Active Acne: Causes and Medical Treatments

Acne develops when dead cells clog the pores and sebum, the oily substance produced by the sebaceous glands, builds up behind this plug. Bacteria present in the pores contribute to the plug and to inflammation. Acne is therefore not merely an infection, and it is not a sign of dirty skin: it does not reflect your hygiene habits. Bacteria, hormones and stress contribute to flare-ups, but none of them has been shown to be the cause on its own.

In adults, several factors contribute, and none explains everything. Hormonal changes play a role, but they are not the only cause. Stress is linked to flare-ups. Certain medications can cause pimples or make them worse: if you suspect that your medication is contributing, keep taking it and talk to the doctor who prescribed it.

The links between diet and acne remain uncertain. A specific diet cannot be recommended on its own to treat acne: treatment and assessment still have their place. Nor is there a food that everyone should cut out. Vitamin B12 supplements have been linked to a change in the activity of skin bacteria in some people; this does not mean that they cause your acne. If this supplement was prescribed for you, talk to the prescriber before changing how you take it.

Are you wondering whether cannabis contributes to your pimples? An association with acne is not enough to make it the cause of your flare-ups. Raise this question during your consultation, along with your medications and supplements.

A blackhead is an open comedone, and a whitehead is a closed comedone. A papule is a raised red pimple; a pustule is a red pimple that contains pus. A nodule is a deeper lesion, under the skin. These lesions can occur together on the same face.

Severity is not determined using a score you calculate yourself. It is assessed based on the extent of the lesions, their depth, the scars they leave and their effect on your mood. Severe acne covers a large part of the face, back or chest, with many pimples, deeper nodules and cysts, redness and inflammation. Yet acne that is not widespread can still weigh heavily on you: how you feel matters as much as the number of pimples.

Only the doctor can confirm, on examination, that your pimples are acne, by looking at the lesions and how they are distributed. The doctor also rules out conditions that look similar, such as rosacea, folliculitis or a rash caused by a medication. What is sometimes called acne rosacea is a form of rosacea, not acne: blackheads and whiteheads point to acne, persistent redness in the centre of the face points to rosacea, and a single one of these signs is not enough to tell them apart.

For your facial skin care, cleanse gently: washing more often, scrubbing, exfoliating or using harsh cleansers and alcohol-based lotions irritates the skin and can make acne worse. Choose moisturizers and sunscreens that are non-comedogenic, meaning formulated not to clog pores, and oil-free. Repeatedly squeezing or picking at pimples increases the risk of scarring. These habits support treatment; they do not replace it.

Treatments prescribed during a medical consultation that are applied directly to the skin are part of acne management. Some act on clogged pores and calm inflammation. They can be combined, because acne has several components and not every treatment acts on the same one. The choice of treatment and how to apply it depend on the lesions you have and how well your skin tolerates it.

Early on, many of these treatments dry out the skin or make it peel or turn red, and sometimes more pimples seem to appear at first. Report these reactions to the prescriber so that the treatment can be adjusted. Do not let significant irritation continue without telling the prescriber.

A treatment is called systemic when it is taken by mouth rather than applied to the skin.

Some treatments taken by mouth are considered for moderate to severe inflammatory pimples. Their limitations differ from one option to another: some do not work on nodular acne, which is one of the reasons the choice is made during a medical consultation, never indiscriminately.

Among these options, those that act against bacteria are used for as short a time as possible, because repeated use causes bacteria to become resistant. The prescriber chooses the shortest duration and monitors how your acne responds.

For severe acne, or when the usual treatments, applied to the skin or taken by mouth, have not been enough, a particular systemic treatment can be considered during a consultation. Deep lesions and the risk of scarring are factors in this decision.

This treatment can reduce severe acne, sometimes making it disappear; it does not guarantee that the acne will not come back. If flare-ups return during or after treatment, talk to the prescriber to reassess your treatment plan.

This option can also dry out and irritate the eyes. Mention these symptoms to the prescriber: they are among the effects to discuss at follow-up, even if the pimples are improving.

This treatment can cause serious birth defects in an unborn child. If you are pregnant or planning a pregnancy, say so before any discussion of treatment. A doctor assesses each person before prescribing it, then monitors them during treatment. You and the prescriber clarify which tests and pregnancy prevention measures apply.

Allow at least six to eight weeks before you notice fewer new flare-ups. This is the guideline for the first signs of improvement, not for all lesions to disappear or for treatment to end, and the timing varies from one treatment and one person to another. Note the start date, how often you actually use the treatment and how your skin reacts: at follow-up, these notes help distinguish between not having used the treatment long enough, poor tolerance and an insufficient response. A relapse can occur during or after treatment; if it does, talk to the prescriber to reassess your treatment plan.

There is no medication that is the most effective for everyone: no acne treatment suits every person, even though the goals are the same. The choice is based on the type of lesions, their severity, how well your skin tolerates treatment, your medical history, your medications, the treatments already tried and whether you are pregnant. It is reassessed over time.

The realistic goal is to reduce flare-ups with a treatment your skin tolerates, observe how your skin responds, then reassess. The result and the timing vary from person to person; no treatment suits everyone. In adult men too, pimples that are still present must be distinguished from the marks left after a flare-up. On medium to dark skin, particularly skin types IV to VI, a darker spot is not an active pimple: treating flare-ups and fading these marks are two different goals. The choice is discussed based on your lesions and your skin, without assuming that one option is appropriate for all skin tones.

Controlling active acne helps prevent new scars by reducing inflammation. Repeatedly squeezing or picking at pimples increases the risk. No method guarantees that no scar will form.

An acne scar can be indented, with a loss of tissue, or raised, with excess tissue. A darker spot, known as post-inflammatory hyperpigmentation, appears after irritation or an injury to the skin: it is neither an active pimple nor a scar, whether your skin is medium-toned, dark or any other tone. Peels, procedures that target individual scars and fillers are used for acne scars that have already formed, not for pimples that are still present. These options are discussed according to the indentations or raised areas to be corrected.

In adulthood, hormones fluctuate, affecting acne in many women: around their periods, during pregnancy, in perimenopause and menopause, and when starting or stopping hormonal contraception. That is why acne can appear for the first time around age fifty. These fluctuations are not enough to conclude that there is a hormonal imbalance, and they do not mean that a treatment needs to be changed or stopped: do not change anything without talking to the doctor who prescribed it. Instead, note when your flare-ups occur, the products you use and your current treatments: this information helps identify what contributes to them. See a doctor if acne appears suddenly in adulthood with irregular periods or increased hair growth, or if it leaves scars or spots.

Acne is described as hormonal when flare-ups seem to follow hormonal changes. Pimples on the lower face are not enough to conclude that the cause is hormonal. The doctor examines the skin and takes your medical history into account.

If you have polycystic ovary syndrome (PCOS), tell the doctor about this diagnosis and your current treatments; your pimples cannot be used to diagnose it. If you suspect endometriosis, discuss it in a separate consultation: do not assume straight away that it is causing your pimples.

Any medication that acts on hormones is considered a hormonal treatment. For some women whose acne persists, the doctor may discuss this approach after examining the skin and gathering information about your health. This approach targets the effects of hormones; it is different from treatments that target bacteria or clogged pores. It does not suit everyone; results vary from person to person.

Some hormonal options increase the risk of blood clots, heart attack and high blood pressure. So mention your medical history of blood clots, heart disease, high blood pressure or migraines, as well as your medications, supplements and natural health products. Also say whether you are pregnant or planning to become pregnant. After an examination, the doctor determines what would make an option unsuitable for you.