Acne (Pimples): Types and Treatment

Acne is a common skin condition caused by blockage and inflammation of the hair follicles and sebaceous glands (the pilosebaceous unit). When increased oil production, dead skin cells blocking the follicular opening, proliferation of Cutibacterium acnes and an inflammatory response occur together, blackheads, whiteheads, inflamed pimples and deeper lesions may develop.

Although acne is most common during adolescence, it can occur at any age; adult acne is especially common in women. Acne is not merely a cosmetic concern. Because untreated acne can leave permanent scars and pigmentation, it is important to address it at the right time and with the appropriate methods.

At what ages does acne occur?

Acne most commonly begins during adolescence; however, “adult acne” that continues after age 25 or appears for the first time in adulthood is also quite common, particularly in women. Acne-like conditions may rarely occur in infancy and childhood, and these should be evaluated separately.

Why should acne be taken seriously?

Acne should not be viewed as a simple problem that can simply be “waited out,” because untreated moderate to severe acne may leave permanent depressed scars and persistent pigmentation. Its appearance may also negatively affect self-confidence and social life. Early and appropriate treatment is important for both skin health and quality of life.

Is acne related to skin type?

Acne is most common in oily and combination skin, but it may also occur in dry and sensitive skin. Skin type affects the choice of products and treatment more than it determines whether acne will occur; therefore, the simplification “oily skin = acne” is not always accurate.

Frequently Asked Questions

Is acne contagious? No. Acne is not a contagious condition and is not transmitted through contact or shared personal items.

Is acne only a teenage problem? No. It can also occur in the 30s and 40s. Hormonal factors may be more prominent in adult acne.

Acne does not have a single appearance; it is classified into different types according to lesion type and severity. The treatment plan is largely determined by this distinction.

Comedonal acne

This type is characterized by blackheads (open comedones) and whiteheads (closed comedones), with inflammation not being the predominant feature. It is commonly seen on the forehead, nose and chin.

Papulopustular (inflammatory) acne

This type presents with red, raised lesions (papules) and pus-filled pimples (pustules). It is one of the most common forms and occurs when inflammation develops alongside comedones.

Nodulocystic (deep) acne

This form occurs deeper in the skin, with painful nodules and cysts, and carries the highest risk of scarring. It may require more intensive and sometimes systemic treatment; early and appropriate management is important.

Severity levels

Acne is classified as mild, moderate or severe according to the number of lesions, the degree of inflammation and the extent of involvement. Treatment is intensified as severity increases.

Glossary of lesion types

• Comedone: Blackhead (open) or whitehead (closed) — non-inflammatory blockages
• Papule: A small, red, raised lesion without visible pus
• Pustule: A classic pimple filled with pus, often with a white head
• Nodule: A deep, firm and painful lesion beneath the skin
• Cyst: A deep, softer lesion with a high risk of scarring

Why does the type matter?

The type of acne determines the treatment roadmap. In comedonal acne, approaches that help clear blocked pores are emphasized, while inflammatory and cystic acne may require treatments targeting inflammation and, when necessary, systemic therapy. Misclassified acne can lead to months of ineffective product use and an increased risk of scarring.

Severe and rare forms

Rare severe forms such as acne fulminans and acne conglobata may involve widespread, deep lesions and sometimes systemic symptoms such as fever or joint pain. These conditions require urgent dermatological assessment and close follow-up and cannot be managed with routine acne care alone.

Frequently Asked Questions

Are blackheads dirt? No. Their dark color is not caused by dirt; it results from oxidation of sebum at the pore opening when exposed to air. Scrubbing them away is not a solution.

Does cystic acne go away on its own? Waiting may increase the risk of scarring. Nodulocystic acne is a form that should be evaluated by a physician as soon as possible.

Multiple factors contribute to the development of acne. Rather than looking for a single “culprit,” it is more appropriate to identify the triggers that are specific to the individual.

Main contributing factors

• Increased oil (sebum) production
• Dead skin cells blocking the follicular opening
• Proliferation of C. acnes bacteria and inflammation
• Hormonal changes (puberty, menstrual cycle and certain hormonal conditions)
• Genetic predisposition
• Comedogenic (pore-clogging) cosmetics and skin-care products
• Certain medications
• Mechanical irritation (picking, friction and frequent touching)

Lifestyle factors such as diet, stress and sleep may influence acne in some people; however, the relationship varies from person to person and is not the sole determining factor. Squeezing or picking pimples increases inflammation and the risk of scarring.

The role of diet and lifestyle

The effect of diet on acne varies between individuals. In some people, high-glycemic-index foods and certain dairy products may trigger or worsen acne. Stress and sleep deprivation may also aggravate acne through hormonal pathways. However, “treating acne with diet alone” is not realistic; these factors are considered supportive components of treatment.

Why does cosmetic selection matter?

Pore-clogging (comedogenic) foundation, sunscreen and skin-care products may trigger acne or contribute to persistence despite treatment. For acne-prone skin, choosing non-comedogenic products that are appropriate for the skin type can directly affect treatment success.

The effect of masks and sweating (“maskne”)

Prolonged mask use may trigger acne around the chin and mouth by increasing moisture, friction and bacterial load. Similarly, mechanical acne may develop in areas where helmets, neck supports or sports equipment contact the skin. Keeping contact surfaces clean and cleansing the skin gently are important.

Frequently Asked Questions

Does chocolate cause acne? Evidence varies from person to person. Limiting it may be reasonable for those who notice a clear association, but it should not be considered the single cause.

Does washing the face frequently clear acne? No. Excessive cleansing may damage the skin barrier and worsen acne. Gentle cleansing twice daily is generally sufficient.

Hormonal acne is a form of acne associated with hormonal fluctuations. It is particularly common in adult women and may present with lesions concentrated around the chin, jawline and mouth that become more noticeable before menstruation.

Some patients may also have irregular menstrual cycles, excess hair growth or weight changes. In such cases, evaluation for an underlying hormonal cause, such as polycystic ovary syndrome (PCOS), may be necessary. In addition to standard acne treatments, hormonal acne may require an approach directed at the underlying cause; therefore, assessment is individualized.

Which signs suggest a hormonal cause?

• Acne concentrated on the chin, jawline and neck
• Noticeable flare-ups before menstruation
• Irregular periods, excess hair growth or accompanying hair loss
• Recurrent acne that is resistant to standard treatments

Evaluation process

When these signs are present, the medical history is reviewed and, when necessary, laboratory testing is performed to evaluate for an underlying hormonal condition such as PCOS. The goal is not only to suppress the acne, but also to correctly identify the cause in order to reduce recurrences. When needed, care is coordinated with other relevant medical specialties.

Skin care for hormonal acne

Skin care for hormonal acne should not aim to dry out or “punish” the skin, but to support it while preserving the skin barrier. A gentle cleanser, a non-comedogenic moisturizer and regular sun protection form the basic trio; aggressive peeling and using too many active ingredients at once may worsen the condition.

Frequently Asked Questions

Is it normal for acne to worsen before a period? It is common; however, evaluation is recommended if there are pronounced, scarring flare-ups every month.

Does everyone need hormone testing? No. Tests are planned when the history and examination suggest a possible hormonal cause.

Acne does not occur only on the face; it may also develop on areas with a high density of sebaceous glands, such as the back, chest and shoulders. Sweat, friction from tight clothing or backpack straps, non-breathable garments and certain products may trigger body acne.

Because the skin on the body is thicker, body acne can sometimes be more persistent than facial acne and may take longer to treat. It is important to avoid squeezing or picking lesions, not remain in sweaty clothing for long periods and follow the recommended treatment consistently. Some acne-like eruptions on the back may not actually be acne; persistent or itchy rashes should therefore be evaluated.

Triggers and prevention

• Remaining in sweaty clothing for long periods — showering soon after exercise is recommended
• Tight, synthetic and non-breathable clothing
• Sources of friction such as backpacks and straps
• Heavy or oily body products and contact of some hair-care products with the back

How is back acne treatment different?

Because the skin on the back is thicker than facial skin, stronger topical products and, when necessary, systemic options may be used. Since the area can be difficult to reach, spray and wash formulations may make treatment easier to follow. In persistent and widespread cases, treatment may take longer than for facial acne.

The role of hair products

Conditioners, oils and styling products that come into contact with the back or forehead may clog pores and trigger acne (“pomade acne”). Washing the hair first in the shower, then cleansing the body, and minimizing product contact with the skin can significantly reduce this effect.

Frequently Asked Questions

Is showering after exercise really important? Yes. Sweat and friction remaining on the skin may contribute to follicular blockage and inflammation.

Is every pimple on the back acne? No. Folliculitis and fungal eruptions may resemble acne. Persistent or itchy conditions should be evaluated.

The goals of acne treatment are to clear existing lesions, reduce the formation of new breakouts and, most importantly, prevent permanent scars and pigmentation. Treatment is personalized according to the type, severity and location of acne and the patient’s overall condition. Patience is required, as results usually become visible gradually over several weeks.

Topical treatments

Options such as retinoids, benzoyl peroxide, azelaic acid and certain topical antibiotics may be used alone or in combination depending on the type of acne. The appropriate product and method of use are determined by the physician.

Systemic (oral) treatments

For moderate to severe acne or cases with a risk of scarring, oral antibiotics, hormonal therapies in suitable patients or isotretinoin may be considered. These treatments are used only under medical supervision with the necessary follow-up.

Supportive procedures

In suitable patients, chemical peels, comedone extraction and certain light or laser treatments may support medical therapy. These procedures do not replace treatment; they are considered as part of the overall plan.

Skin care

Gentle cleansing, non-comedogenic products and regular sun protection are integral parts of acne treatment. Aggressive practices that excessively dry or irritate the skin may worsen acne.

How does the treatment process progress?

At the first examination, the type and severity of acne are assessed, potential triggers are reviewed and a personalized plan is created. Response to treatment is generally evaluated after 6–12 weeks, and the plan is adjusted during follow-up when necessary. After improvement, maintenance treatment may be continued to help prevent recurrence.

Why is patience important during treatment?

Acne treatments work gradually; the absence of a visible change in the first few weeks does not mean that treatment is ineffective. Frequently changing products, stopping treatment too early and turning to “quick fixes” promoted on social media are among the most common reasons the process takes longer.

Why is follow-up important with systemic treatments?

Potent oral acne treatments can be effective, but they require regular medical follow-up for dose, duration and possible side effects. Some treatments require blood tests at certain intervals, and pregnancy plans must always be discussed in advance. Unsupervised use based on hearsay can carry serious risks.

Frequently Asked Questions

When does treatment start to work? With most treatments, meaningful improvement is seen within 6–12 weeks; cystic acne may take longer.

Can acne return after treatment ends? Yes. Because the underlying tendency may persist, maintenance care and an appropriate skin-care routine are important.

Two different types of skin changes may remain after acne, and their treatments differ. Distinguishing between them correctly is important in order to choose the appropriate approach.

Color changes (post-acne marks)

Red-pink areas (post-inflammatory erythema) or brown areas (post-inflammatory hyperpigmentation) left after a pimple resolves are often not permanent “scars” and tend to fade over time. Sun protection and appropriate skin care can support this process.

Depressed (atrophic) scars

Scars that leave permanent depressions in the skin may be treated individually according to scar type with methods such as fractional laser, microneedling radiofrequency, microneedling, chemical peels and, in some cases, subcision. Active acne should first be brought under control to achieve lasting improvement.

The goal of scar treatment is not to “erase scars completely,” but to achieve a meaningful improvement in their appearance. The process requires patience and usually a series of sessions. You can also review the relevant pigmentation and scar pages on the website for more details.

Scar or mark? How can you tell the difference?

Red or brown areas that remain level with the skin or fade when the skin is stretched are usually marks and tend to lighten over time. A depression or firmness that remains visible even when the skin is stretched is more consistent with a scar and may require a procedure. Making this distinction is the first step toward selecting the correct treatment.

How to reduce the risk of scarring

• Do not squeeze, pick or scratch pimples
• Treat active acne early
• Use regular sun protection to reduce darkening of post-acne marks
• Do not stop treatment early; continue follow-up appointments

When should acne scar treatment begin?

Procedures for depressed scars are started after active acne has been brought under control; otherwise, new lesions may create new scars and reduce the benefit of treatment. For red or brown post-acne marks, sun protection and appropriate skin care can begin without waiting for procedural treatment.

Frequently Asked Questions

Do red and brown post-acne marks fade on their own? Many fade over time; sun protection and appropriate skin care can significantly support this process.

Can depressed acne scars be treated with creams? No. Creams are not sufficient for atrophic scars. Procedures such as laser and microneedling radiofrequency are generally required.