Acne & blemish-prone skin – Symptoms, causes and treatment advice

Acne (full name Acne Vulgaris) is the most common skin condition in industrialised nations and it typically results in pimples and blemishes on the face, neck, back and chest. It usually begins during puberty, in line with hormone changes, and may persist into later adulthood.

This article examines the meaning of blemished skin, what makes skin acne-prone and how best to alleviate symptoms and care for skin.

Although both terms are often used reciprocally when discussing skin that is prone to breakouts and flare-ups, acne and blemish-prone skin do have several differences. 

Acne is a non-contagious skin condition characterised by pimples caused by inflamed and infected sebaceous glands. Blemish-prone skin is skin that has a potential to develop comedones and pimples. It is often oily and appears shiny. This is because the sebaceous glands produce more sebum than in other skin types. 

The condition is most common in adolescents, with 70-95% affected to some degree by blemished skin, and 15-30% will use acne medication to relieve symptoms¹. Symptoms can persist into adulthood and some people, especially women, experience symptoms for the first time after the age of 25. Persistent or late-onset acne is known as Acne Tarda.

Acne typically appears on the face, neck, shoulders, chest and back and ranges in severity from light Acne (known as Acne Comedonica) through moderate Acne (Acne Papulopustulosa) to severe Acne (Acne Conglobata). Learn more about the different types of Acne here.

But Acne doesn’t just affect people’s skin, it impacts on their quality of life too. Acne's psychological impact can be considerable as symptoms can be stressful and cause issues around self-confidence. This is just one reason why it’s important to consult a dermatologist if you are in any way troubled by your skin condition. 

There are a range of effective Acne treatment options available and timely medication can prevent a deterioration in skin condition and subsequent damage, such as hyperpigmentation and scarring.

¹ C.C.Zouboulis, Hautarzt 2014 65: 733-750

Acne is sometimes confused with Rosacea as it can also cause papules and pustules. Rosacea is a hypersensitive skin disorder where facial blood vessels enlarge causing a reddened appearance. Rosacea requires different treatment to acne and you can find out more about how to care for it here. If you are unsure if you have Acne or Rosacea, ask your doctor.

There are several myths surrounding Acne - for example, that people with blemishes are less hygenic than others. Whilst this is untrue, there are several key factors that medical professionals know are likely to make some people more prone to Acne than others:

Genetics
Genes determine our skin type and some of us have skin that is more reactive and prone to inflammation, blemishes and acne than others. If both your parents had Acne there is a higher chance that you will develop the condition.

Hormones
Acne is a hormonal condition. Hormones are responsible for the development of the sebaceous glands and they also stimulate sebum production in those sebaceous glands (an overproduction of sebum is one of the symptoms that defines blemish-prone skin).

The increase of hormones during puberty is the main reason why Acne is most prevalent in adolescence, but hormones continue to effect men and women differently at different life stages. Changes in hormonal levels during the menstrual cycle often causes flare-ups for women in their 20s and 30s, with late onset cases generally known as Acne Tarda. Find out more about the relationship between hormones and Acne here.

Medication
Some medications including antidepressants, antiepileptics, steroids and lithium are known to cause Acne. Prolonged use of antibiotics can also impact on skin health,  potentially leading to Acne.

Acne Fulminans, a rare condition, can also be developed as a side effect of anabolic steroid abuse by some bodybuilders.

Diet
There is some evidence of correlation between diet and Acne. A diet with a high glycemic index and lots of dairy products may trigger or exacerbate Acne. Read more in Acne and diet: the background.

Stress
Stress can trigger hormones which in turn stimulate sebum production and exacerbate Acne. Read more in Acne and stress.

Smoking
Research indicates that smoking exacerbates Acne by causing oxidative stress to skin and altering sebum composition².

Inappropriate skincare
Harsh, soap-based cleansers and water that is too hot can disrupt skin’s natural balance and exacerbate symptoms. Some skincare products and make-up are also comedogenic (meaning they can cause clogged pores and cause acne).

Find out more about building a skincare routine for acne prone skin.

² - B. Capitanio et al from British Journal of Dermatology 2007. ed. 157 pp 1040-1085

There are many complex and interrelated factors involved in the development of blemishes and Acne.

Inflammation
Acne is an inflammatory disease and inflammation is present at every stage of its development. As we know, our genetics and hormones make some of us more prone to inflammation than others. Micro-inflammation (non-visible inflammation) is a root cause of Acne and can be triggered by many different factors including changes in hormones, bacteria and changes in the composition of sebum on the surface of skin.

Seborrhea
The sebaceous glands secrete an oily substance called sebum that keeps skin and hair supple. Excess sebum production (triggered by hormones), which typifies blemish- and Acne-prone skin, is known as seborrhea. Excess sebum on skin’s surface interferes with the natural process by which skin sheds dead cells (known as desquamation). The composition of the sebum lipids which build up in the sebaceous glands also cause further micro-inflammation.

Hyperkeratosis
Hyperkeratosis is an abnormal thickening of the external layers of skin. It is caused by excessive cell production (triggered by hormones) and inadequate desquamation of dead cells. These cells form plugs that block the sebaceous glands. Sebum builds up and the follicle wall bulges causing comedones (blackheads and whiteheads).

Bacteria
Propionibacterium acnes (or P. acnes) is a bacteria that normally lives harmlessly on skin’s surface, but people with blemish- and Acne-prone skin can be more sensitive to it and it can trigger inflammation. Excessive sebum production also creates an environment which helps P. acnes to grow. It starts to colonise the duct of the plugged sebaceous gland causing further inflammation and leading to papules and pustules.

In severe cases the follicular wall bursts in the late stages of inflammation. Lipids, fatty acids, corneocytes (cells), bacteria and cell fragments are released and can cause further inflammation in the surrounding skin.

As there are different types of Acne, so there are different types of blemishes. The word `blemish` is normally used when something is temporary (such as blackheads and whiteheads) whereas the word `spot` suggests something more permanent (such as age spots and sun spots).

Here is an explanation of some of the most commonly used terms:

• Blackhead (or open comedone): a small, dark, flat blemish resulting from a blocked sebaceous gland. The dark colouration is caused when sebum reacts with oxygen and has nothing to do with dirt.
• Whitehead (or closed comedone): a raised, round blemish with a milky-white cover. Also the result of a blocked sebaceous gland. A type of pimple.
• Pimple: an inflamed (raised and coloured) blemish that fills with pus and is usually painful. It is the colloquial term used for all blemishes: comodones, papules and pustules.
• Papule: a solid elevation of the skin that does not contain pus, an inflamed pimple.
• Pustule: when a whitehead or pimple increases in size and severity it is known as a pustule, inflamed pimple with pus.
• Nodule: hard Acne lesion (area of damaged tissue) lodged deep within skin. Normally on larger areas of skin such as the back and shoulders.
• Cysts: soft, pus filled acne lesion lodged deep within skin. Caused when the follicular wall bursts in the late stages of inflammation.

At present there is no 'cure' for Acne, although there are several tips and treatments which can be very effective in preventing break outs, such as learning how to prevent clogged pores from becoming acne.

A thorough skincare routine
Cleanse your skin twice a day and care for it using products that have been specially formulated to suit your skin’s particular needs such as those in the Eucerin DermoPurifyer Oil Control range. Find out more in the ideal skincare products and routine for blemish-prone skin.

Non-comedogenic coverage
Only use concealers and make-up products that have been specially formulated for Acne-prone skin such Eucerin DermoPurifyer Oil Control Mattifying Fluid. 

Medical treatment
There is a selection of options available for Acne. Your doctor will be able to advise which is best for you. Find out more in acne medication and possible side effects.

Sun protection
Blemishes can cause pigmentation issues if over-exposed to the sun, and Acne medications can make skin more sensitive to UV rays, so it’s important to use appropriate sun protection. Try  or Eucerin Oil Control Sun Gel Crème SPF 50+. Read more in Sunscreen for acne-prone skin.

Look after yourself
Exercise, a good night’s sleep, quitting smoking, and a balanced diet will help you to stay healthy and positive. A healthy lifestyle will also reduce stress which can trigger hormones and exacerbate Acne, and therefore improve your skin’s natural resilience. Find out more in what changes you can make to your diet, Acne and exercise, and Acne and stress.