All You Need to Know About Acne

Pimples are a teenage rite of passage - a sign of growing up and entering adulthood. But they sure can be pesky, especially if they are persistent. “I didn’t experience nearly as much acne in my teenage years as I did in my twenties,” says Erica M, a creative consultant who has had a long relationship with acne. “I made several mistakes and spent a lot of money self-diagnosing my acne by buying serums or ampoules, only to end up exacerbating the issue. Eventually, I visited a dermatologist who made me do some blood work and prescribed a no-nonsense skincare routine along with oral medication that helped clear out most of my acne. If only I had the wisdom to visit my doctor sooner than get swayed by social media.” 

If this sounds like you, you’re not alone. More and more brands and beauty influencers are convincing people that a 9-step regimen is the answer to ‘flawless’, ‘glass’ skin. Unreasonable beauty standards continue to pressure people to look a certain way. While pockets of the internet have begun celebrating Photoshop-free and makeup-free beauty, it is important to consume online content with a grain of salt, especially regarding your health. And, yes, your skin is very often a reflection of your health.

All acne is not the same. It is often a result of pre-existing health conditions - such as PCOS in people with a uterus or other causes, such as hormonal imbalances, lifestyle changes, stress levels, and much more. There’s a lot to it that cannot be decoded without the intervention of a medical professional. 

While both the terms are often used interchangeably, there’s a key difference between the meaning of acne and pimples.

Acne, or acne vulgaris, is a skin condition that occurs when your pores become clogged. This clogging is caused by a combination of factors, including excess oil production, dead skin cells, bacteria, etc. According to Dr Sanjeev Gulati, M.D, Dermatology & Venereology, acne is an overall skin condition characterised by inflammation, clogged pores, and the formation of pimples. It is the umbrella term encompassing the entire issue. 

On the other hand, pimples are one of the symptoms of acne. They are the visible bumps and blemishes that appear on your skin. So, every pimple is a sign of acne, but not everyone with a pimple has acne. A single pimple might occur occasionally due to other factors like hormonal changes or clogged pores without signifying an underlying acne condition. 

Acne is caused by a combination of various factors.  Some of them include:

These tiny glands attached to the hair follicles produce sebum, an oily substance that hydrates your skin. However, hormonal changes or individual susceptibility can lead to excess sebum production, causing blockage.

Usually, these cells shed naturally. But sometimes, they can clump together and stick within the pore, forming a plug. 

This bacteria naturally lives on your skin. When pores are clogged, C. acnes can multiply rapidly, leading to inflammation and blemishes. 

Dr Gulati explains that “Acne isn't contagious, so you can't "catch" it from someone else's skin. Instead, it's usually due to factors like hormones, genetics, what you eat, medications, and how you care for your skin. Also, things like wearing tight clothes or helmets, using harsh skincare products, or feeling stressed can all play a role.” He also says that sharing makeup, or makeup applicators and brushes, can transfer acne-causing bacteria, dead skin cells and oil to the other person’s skin. 

Emerging research suggests that inflammation plays a key role in the development of acne. When inflammation is combined with C. acnes, excess sebum, and dead skin cells, it sets the stage for acne to thrive.

Another factor that causes acne is stress. When you're stressed, your skin feels it, too. Dr Gulati says, “When stress hits, it disrupts our skin's endocrine signals, throwing everything off balance and causing increased inflammation and sebum production, which leads to breakouts.”

Also known as open comedones, blackheads are small, dark-coloured bumps on your skin when the hair follicles get jammed with dead skin cells and sebum. The dark colour comes from the oxidation of exposed sebum and debris. Blackheads are typically found on the nose, chin, and forehead.

Whiteheads are also known as closed comedones. Whiteheads are small, white, or flesh-coloured bumps resulting from choked hair follicles due to excess oil and dead skin cells. The difference between blackheads and whiteheads is that the latter are covered by a thin layer of skin, which prevents oxidation and keeps them from turning dark. Whiteheads are usually found on the face, chest, and back.

Papules are small and red, and bumps we get on the skin cause inflammation and irritation. Papules are usually tender to the touch and can be itchy or painful. They are generally found on the face, chest, and back.

Pustules, like papules, are small red bumps. The primary difference between the two is the presence of pus in pustules, giving them a white or yellowish appearance. This pus is a combination of dead skin cells, white blood cells, and bacteria. Pustules are often tender to the touch and can be painful or itchy. They are commonly found on the face, chest, and back.

Nodules are larger bumps, leading to inflammation and irritation. Unlike papules and pustules, which are superficial, nodules extend deeper into the skin layers. They may be tender to the touch and are typically more painful than other types of acne. Nodules are commonly found on the lower face, chest, and back.

Cysts are big, swollen bumps causing inflammation and pain. They're similar to nodules but filled with pus, made of white blood cells, dead skin cells, and bacteria. This pus can make the cyst even more painful and swollen. Cysts are frequently found on the face, chest, and back, often leading to scars.

Erica M shares, “I was a regular pimple-popper. I could not help myself; it was too tempting until I started to observe that I was getting a lot of scars. My dermatologist had to conduct a few sessions of anti-scar procedures to fade them. Now, when I get a pimple, I know to leave it alone.”

Dr Gulati advises against popping pimples or treating acne on your own. Self-treating acne may lead to scarring and hyperpigmentation or worsen the condition by spreading the infection to neighbouring tissue. Moreover, with the rise in information around active ingredients in skincare, it’s easier than ever to shop online for the next trending active. However, you may risk harming your skin barrier if used without caution. Not using adequate sunscreen may lead to hyperpigmentation. 

Research estimates that acne is the eighth most common disease globally. With new medical advancements, acne treatment is becoming more sophisticated. Trust a dermatologist or, at times, an endocrinologist to give you a precise diagnosis of whether your acne is a symptom of any underlying condition and to safely and effectively treat it. 

Medically reviewed by:

Dr Apoorva Raghavan, Dermatologist and Aesthetician