The symptoms of acne include:

• Non-inflamed bumps and blackheads
• Inflamed red pimples and pustules
• Tender, pus-filled cysts

The severity of your acne will depend on which of these symptoms you have, and your treatment will change with it. Usually, your doctor will assess the severity of acne by the type of spots you have, and how many there are.

Most often treated with over-the-counter topical medicine, mild acne is considered to be primarily whiteheads or blackheads, with the occasional papule or pustule, and no nodules or cysts.

The characteristics of mild acne include:

• Less than 20 comedones
• Less than 15 inflammatory lesions
• A total lesion count of less than 30.

If you have widespread whiteheads or blackheads, with multiple papules and/or pustules, you are likely to have moderate acne. Moderate acne usually requires prescription medication and may seem to get worse before it gets better.

The characteristics of moderate acne include:

• 20-100 comedones
• 15-50 inflammatory lesions
• A total lesion count of 30-125.

With severe acne, you will have many large, painful papules, pustules, nodules or cysts. Your spots may turn a deep red or purple colour and often causes acne scars. Prompt treatment from your GP can minimise this risk, and they may refer you to a dermatologist.

The characteristics of moderate acne include:

• More than 5 pseudocysts
• More than 100 comedones
• More than 50 inflammatory lesions
• A total lesion count of more than 125.

You should see your GP if:

• Your acne is moderate or severe
• Over-the-counter medicine hasn’t worked
• You feel embarrassed or depressed because of your acne

One of the most frequent types of acne is whiteheads: small, round, white bumps on the skin's surface. Whiteheads are caused by the pores in your skin becoming clogged with dead skin, bacteria and oil. If these clogged pores are ‘closed’ (covered with a layer of thin skin), they appear white on the surface.

Often seeming to develop at the worst time, whiteheads can be annoying. However, they are little to worry about. Whiteheads can be easily treated through over-the-counter medical treatments and small lifestyle changes.

The other type of mild acne is blackheads. Blackheads are similar to whiteheads except for one key difference. As the top of the clogged pores are open, the surface of these spots appear dark or black instead of white. Contrary to popular belief, this black colour is not from dirt but because bacteria or dead skin cells are reacting with oxygen.

If you have red bumps on the surface of your skin, you might have acne papules. Acne papules are inflamed blemishes that form when there is a high break in the follicle wall. They often feel hard, tender and sore. Also known as pimples or zits, papules often turn into pustules.

Pustules look similar to papules but are often larger. You can identify this type of acne from the white tips at the centre, caused by a build-up of fluid or pus. Pustules can develop on any part of the body, but this form of acne most commonly affects the back, chest and face.

If your acne is severe, it is likely to include nodules. Nodular acne is made up of large, inflamed and painful bumps. When blocked pores become more irritated they grow even bigger and affect deeper layers of the skin. If you have nodular acne you should visit your GP to receive the right treatment.

Cystic acne is the most severe type of spot caused by acne. Cystic acne is caused by bacteria trapped inside of your pores reaching too deep into your skin. Compared to nodules, cysts are often softer and contain pus, looking similar to boils. You should avoid any temptation to pop cysts as this carries a large risk of causing permanent scarring. Instead, see your GP to receive the correct treatment.

Acne can be caused by:

• Excess oil production
• Hair follicles clogged by oil and dead skin cells
• Bacteria
• Excess activity of androgens, a specific group of hormones

Four key factors can aggravate or trigger acne:

• Hormones. This can be triggered by puberty, pregnancy and the use of oral contraceptives
• Certain medications. These medications include drugs containing corticosteroids, testosterone or lithium
• Diet
• Stress

Acne affects any part of the body where there are many sebaceous glands in the skin. The areas most commonly affected by acne are the face, back, chest, shoulders and upper arms. Though less frequent, acne can also affect the scalp and buttocks.

One of the common causes of acne is the fluctuations in your hormones. A rise in androgens, such as testosterone, can increase oil production and the risk of your pores becoming clogged. Though most common in teenagers during puberty, hormonal acne can also affect adults.

According to Ayurvedic tradition, areas on our body reflect our inner health. However, there’s little to no scientific evidence that this is true. Many acne face maps suggest unproven links between where acne affects you and why. For instance, forehead acne does not equal liver disease, despite what you might read.

Despite what you may have heard, spot popping or squeezing may make your acne worse. Squeezing your spots can push bacteria and pus deeper into the skin, causing more swelling and redness. It may also leave you with permanent scarring.

If you are wondering whether diet affects acne, you’re not alone. Research is constantly being carried out to identify whether a correlation exists between diet and breakouts. At the moment, research suggests there is no clear link that diet causes acne, though it may influence it.

Poor hygiene does not cause acne. Many of the biological reactions that cause acne occur beneath the skin, so the cleanliness of your skin has no impact. In fact, excessive washing may make it worse.

If acne affects your self-esteem, oil-free or water-based make-up can still be used as most cosmetics and skin-care products do not clog pores. Choose products that are labelled as being ‘non-acnegenic’ (should not cause acne) or ‘non-comedogenic’ (should not cause blackheads or whiteheads).

Contrary to the common assumption that acne only affects teenagers, acne can also affect adults and babies. Acne most commonly starts during puberty, affecting more than 85% of teenagers, because of increased hormone activity that produces more oil. However, adult acne does affect people in their twenties, thirties and forties.

Acne treatments fall into the following categories:

• Topical treatments
• Oral treatments
• High street products
• Natural remedies
• Self-care

Topical treatments will usually be your first choice if you have mild to moderate acne. Apply them to the entire affected area of the skin, not just to individual spots. Depending on the treatment, it is recommended that you apply either every night or twice daily.

Topical treatments include:

• Benzoyl peroxide
• Antibiotics (e.g. tetracycline, erythromycin and clindamycin)
• Retinoids (e.g. adapalene, tretinoin and isotretinoin)
• Azelaic acid
• Nicotinamide

Prescribed topical preparations may contain one or a combination of the above.

Your GP may prescribe a course of antibiotic tablets to be taken in combination with a topical treatment. These tablets are usually erythromycin or a type of tetracycline. You should take your course of antibiotics for at least two months, continuing use for six months after there is no further improvement.

Oral treatments work best when combined with a topical gel or cream, usually a topical retinoid. Sometimes the first antibiotic that your GP tries does not work, but if this is the case, there are several alternatives that you can try. It is important to return for review, in order to change the treatment if needed. When taking oral antibiotics, you may find that you experience side effects, such as stomach upset, or thrush. If this is the case, you should see your GP to consider whether you can switch to a different medication.

In cases of severe or resistant acne, where oral antibiotics combined with topical treatments are not effective, the GP may consider a specific type of oral contraceptive pill, called co-cyprindiol, for women. While this treatment is often effective to treat acne, it carries the risk of deep vein thrombosis (a blood clot, usually in the leg).

Your GP may decide to refer you to the dermatologist, and consideration may be given to starting oral retinoids. This is an effective but potent treatment for acne, and cannot be taken if there is any possibility of pregnancy. It can also have an impact on mood, mental health, and rarely cause blood abnormalities. For these reasons, a full assessment and regular monitoring is required when taking it.

There are a number of natural acne treatments that may help get rid of acne. As many of these remedies are quite potent, make sure to dilute them before applying them to your skin. Methods to treat acne naturally include:

• Apple cider vinegar. Apple cider vinegar contains lactic acid which helps reduce inflammatory lesions. Make sure to use it in small amounts diluted with water
• Tea tree oil
• Green tea applied directly to the skin

There are many steps you can take at home to help ease the symptoms of acne:

• Don’t pop. Try to avoid picking or squeezing your spots as this can aggravate them and cause scarring.
• Take action. Start the right treatment as soon as symptoms appear. This will also help you avoid permanent scarring.
• Don’t rush. Most treatments take at least two months before seeing improvement. Make sure you follow the correct guidelines to see maximum results.
• Care for your skin. Cleanse your skin and remove make-up with a mild soap, an oil-free soap substitute, or a gentle cleanser and water. Do not scrub too hard as this can irritate the skin and aggravate your acne. Remember that acne is not due to poor hygiene.

While it is sensible to wash with a gentle cleanser, you should avoid washing affected areas more than twice a day. Excessive washing can irritate the skin and aggravate symptoms.

Stress can aggravate acne. Try to get enough sleep and practice relaxation techniques in order to reduce the risk of breakouts.

Touching your face can trigger more acne, lead to infection or cause permanent scarring.

If you find that the sun aggravates your acne, you aren’t alone. Some acne medications make you more susceptible to the sun’s rays. Try to regularly use a noncomedogenic sunscreen. It is recommended that everyone uses sunscreen on the face daily, regardless of underlying skin conditions, in order to protect the skin from sun damage.

Acne scars are most often caused by severe acne such as nodules or cysts. When these spots burst they damage the nearby skin, causing scarring. Acne scars can also be caused by picking or squeezing your spots, so it is important to avoid this.

There are three main types of acne scar:

• Ice pick scars. These are small, deep holes in the surface of your skin that appear like the skin has been punctured by a sharp instrument. Ice pick scars are caused when an infection from a cyst works its way to the surface of the skin.
• Boxcar scars. These are broad depressions with sharply defined edges. Boxcar scars form when too little collagen is produced during wound healing.
• Rolling scars. These have smooth edges that give the skin an uneven or rolling appearance. They are caused by bands of scar tissue that form under the skin.

Unfortunately, there is no easy treatment for acne scar removal. Under the NHS, the options are classed as cosmetic surgery and so are usually unavailable. The types of treatment available to reduce acne scars are:

• Dermabrasion. This involves removing the top layer of skin, either using lasers or a specially made wire brush.
• Laser treatments. These treatments can either remove a small patch of skin to encourage new skin, or stimulate growth of new collagen to repair some of the damage.
• Punch techniques. If you have ice pick or boxcar scars, punch techniques surgically remove the scars and then seal, elevate or ‘plug’ the wound.
• Subcision. If you have rolling scars, subcision involves removing the upper layer of skin from the underlying scar tissue. This helps form new connective tissue, pushing up the scar to be level with the surface of the skin.

While many people want to instantly banish acne scars, learning to cope with them is equally important. Acne scars can often cause anxiety, stress and depression. If you find you have little interest in seeing your friends or are anxious to leave home, it is important to speak to your GP.

If you’ve noticed small red or white bumps on your baby’s cheeks, nose and forehead, they may have baby acne. These breakouts may also appear on your baby’s chin, scalp, neck, back or chest. Baby acne often develops within the first two weeks after birth, but can develop any time before six weeks of age.

Although baby acne and eczema can look quite similar, there are differences to help tell them apart.

Baby acne

• Made up of white pimples, red spots, blackheads and whiteheads
• Bumpy
• Not itchy
• Affects the face, cheeks, upper back and neck

Eczema

• Usually made up of red bumps on the face. Symptoms can also include dry skin, red or inflamed patches, dark patches, rough or scaly skin, crusty or oozing skin, and areas of swollen skin
• Not bumpy
• Itchy
• Can become infected, developing a yellow crust or small lumps that contain pus

Unfortunately, the exact cause of baby acne is currently unknown. However, research suggests that it seems to be associated with maternal hormones that pass from the placenta to the baby during pregnancy.

Baby acne usually clears within a month by itself. If your baby’s acne does not clear within this time, you may wish to see a GP.

Baby acne is generally nothing you need to worry about, clearing by itself without any specific home-care or medical care. There are steps you can take, however, to help keep your baby’s skin as healthy as possible:

• Wash your baby’s face daily with lukewarm water. Bath time is a perfect time to do this.
• Avoid harsh products. Adult acne products aren’t recommended for babies. Also avoid bubble baths, scented soaps, or any other soaps containing excessive chemicals.
• Don’t scrub. Scrubbing your baby’s skin with a towel can further aggravate the skin. Instead, gently sweep a washcloth over the face in a circular motion. Once the cleanser is washed off, pat your baby’s face dry with a towel.
• Don’t squeeze. Avoid squeezing or pinching your baby’s acne, as this will irritate the skin and may worsen the problem.
• Be patient. Baby acne is typically harmless, and will quickly resolve itself.
• Wipe breast milk over the spots - there is some anecdotal evidence that this can reduce the skin inflammation.

As acne is so common in teenagers, it can be easy to think it will just pass on its own. However, though hormonal acne is an almost guaranteed part of teenage life, there are a number of treatments available that can reduce symptoms. Over-the-counter products or a visit to your GP can prevent acne from worsening and help avoid acne scars.

It may seem obvious, but for hormonal acne treatment to work, you must keep using it. If other responsibilities are adding up or improvement isn’t instantaneous, it can be easy to forget this. Make sure to maintain regular use of your treatment to ensure maximum results.

During your teenage years, everything can seem stressful. Exams, job hunting and planning for your future can all add pressure. However, stress can cause acne to flare up. Try to destress by effectively balancing your time between study and social occasions, and take regular time for yourself to relax.

You may have found that acne has caused a negative effect on your self-esteem or self-confidence. This isn’t unusual. Research has shown that acne can lead to depression, anxiety, or both. It is important you start the right course of treatment to help clear your acne and these worries. If you have any of the following symptoms, visit your GP to find a solution for your acne:

• Sadness that lasts for two weeks or more
• Loss of interest in activities that you once enjoyed
• A tendency to avoid social activities, even with friends or people your age

Having a one-to-one meeting with your GP can give you space to discuss your acne and find the right treatment. Rather than waiting for acne to clear on its own, your GP may be able to prescribe you an effective topical or oral medicine.

More than one out of every two pregnant women can expect to develop acne. The primary cause is an overproduction of oil (sebum) because of increased hormone levels in the first trimester. In some cases, it can be severe, but can most often be treated with self-care and medication.

If you have acne during pregnancy, the first step is self-care:

• Wash the affected areas with a gentle cleanser. Use your hands to wash twice a day with mild soap and lukewarm water. Avoid excessive washing and scrubbing as this can irritate the skin.
• Don’t pick or squeeze blemishes. This can cause infection or scarring.
• Avoid irritants. Don’t use greasy or oily cosmetics, hair products or acne concealers. Look for products labelled water-based or noncomedogenic.
• Be vigilant. Sweat and oils can contribute to acne, so avoid resting your hands or objects on your face, and keep your hair clean by shampooing regularly.

If these treatments do not work, medication is available. However, you should always check with your GP that the treatment will not impact your pregnancy.

If you want to steer away from acne medications during pregnancy, there are a number of all-natural remedies that may help ease your acne:

• Apple cider vinegar. Mix one part raw, unfiltered apple cider vinegar to three parts distilled water. Soak a cotton ball with the mixture and apply to your skin to absorb the oil.
• Baking soda. Mix one tablespoon of baking soda with one tablespoon of water. Apply to individual pimples and allow the mixture to dry before washing it off.
• Citrus fruit. Squeeze the juice from a lemon or lime and apply directly to your spots with a cotton ball. Leave for ten minutes before rinsing with cool water.
• Honey. Rinse your face with warm water, then apply honey directly to the affected area. Leave for 20 to 30 minutes before rinsing again.
• Coconut oil. Apply virgin coconut oil instead of moisturiser before going to sleep.
• Oatmeal and cucumber. This guide shows you the necessary steps to create a simple, homemade face mask.

Unfortunately, there is no guaranteed way to avoid acne when pregnant. However, regular self-care can reduce the risk.

There are a small number of spots, bumps and lesions so this acne is considered mild:

Multiple whiteheads, blackheads, papules and pustules:

Large, painful papules, pustules, nodules or cysts. Spots have turned a deep red or purple colour:

A clogged pore closed with a layer of skin, appearing white on the surface:

A clogged pore exposed to open air, causing the surface of the spot to turn dark or black:

Red bumps on the surface of the skin that often feel hard, tender and sore:

Similar to papules but often larger with white tips at the centre from build-up fluid or pus:

Large, inflamed and painful bumps affecting deeper layers of the skin:

A similar size to nodules, cysts resemble boils and are often softer and contain pus:

Baby acne:

Image source: Acne Scars: Pathogenesis, Classification and Treatment. Gabriella Fabbrocini et al.

Small, deep holes in the surface of the skin that resemble punctures:

Image source: Acne Scars: Pathogenesis, Classification and Treatment. Gabriella Fabbrocini et al.

These are broad depressions with sharply defined edges:

These scars have smooth edges that give the skin a rolling or uneven appearance:

The Medicspot clinical station allows doctors to look at your skin close-up to diagnose and treat acne vulgaris.

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Dr Farah Gilani completed her medical degree at Glasgow University in 2007, also achieving a First class BSc in Psychological Medicine. Initially training in paediatrics, she moved on to General Practice and now works as a portfolio GP. As well as working in general practice, she has a role as paediatric scholar and as a forensic offences examiner. She is developing a range of interests, including child and women’s health, nutrition and allergy. She enjoys writing and has published articles in the British Journal of General Practice, and its sister publication, Innovait. Outside work, Dr Gilani is a busy mum to 8-year-old Zakariah and newly arrived twins, Noah and Elijah. She loves to cook for her husband and children, trying out new recipes and transitioning to a more plant-based diet. She enjoys yoga, running and netball.

Emma Coleman qualified in General Nursing in 1996 and went onto study Dermatology at the University of South Wales, gaining a Distinction at Diploma level before specialising in cosmetic procedures and non-surgical facial rejuvenation in London. Emma has a special interest in acne and is the founder of Emma Coleman Skin clinics across Kent and London in the UK. Emma adopts a holistic approach to dermatology, designing tailored programs for her clients combining prescription medications, diet, lifestyle and skincare. Emma launched her own natural antioxidant skincare line in 2013, designed for clients to use alongside her treatments.

Dr Faiza Khalid is a Medicspot GP with 12 years of experience. Born and raised in the Home Counties, she pursued her passion for medical sciences at The University of Leeds and proceeded to read her degree in Medicine at The Leicester-Warwick Medical School. In addition to being a GP, she is a qualified GP trainer with an interest in medical education and lifestyle medicine.

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.