time in life, some more severe than others. Good skin care is extremely helpful for a variety of reasons, but it has little to do with whether one gets the disease. Still, it can play a role in strengthening only overall skin health, as well as improve the mental outlook that helps combat the condition.

Knowledge of acne will help males and females more effectively deal with the condition, since it affects them differently. Acne tends to occur earlier in pre-teen to teen females, but more severely to males once they contract it. Later, the situation is altered.

Men and women may need different approaches to treatment, as well. Makeup, shaving and other gender specific practices play a role in dealing with acne. The two sexes react to medications differently, in part because of hormonal variations between the two. In some instances, simple mild cleansing and time is enough to treat acne. In other cases, more stringent efforts are required.

But over the counter medications can be equally effective for both sexes, as can prescription drugs. Light treatments and lasers, though sometimes more expensive, can be used to treat acne in nearly everyone.

Even effective treatments, though, don’t totally eliminate the possibility of acne scarring. Dealing with that opens up a whole other range of treatment options to explore. Dermabrasion, laser resurfacing and other techniques have helped millions safely.

No matter your age, gender or circumstances the treatment of acne has advanced to a stage that the odds are very good for total cure. The first step requires nothing harder than a little research…

Isotretinoin (Accutane)

Accutane is one of the oldest, and among the most effective, prescription medications for the treatment of moderate to severe acne. It is used on cystic and other advanced forms and has been used safely by millions for that purpose. But it does have some potential side effects and risks.

Pregnant women are generally advised to avoid taking isotretinoin. Several studies have suggested that it can produce birth defects. It’s a synthetic molecule, a retinoid similar to Vitamin A, available in pill form. As such, it can be abused. Normal dosage is once or twice per day for 4-5 months.

It works to reduce oil production, unclog pores and kill the bacteria that contribute to acne. It can also cause headache, excessive skin dryness, diarrhea and other problems. However, like all side effects, everyone is affected differently. That’s one of the major reasons it’s important to see a professional regularly during the course of treatment.

Oral Antibiotics

Acne is caused, in part, by a bacteria (Propionibacterium acnes). So, the disease can be combated, in part, by taking antibiotics. Like all powerful antibiotics some care is necessary when using these.

Tetracycline (or its derivatives, doxycycline and minocycline) is one of the most commonly used. Both forms have been in use for many years and can substantially reduce inflammatory acne. Normal dosage is 5-10 grams per day at first, though it’s reduced as treatment progresses. Treatments may take several months. It, too, though carries some risk. Some patients’ skin becomes sensitive to the sun during treatment.

Erythromycin is another common treatment for acne. It’s a broad spectrum antibiotic and can kill Propionibacterium acnes effectively. Like any powerful antibiotic, though, it can sometimes cause gastrointestinal irritation. That’s a major reason it’s a prescription drug.

Topical Treatments

Some topical antibiotics can attack the Propionibacterium acnes bacteria directly through the surface of the skin. They’re typically used to treat less severe cases of acne. They may even be used in cases of acne vulgaris, a mild form.

A number of retinoids are sometimes prescribed. They may be the same compound used in over the counter medications, but in dosages high enough to warrant or require a prescription. Adapalene is a gel or cream that is usually effective within two or three months. It can cause minor skin dryness and irritation. It helps unclog pores. Tretinoin is a natural retinoid that has similar effects.

Anyone who has tried over the counter medications or treatments and not received satisfactory results has many other options. Nearly all acne can be successfully treated. Get a professional diagnosis to explore your options.

But more severe forms, where nodules or cysts form, where papule or pustules have spread around the face, shoulders and chest often call for a visit to the dermatologist. These skin professionals will obtain a complete history and carefully examine the affected areas. They’ll note the color, number and size of outbreaks.

The acne may consist of a field of small, white bumps called whiteheads. These will often disappear on their own. Blackheads form when the material reaches the surface, where it combines with air to form the characteristic dark color. These two are called, respectively, closed or open comedones. A good antibacterial cleanser and time may be all that’s needed.

In the more severe cases, where nodules or cysts form, the patient may have other symptoms we don’t commonly associate with acne, such as fever and aching joints, or even headaches and GI (gastrointestinal) distress. These indicate more serious types of acne, calling for more specialized treatments, such as prescription drugs or lasers.

When symptoms appeared, and in what order, is important. Typically, only the patient can provide that information. It’s useful to keep track by keeping a log. Note what type of lesion occurred before the appearance of any pustules and when.

Along the way the dermatologist will, naturally, attempt to rule out any alternative explanations.

Certain insect bites, such as mosquito or spider bites, can temporarily resemble acne. Mosquito bite lesions, left alone, will disappear in a day or two for all but those who are allergic. Spider bites are often harmless, but some may be poisonous and lesions can spread. That calls for entirely different treatment from acne.

Rosacea is a common skin disorder that differs from acne in several respects, but still forms papules and red pustules. Keratosis pilaris produces small bumps that may resemble whiteheads. Miliaria rubra, or heat rash, produces small red bumps. All of these would call for very different treatment from acne.

Similarly, many allergies can produce skin lesions, redness and many other symptoms similar to acne. Sexually transmitted diseases are a common ailment. Sometimes they actually produce acne, but they can cause other skin problems, too. Herpes, for example, may show up as red, painful bumps on the buttocks.

Certain drugs can actually cause acne. Anabolic steroids, lithium and prednisone, are common today. Phenobarbital and tetracycline can cause acne. Dermatologists will require a complete and honest history of drug use in order to make a proper diagnosis.

Sometimes, even excess use of Vitamin B complex can cause acne. The doctor will need to know about diet, supplements and whether any over the counter medications or remedies have already been tried.

Knowing as much as possible about your own skin and the history of any outbreaks will aid proper diagnosis. That, it should go without saying, is key to any proper treatment. 

True scars are a permanent change to skin tissue produced by the healing process itself, chiefly creating fibrous tissue. As white blood cells attack bacteria they can produce changes in underlying skin cells in the surrounding area. This is one way scars become permanent.

They may also not be limited to areas under the surface.

So-called icepick scars are small pinholes that form in the surface of the skin. They look as if the skin has been poked with an icepick, hence the name. They’re typically too deep to be treated with simple dermabrasion or even laser resurfacing.

Boxcar scars are similar, except they tend to be flatter on the bottom, rather than narrowing to a point like icepick scars. Since they’re often shallower they can sometimes be treated with resurfacing techniques.

Keloid scars are firm and grow beyond the site of the injury. They’re characterized by an excess production of collagen. They often result in a shiny pink or red scar.

Prevention is the best option, of course. But when that’s not possible, there are a number of standard treatments.

Dermabrasion

Dermabrasion is used to treat a wide range of skin conditions, including mild to moderate acne scarring. A local anesthetic is given and the professional uses a high speed brush to remove layers of skin. The skin then naturally regenerates, minus the scar in many cases. When it’s not entirely removed, it’s often less obvious.

A variation on the technique is known as microdermabrasion. Instead of a high speed brush, aluminum oxide crystals are moved rapidly through a type of vacuum hose. They carry away skin cells on their way to being collected. It’s less invasive or traumatic to the skin, but the results may, therefore, be less.

Lasers

Laser treatment can be effective for some patients. Used well, they can change the contour and size of scars. CO2 lasers are often used to remove some tissue. Sometimes a single treatment is enough, but redness can persist for several weeks afterward. Lasers work in these types of treatment, essentially, by burning.

Surgery

A technique called ‘punching’ can be used to remove some icepick scars. The scar is excised down to subcutaneous fat and the resulting hole repaired. The repair may be done with sutures or a small skin graft.

Subcisions may be performed. These involve actually lifting the scar tissue away from unscarred skin. Results are mixed, but the technique can be effective.

Drugs

Keloids don’t respond well to these mechanical techniques, since altering the skin often just provokes the formation of more keloids. Sometimes a topical retinoid is applied. In other cases steroid-type drugs are injected directly into the skin around the scar. They’re difficult to treat by any means and results vary widely from person to person.

Whatever treatment method you seek, it’s important to consult a professional for proper diagnosis. That’s the best way to find out about all the available alternatives, and their potential risks and benefits. 

Diet

There’s no direct link between eating chocolate or greasy cheeseburgers and developing acne. Soft drinks do not increase the odds. What is true is that diet plays a role in all the body’s systems, and so has a minor part in whether acne is more or less likely.

For example, eating greasy foods doesn’t directly translate into increased oil production from the sebaceous glands that contribute to acne. But foods that do increase the oil production would. However, excess iodized salt is the only food substance that has been shown to have any substantial effect. It only worsens existing acne. It doesn’t cause it.

Hygiene

Diet and hygiene are closely linked. But that’s more because people tend to have habits. People who have a non-nutritious or unhealthy diet tend to have poor hygiene habits as well. But even here the influence on the development of acne is minor at best.

The odds of acne are increased when a pore gets plugged and bacteria are trapped inside. White blood cells rush to the area to combat the bacteria. Trapped dead skin cells contribute. The result can be inflammation and the creation of pus, a component of one type of acne.

So, hygiene habits that tend to close the pores can play a role. But the effect is minimal. The dead skin cells and bacteria that get trapped, and can’t make their way out of the pore to the surface, are only somewhat influenced by whether a person washes the face regularly and well. After acne occurs good skin care is particularly important, though.

A mild cleansing twice a day with soap and water, not heavy scrubbing several times per day, is best. That helps encourage healthy skin in general.

But acne is strongly influenced by excess sebum production (a natural skin oil), triggered primarily by hormones. Good hygiene is a good idea for many reasons. But it helps more in treating acne that has already occurred by providing a good surface for medications to do their work most effectively.

Harsh cleansers applied roughly don’t just clear away the excess oil that plays a role in acne formation. Rather, it weakens the skin’s ability to deal with it. Also, contemporary makeup formulations will rarely increase the odds of forming acne.

Stress

As a factor that weakens the immune system and influences hormones, stress might be thought to play a role in the onset of acne. But no clear correlation is found in major studies. Stress can have a small effect on acne that has already formed, but as a possible cause it ranks very low on the list.

Here again, though, people who experience excess or chronic stress tend to be in the cluster of those who have other health problems. Always a good thing to avoid. Keep in mind that stress and being challenged by ordinary life events are not the same thing. Stress occurs when someone thinks they’re not up to the task of dealing with those challenges well.

Medication

Increasing the dosage of over the counter (or, worse, prescription) medications to treat acne is harmful, not helpful. At best, it wastes medication. At worst, it can actually harm the skin. Stick to the recommendations on the instructions. If over the counter medications don’t clear up the condition within a couple of weeks, seek the guidance of a dermatologist for better treatments. 

Some believe, mistakenly, that a thorough scrubbing will help prevent acne. Actually, washing has little effect on whether acne develops or not. The effects occur mostly afterward, once acne has occurred.

Scrubbing doesn’t help, in general, though. It merely roughens and often dries out the skin. Harsh treatment of skin exposes lower layers, which then have to develop a protective coating of oil and outer dermis. In the interim, the skin is exposed to airborne and contact bacteria. The skin is our first defense against pathogens of all kinds. Removing multiple layers of it doesn’t promote good skin health.

Instead, a gentle washing with a mild cleanser is the answer. Be thorough. Since acne can occur on shoulders, back and chest as well as the face, take care of those areas in the shower. During mid-day and in the evening, a mild cleaning from underneath the jaw to the hairline is helpful.

While natural skin oil (sebum) plays a role in developing acne, removing every trace of it is not beneficial. Sebum helps keep skin flexible, which discourages microcracks from forming. These can provide a pathway for bacteria. It also keeps the skin from becoming excessively dry, which can again lead to small cracks in the outer layers.

Astringents that remove oil should be used sparingly. Over the counter acne treatments are specially formulated to achieve the right balance. They should be used according to the directions.

Shaving is always a challenge, of course. Men’s faces are the hardest problem to solve. Electric razors help solve it, but even they can nick the skin, especially when it contains blemishes. There’s no substitute for patient, careful movements. Use of a pre-shave softener can help, too.

Use of a manual or safety razor is possible. It plays a negligible role in developing acne. An ingrown hair and clogged pores that produce acne follow from different causes. Don’t backshave against the direction of hair growth, though. Softening the beard before shaving with warm water and soap can help smooth the process.

For women, there are other helpful recommendations.

Makeup selection is easier these days. There are numerous formulations that specifically address the possibility of acne. They are designed not to clog pores. Going light on the foundation can help. Subtle cheek blush is better than slathering it on. Look for makeup labeled ‘non-comedogenic’. ‘Comedones’ is a general term for the most common types of mild acne, including blackheads and whiteheads.

An over-the-counter antibacterial can help prevent acne, but is most helpful after it has developed. But follow the directions. Over medicating can lead to clogged pores and damaged skin, exactly the conditions that tend to promote acne.

Keeping pores open in order to allow for natural oil movement and shedding dead skin cells is key to minimizing outbreaks. Proper skin care practices aid both. 

Professionals recommending a course of treatment will rank acne by Grade.

Grade I includes milder, non-inflamed types such as blackheads, whiteheads or milia. Grade II involves a larger number of these, and frequently includes papules or pustules that are mildly inflamed.

Papules are small lesions, a change or break in the skin, that is smaller than 5 mm – about the width of a thin cigarette. They’re in the form of a bump that rises above the surface. A pustule, by contrast, is pus-filled – a mixture of bacteria, white blood cells and dead skin cells.

Grade III is more severe. The papules or pustules will be red, larger and more numerous. Grade IV is the most severe level, and includes nodules and cysts. The inflammation is usually wide spread and includes more than just the face.

Acne vulgaris is the common form of mild acne. Any of the Grade I forms will fall under this heading. They can usually be treated with over the counter medications.

In more severe form acne can develop into a type known as acne congoblata. The name may sound amusing, but the condition is anything but. It’s characterized by heavy inflammation and deep abscesses. The result is often scarring and other forms of serious skin damage.

Inflamed nodules will form around comedones – a general term for blackheads, whiteheads and milia. They often grow until they spontaneously discharge pus. While they do, they’re painful. When they do, they’re unsightly. Keliod-type scars are commonly left behind.

Another type is known as acne fulminans. Here, the nodules will often ulcerate, leading to a painful and recurrent form of acne. The person afflicted may even develop a fever or aching joints. Treatment with corticosteroids or NSAIDs (non-steroidal anti-inflammatory drugs) is usually called for. But these treat symptoms, not the underlying cause.

In still more severe forms, a person may develop nodulocystic acne. Cysts form (red bumps produced by severe inflammation), but they’re of an unusual type. Sometimes they become numerous and close enough together to form a larger inflamed area. When they form small tunnels under the skin, infection can spread more readily. A treatment of antibiotics is called for, and isotretinoin (brand name: Accutane) is frequently employed.

Gram-negative folliculitis occurs when the follicles – the shaft in which hairs grow and sebum flows from the sebaceous glands – become infected. Bacteria grow inside and the body responds by dispatching white blood cells to fight the infection. The result is a deep eruption that calls for special treatment.

The type of bacteria that produces it may be resistant to normal antibiotics. In fact, the condition may have resulted from treatment of other types of acne treated with antibiotics.

Proper diagnosis of these forms of acne calls for a visit to a professional. A dermatologist’s care is warranted in these cases, as it may be in other forms of severe acne.

In the surface of the skin are pores, tiny openings called a hair follicle. Deeper inside the pore, near the base of the follicle, there are sebaceous glands that produce sebum, a natural type of oil. That oil helps keep the skin flexible and protected.

Hair continues to grow through the surface, while oil or sebum oozes out the side and is spread around the area. Skin cells grow and die and are sloughed off through washing, rubbing or spontaneously. But that process can be interrupted when the pores close and when bacteria form inside them. The result is acne.

The white pimples that sometimes form are usually a combination of dead skin cells, white blood cells and bacteria. The trapped pus often creates an inflamed, red area around it. The term ‘pus’ is an adaptation of ‘pustule’, a type of acne that results when the follicle wall bursts and the white blood cells rush into the area as part of a healing process.

When the tiny bumps or spots appear black they’re called blackheads, naturally enough. They’re a non-inflamed form of acne that come from the material having poked through the surface. Their dark color isn’t the result of contact with dirt on the skin. It’s a combination of dead skin cells and sebum that have oxidized. Oxygen in the air causes a chemical reaction that turns them black.

Often, however, the material doesn’t break the skin, but simply pushes it up, forming a small, white bump called whiteheads. One form are known as ‘milia’. Normally dead skin cells will get washed off or simply fall off the surface. But they can get trapped underneath the surface. This type of acne is common among infants, but can affect people at any age.

All these variations go by a general medical term called ‘comedones’, and whether that formation is open or closed is part of the clinical difference between them.

As the acne develops it can variously form what are called papules, nodules or cysts. A papule forms when the walls holding the hair follicle burst near the surface. They’re small and don’t contain pus. A nodule is a hardened lump under the skin, resulting from a break at the base of the follicle. A cyst is a larger, reddened bump. They’re soft, but can be very painful.

Naturally, while it’s helpful to know what acne is, the most important thing is to be able to treat it. In order to do that, it’s necessary to know what type we have. We turn to that next…