Acne: Disease Forms, 6 Dos & 3 Don’ts for Treatment

Adolescents are particularly affected by acne, but some people in their 30s and 40s still suffer from the painful skin disease. We will explain the causes and proper care of acne skin to you.

Acne is one of the most common skin diseases. It is often associated with painful pustules, inflamed papules and oily skin. Acne is often very distressing for those affected. We will explain the possible causes of the disease and give you tips on care.

How Acne Forms

Young people in particular are affected by acne. Up to 95 percent of all teenagers have to struggle with the symptoms of acne – some more and others less. In general, acne refers to the disease of the sebaceous glands and hair follicles , which usually become painfully inflamed in the face, décolleté and back area.

The reason for the disease is usually the hormonal change during puberty. During this time, the body produces more male sex hormones such as testosterone, which promote sebum production. However, the male hormones not only stimulate the flow of sebum, but also the skin cells to form more horny substance. Horny substance consists mainly of dead skin cells and keratin and can clog pores if produced in excess. The horny substance prevents the sebum from draining properly. This accumulates in the pore and forms a closed or open blackhead, which often develops into severe inflammation in acne.

You can recognize open blackheads by the typical dark discoloration of the pore. This is caused by the pigment melanin inside the pore, which turns dark in connection with oxygen. While you can remove open blackheads without much difficulty, closed blackheads are often responsible for the severe scarring associated with acne. Closed blackheads get infected easily when you try to remove them yourself.

Inflammation occurs when there are more bacteria on the skin . And these have particularly good growth conditions on acne skin and promote inflammation on the skin. This can cause painful pimples, which manifest themselves in lumps and pustules in acne.

Different forms of acne

Acne can come in different forms and in different degrees. Most forms are relatively mild and do not require medical therapy to heal. In mild cases, self-treatment with over-the-counter preparations from pharmacies and drugstores is common. Only about 40 percent of all acne cases require medical treatment. Nevertheless, acne is one of the most common dermatological diagnoses and the most common reason for a visit to the dermatologist.

Many acne cases go away after puberty. From the age of 30, the skin produces less sebum. With increasing age, the probability is higher that the skin disease will be milder and even disappear completely. In some cases, however, acne persists beyond the age of 30. A so-called late-type acne is often genetic and is mainly related to a previous illness in the mother.

All hormonal forms of acne can be summarized under the term acne vulgaris . While mild forms, acne vulgaris grades I – II, do not require medical treatment, medical treatment for severe forms of acne, acne vulgaris grades III – IV, is recommended. In general, the skin disease can manifest itself in four different forms:

Acne comedonica : In this form, mainly closed and also open blackheads appear, but hardly any and only slight inflammation. The skin on the face in the area of ​​the T-zone (nose, chin and forehead) is particularly affected. After puberty, acne comedonica usually heals without scarring.

Acne papulo-pustulosa : In addition to blackheads, there are also inflammatory, purulent pustules and painful nodules that can reach a diameter of one centimeter. The inflammation is moderate but can still cause tissue scarring. It is often not just the face that is affected, but also the décolleté, back and arms.

Acne conglobata : This severe form of acne causes painful nodules up to two centimeters in size, which are very inflamed and often occur over a large area. Some may develop into abscesses. Scarring is typical of this form of acne. Men in particular are affected.

Acne fulminans : Acne fulminans resembles a particularly severe form of acne conglobata, but it requires different treatment. Acne fulminans differs from the other forms of acne and often requires hospital treatment. It can lead to high fever and internal inflammation. The skin changes are extremely painful and occur suddenly and over a large area. It mainly affects boys between the ages of 13 and 16 and the skin on the chest and back. Sometimes the face can also be affected.

In addition to these main forms, there are some less common forms of acne that manifest themselves differently. These include, among other things:

Acne inversa : Acne inversa affects women in particular and usually manifests itself as painful inflammation under the arms, in the genital area and in the groin area. Not only are there many sweat glands and hair follicles in these areas of the body, but the skin also lies in folds on top of each other, which can promote inflammation. The form of acne often occurs after the age of 23.

Acne neonatalis : Also known as neonatal acne or baby acne, acne neonatalis occurs in around 20 percent of newborns and is most common on the cheeks. Usually these are closed blackheads.

Acne infantilis : Acne infantilis or toddler acne often occurs in the first year of life and again mainly on the cheeks. Here the blackheads appear close together and can sometimes develop into pustules.

Acne tarda : Acne tarda or late acne occurs mainly in women over the age of 25 and primarily affects the chin and jaw area, but sometimes also the neck, décolleté and torso. It mainly affects women who have been using hormonal contraception since puberty and stop taking the contraceptive pill after many years.

In some cases, acne develops as a result of external influences such as taking medication or chemical substances such as chlorine and fluorine, which are mainly found in toothpaste. Drugs such as anabolic steroids in particular can trigger drug acne or acne medicamentosa . Contact acne or acne venenata primarily affects people who work with chemicals and whose skin comes into direct contact with these substances.

Acne vulgaris versus Mallorca-Akne

Although both hormonal acne and Mallorca acne (acne aestuvalis) are included under the term acne, the two forms differ in their origin. While acne vulgaris results from a clogged pore, Mallorcan acne results from the sun-induced inflammation of the follicle . This is mainly due to UV-A radiation, which reacts with certain care substances, including those in sunscreen. Young women and people with oily skin are particularly affected. In contrast to acne vulgaris, Mallorca acne occurs less on the face, but mainly on the shoulders and upper arms.

To prevent Mallorca acne, you should ensure a high level of UVA protection and only use sunscreen and skin care products that are free of oil and emulsifiers .

Acne Treatment: Tips for Sufferers

While you can treat mild forms of acne very well with over-the-counter preparations from pharmacies and drugstores, you should definitely consult a dermatologist and sometimes a medical beautician for severe acne , who will analyze your skin in detail and tailor an individual therapy to your skin can. It should also be ruled out whether it is another inflammatory skin disease that looks similar to acne. The dermatologist should not only take a close look at your skin, but also hereditary predispositions, medication intake and your diet in order to make a suitable diagnosis and therapy.

As a rule, acne vulgaris always takes a similar course. While the first symptoms slowly accumulate over months, the full extent of the disease is usually reached after a year. Over the next few years, there are relapsing outbreaks until, towards the end of the second decade of life, there is a slow improvement. However, in some cases, after symptoms have improved, there may be relapses that occur suddenly or develop slowly.

Maintain mild and oil-free

Proper skin care plays a crucial role in treating acne. Acne is particularly associated with a sensitive skin type and should therefore be treated with special and particularly mild products. Cleaning products that are too aggressive and harsh can have a negative effect on the pH value of the skin and even worsen your complexion. That is why those affected should use particularly mild products that are at best fragrance- free and alcohol -free .

The skin should be cleaned with a pH-neutral and soap-free washing lotion that does not irritate the skin and gently removes dirt and sebum. However, you should not cleanse your skin too often, as this can put unnecessary strain on it. Twice a day is enough. After cleansing, you should moisturize your skin with a moisturizer . Especially with impure and oily skin, many sufferers tend to omit moisturizers. However, this can further increase sebum production due to the loss of moisture and even worsen the symptoms.

When it comes to acne, it’s important to keep your moisturizer free of grease and oil , as this can further clog pores and worsen symptoms. Water-based face creams with moisturizing ingredients such as aloe vera and hyaluronic acid are better . Since many acne remedies make your skin very sensitive to the sun, you should definitely wear a high level of sun protection. Your sunscreen should also be oil-free and suitable for acne-prone skin. You can find more tips for caring for impure skin here.

Use acne cream

You can use a special acne cream for supportive treatment. Acne creams can promote wound healing , inhibit inflammation and stimulate skin renewal . In most cases, acne cream should be applied in addition to your moisturizer, usually after, to avoid drying out your skin and worsening your complexion. You can find out how to use the cream correctly from your dermatologist or pharmacist.

Some acne creams are only suitable for spot application . You should therefore not apply it all over the face, neck and décolleté, but only on the affected areas of the skin, as some of the active ingredients can irritate healthy skin. While some acne creams are available over-the-counter at pharmacies and retailers, others require a doctor’s prescription. This usually depends on the substances contained and their effectiveness. Typical active ingredients in acne creams include:

  • Retinoids : Retinoids are effective against both blackheads and inflammation. The substance is a modification of vitamin A, which can promote cell communication and thus accelerate cell renewal. So it has a skin peeling effect. Retinoids can not only reduce the flow of sebum, make pores appear smaller and prevent blemishes, but also reduce sun-related skin damage and work against small wrinkles. Pregnant women should refrain from using the active ingredient.
  • Azelaic acid : Azelaic acid is particularly suitable for combating keratinization disorders and thus combats acne directly at the cause. In addition, the substance has an antibacterial effect and can prevent inflammation. Azelaic acid is also recommended for the treatment of rosacea.
  • Benzoyl Peroxide (BPO) : Benzoyl Peroxide is one of the most popular acne medications and is found in many acne creams and gels. It has an antibacterial effect, but can lead to an initial aggravation. However, it can subsequently provide an improved complexion by drying out pimples and blackheads. The skin can sometimes flake a little at first. Pregnant women should discuss the use of benzoyl peroxide with a doctor beforehand.
  • Chemical peels : Chemical peels include alpha and beta hydroxy acids – AHA and BHA for short. Glycolic acid is the most well-known of the alpha-hydroxy acids, while beta-hydroxy acids are mainly used in skin care in the form of salicylic acid . Chemical peels gently remove dead skin cells, unclog the pores and make the skin glow.
  • Topical antibiotics : Topical antibiotics are applied locally to the skin and are particularly effective there without being associated with extensive side effects. They act directly on the inflammatory bacteria and can therefore fight inflammatory acne particularly well. Typical antibiotics include tetracycline and clindamycin.

Although many acne creams contain only one of the active ingredients, these are usually recommended in combination with other active ingredients . For acne comedonica and acne papulopustulosa, retinoids are usually recommended in combination with benzoyl peroxide and topical antibiotics. Alternatively, azelaic acid can also be used. Although acne cream can in many cases alleviate the symptoms, in the case of severe acne, drug treatment is recommended in addition to topical treatment.

Treat with medication

Drug treatments are only used in very severe acne cases and are recommended in combination with topical treatments. Internal treatment is often recommended, especially for parts of the body that are difficult to access, such as acne on the back. Your dermatologist will prescribe the medication for you. Three medications can be used for internal treatment.

  • Isotretinoin : Isotretinoin can be used both externally and internally for acne and belongs to the group of retinoids. Taking it internally can reduce the size of the sebaceous glands and normalize sebum production, but it can also have serious side effects such as dry skin , liver dysfunction and psychological effects in the form of headaches and possibly even depression. Isotretinoin can be taken for several months.
  • Antibiotics : Taking antibiotics internally for acne can significantly reduce the number of bacteria on the skin, leading to a significant improvement in the appearance of the skin. The maximum duration of antibiotic use for acne is three months. However, antibiotics taken orally not only affect the affected skin areas, but also the rest of the body and can therefore be associated with some side effects.
  • Hormonal contraceptives in women : Women who suffer from acne are often advised to take hormonal contraceptives in the form of birth control pills. These can act directly on the hormones and reduce the number of male sex hormones. In this way they tackle the cause directly at the root. However, when taking birth control pills, you should keep in mind that they are associated with some side effects. In addition, acne can return after stopping the pill.

Counteract acne scars

Moderate and severe acne is often accompanied by scarring caused by deep-seated skin inflammation. Even after the skin disease has healed, the complexion is not even. However, you can treat acne scars well, so that you can significantly reduce the appearance of the annoying bumps.

In order to fade acne scars, you should stimulate skin renewal. This works best if you exfoliate your skin regularly. This will slough off dead skin cells and reveal new and radiant skin cells. Fruit acid peelings , chemical peelings and microdermabrasion , in which the top layer of skin is mechanically abraded, are particularly suitable . You can get all these treatments from a beautician or do them yourself at home.

If you use the scrubs regularly, depending on use between two to three times a week or once a month, the appearance of your acne scars will probably be significantly reduced after just a few weeks. You should definitely discuss with a dermatologist or beautician beforehand how often you carry out the respective application. It is important that you practice patience when using it . It normally takes 30 days for your skin to regenerate cells. You should at least wait until then to see the first improvements.

treat causes

In most cases, acne is genetic or hormonal. Nevertheless, external factors can also promote the development of the skin disease. This is the case, for example, with acne medicamentosa, in which the skin disease is promoted by taking certain medications. Acne venenata is also caused by external factors, namely chemicals.

In these cases, treatment of the causes is necessary to improve the acne symptoms. Skin-irritating chemicals and drugs should be avoided to allow the skin to recover. The situation is similar with other influencing factors that can stress the skin. This can be alcohol and nicotine , but also poor diet . Diet has a major impact on the complexion. If you eat a lot of sugar and fast food, your body may try to flush out the toxins through your skin. This can promote the formation of blackheads and pimples and lead to acne.

Foods in particular that cause blood sugar levels to rise sharply are associated with the formation of acne. This includes foods that are particularly rich in carbohydrates . White flour products, French fries and white rice in particular have a high glycemic value, which means that the blood sugar level rises sharply. Whole grain products, on the other hand, are in a lower range. Even vegetables and fruit, despite their high fructose content, are in many cases in the low range, for example carrots, apples, peaches and corn, and thus form an excellent nutritional basis for acne.

Take psychological consequences seriously

Acne often has some psychological consequences for those affected. The skin changes associated with the disease are a great burden for those affected and can have a negative impact on self-confidence and self-esteem . Many acne sufferers become socially withdrawn and struggle with bullying , prejudice , and rejection , among other things; some are even affected by depression and anxiety and may be at risk of suicide.

It is extremely important to take the psychological consequences of the skin disease seriously and to support those affected during this time. Many of those affected find their appearance unpleasant and women in particular suffer from the disturbing skin changes. Effective treatment of the skin disease is also highly recommended in order to limit the psychological consequences of acne.

Don’ts for acne

Acne skin is very sensitive and reacts quickly with inflammation and scarring if treated incorrectly. In order to prevent these symptoms, there are some factors that you should definitely avoid if you have the skin condition.

Too much makeup

Many sufferers tend to hide their acne under a layer of makeup. However, this can aggravate the skin condition, as makeup further clogs the pores and does not allow the skin to breathe. If you still don’t want to do without makeup, you should make sure that your makeup is oil- free and non – comedogenic . You should also remove your make-up thoroughly in the evening so that your skin can regenerate at night. While you may feel embarrassed about your skin, you should still try to go completely makeup-free at least one day a week to give your skin a day off.

Too much sun exposure and cold temperatures

Environmental influences can also affect your skin. Excessive exposure to the sun and cold in particular can stress the skin. UV-A radiation has a comedogenic effect and can also damage your skin, since many of the acne remedies used can make your skin very sensitive to the sun. Sunbathing is taboo in acne therapy. Cold weather can also make acne worse. Cold temperatures can dry out your skin , even cracking it in some places. Bacteria can nest in these wounds and cause a new acne breakout.

However, long walks in the fresh air also have a positive effect on healing acne. However, you should first care for your skin with suitable sun protection and a good moisturizing cream.

Squeeze pimples yourself

If you suffer from acne, you should definitely keep your fingers off your face. Not only does this make you transfer bacteria from your fingers to your face, but you also encourage scarring and irritate your skin if you pop your pimples on your own. Your skin’s appearance can deteriorate significantly. Instead, you should regularly visit a beautician who professionally cleanses your skin and treats your acne specifically. A beautician has the right tools and works with sterile equipment so that your skin can improve over time.


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