There’s a very high chance you will have experienced acne at some point in your life. In fact, the NHS states about 95% of people aged 11 to 30 are affected by acne to some extent, and it can continue into later adulthood, too.

But despite it being so common, it’s a subject that can often be riddled with overwhelm and confusion. So we asked Dr Anjali Mahto, consultant dermatologist at Self London, to break down everything we need to know about acne.

From different types, ranging from blackheads to cysts, to the most common causes (who knew we inherit the size and activity of our oil glands from our parents?) and the best ingredients to treat it, here’s your definitive guide to acne.

“Acne is a disorder of the pilosebaceous unit of the skin,” explains Dr Mahto. “This consists of a hair follicle and its associated sebaceous or oil gland. Blockage or inflammation of the pilosebaceous units will result in acne.”

While acne is typically associated with faces, Dr Mahto says that oil glands are found in highest density on the face, back and chest, meaning acne is more prevalent on these areas.

She adds: “Acne is increasingly being considered a chronic disease. This means that while it may be controlled, there might be no long-term cure: treatment can be successful but acne can recur over time.”

Type ‘acne’ into Google Images and you’ll see numerous pictures of red, inflamed skin. However, there are several different forms of acne.

“Some acne is non-inflammatory and starts as blackheads and whiteheads, also known as open and closed comedones,” says Dr Mahto. “These are the result of blocked pores and look like little bumps under the surface of the skin.

“Over time, acne can become more inflammatory. Inflammatory acne manifests as small red bumps (papules) or pus-filled spots (pustules). In some cases, acne becomes more severe and results in extremely tender, red spots known as nodules or cysts. This is sometimes referred to as cystic acne and can often result in scarring and therefore requires more aggressive treatment.

“It’s very common for someone to have a variety of types of acne, for example, blackheads as well as pustules.”

As there are many different types of acne, it can present itself in lots of different ways, too. Here, Dr Mahto breaks down the characteristics of different types of acne.

Blackheads: “Small black dots on the surface of the skin. They were originally whiteheads but they have oxidised over time resulting in their black appearance.”

Whiteheads: “Small white dots on the surface of the skin. If left untreated, these will turn into blackheads over time.”

Papules: “Red bumps on the skin’s surface but aren’t filled with pus.”

Pustules: “As above, but are filled with pus as the spot has become infected.”

Nodules: “Harder red bumps on the skin’s surface. They don’t tend to have a white or blackhead at the centre of them.”

Cysts: “Deep, painful red spots that are incredibly tender to the touch.” 

There are many reasons behind acne, but Dr Mahto states the main two are puberty and genetics.

“As we hit puberty, our bodies start to produce male hormones known as androgens – in particular, the hormone testosterone,” she says. “Women also produce androgens, albeit in smaller quantities than men. These androgens act on the oil glands, causing them to increase oil production.

“At the same time, cells lining the hair follicle become ‘sticky’ and start clumping together in a process known as follicular hyperkeratinization.” (We had to sound that word out to ourselves, too.)

Dr Mahto adds: “The end result is that pores become blocked with sticky skin cells and excess oil. A bacterium known as C. acnes, which lives on the skin, can then colonise these areas, stimulating inflammation and deeper spots.”

However, somebody can experience acne for the first time as an adult, too. “Acne when you’re older can have a different impact psychologically on a patient,” says Dr Mahto. “When I have people who present with acne in my clinic, but they’re in their 30s or beyond and have previously never had acne, they often assume that acne is something that teenagers get. This can be difficult to get one’s head around but the truth is acne can affect anyone, at any point of life. It’s just more common during adolescence.”

Then there’s the matter of genetics: Dr Mahto says the size and activity of our oil glands is inherited from our parents. “Many people who have acne are likely to have relatives that have also been affected during their lifetime – though this isn’t always the case; I seem to be the only unlucky member of my family that gets spots! Either way, there are always effective treatment options available.”

Dr Mahto adds that there are some other, less common, causes of acne which include:

• cosmetics
• hair-styling products such as waxes or gels, which contain ingredients like lanolin, beeswax and petroleum jelly
• medications (eg corticosteroids, lithium, iodides)
• medical conditions that can cause hormonal fluctuations (eg polycystic ovarian syndrome, in which androgen levels are higher than usual)
• occlusion from wearing headbands, shoulder pads and backpacks

At-home treatments

“To start with I recommend stripping your skincare back to some basic essentials and look for ingredients including salicylic acid,” advises Dr Mahto. Here, she breaks down what a routine could look like.

AM:

• Cleanse with a gentle cleanser, such as La Roche Posay Effaclar H (£16).
• Sunscreen such as Heliocare Oil-Free Gel Sunscreen (£24.99). Often acne-prone skin types can avoid moisturiser as sunscreen is moisturising enough.

PM:

• Remove makeup with micellar water if you’ve been wearing it.
• Cleanse with a gentle cleanser, such as La Roche Posay Effaclar H again.
• Apply a salicylic acid-based product, such as Paula’s Choice BHA 2% Exfoliant (£34).
• Moisturise with a basic cleanser, such as the CeraVe PM Moisturiser (£15.50).

Dr Mahto adds: “Consistency is key here and so I would recommend trying this for a couple of months. If you see no improvement, then it would be worthwhile booking in with either your GP or a dermatologist to get a formal diagnosis and treatment plan.”

In a skin practice

“I will start by taking a thorough medical history of the patient,” says Dr Mahto. “Then I will take a good look at the skin under a magnifying glass. From there, I will recommend a course of treatment. This is dependent entirely on the type of acne the patient is presenting with.

“Sometimes, the acne is cystic and aggressive treatment will be required to prevent scarring. This would include taking medications such as isotretinoin. Other forms of treatment can include antibiotics, prescription topical creams such as adapalene, as well as overhauling their skincare routine.

“In clinics, lasers and peels can also be incredibly helpful in improving acne and we often find a combination of the above leads to some incredibly impressive results.”

Shoppers are becoming a lot more aware of the skincare formulations they’re buying. However, it can be difficult to know what is best for your individual skin concerns.

“Some of my favourite ingredients for acne include salicylic acid, which is a beta-hydroxy acid that helps to unclog pores,” says Dr Mahto.

“I also really like benzoyl peroxide, which you can get at the pharmacy. This ingredient helps with C.acnes bacteria but please note that it can stain towels, so it’s important to wash your hands thoroughly after applying.

“Beyond this, retinoids (which is the name for vitamin A and its various different forms) can be especially helpful as they help with skin cell turnover which is especially important when one has acne. I personally like retinaldehyde as it’s directly antibacterial and fantastic for those with acne-prone skin.”

This article is part of Skin Freedom, a Stylist Love Women series that aims to champion the reality of women’s skin in all its glory.