Acne

Acne comes in several different forms, ranging from mild to severe:

• Blackheads and whiteheads (comedones): These occur when pores are clogged with oil and dead skin cells. Blackheads are open at the surface and appear dark, while whiteheads remain closed and look like small white bumps.
• Papules and pustules: Papules are small, red, tender bumps, while pustules are inflamed pimples with pus at the tip.
• Nodules: These are large, solid, and painful lumps deep under the skin.
• Cysts: The most severe form of acne, cysts are pus-filled lesions that can cause significant scarring if left untreated.

Understanding the type of acne is essential because treatments vary. While mild acne may respond to over-the-counter products, moderate to severe acne often requires professional intervention from a board-certified dermatologist, such as Dr. Joshua Freedman, to help prevent complications and scarring.

Acne tends to develop in areas of the body where oil glands are most active. Because some regions of the body naturally contain more oil glands, acne is more likely to form there.

• Face: The most common site for acne. The forehead, nose, cheeks, and chin—often referred to as the “T-zone”—produce a high amount of oil, making them prone to breakouts.
• Back: Often called “backne,” this is common because the back has thick skin with many oil glands. Friction from clothing, backpacks, and sweat can worsen back acne.
• Chest: Breakouts on the chest are common in people who sweat heavily or wear tight clothing. Skincare products that clog pores can also contribute.
• Shoulders and upper arms: These areas can develop small bumps or pimples, especially in athletes or people wearing restrictive sports gear.
• Neck and jawline: Adult and hormonal acne often appear here, especially in women, due to hormone fluctuations that increase oil production.

In some cases, people notice acne-like bumps on the buttocks. However, this is usually folliculitis, an inflammation of hair follicles, not true acne.

Acne does not affect just one group of people—it spans across age, gender, and ethnicity. However, some groups are more prone:

• Teenagers: Acne is most common during puberty when hormone levels surge and oil production increases.
• Young adults and women: Hormonal changes related to menstrual cycles, pregnancy, or conditions such as polycystic ovary syndrome (PCOS) often trigger more inflammation
• Adult-onset acne: Increasingly, men and women in their 30s, 40s, and beyond experience adult-onset acne, often tied to stress, lifestyle factors, or hormone fluctuations. It typically appears on the lower face, jawline, and neck.

Studies suggest that nearly 85% of people between the ages of 12 and 24 experience acne at some point, and millions continue to deal with it later in life.

Multiple factors combine to cause acne, and understanding these triggers is the first step toward effective management:

• Excess oil production: Overactive sebaceous glands create too much sebum, which can clog pores.
• Dead skin buildup: Skin cells that do not shed properly can block follicles.
• Bacteria (Cutibacterium acnes): This natural skin bacterium can contribute to inflammation when trapped in pores.
• Hormones: Hormonal changes, especially during puberty, menstrual cycles, and pregnancy, play a significant role in acne flare-ups. Often called hormonal acne.
• Genetics: A family history of acne increases the likelihood of developing the condition.
• Environmental and lifestyle factors: Stress, diet, skincare products, and humid environments can all worsen acne.

It is important to note that acne is not caused by poor hygiene. In fact, over-washing or harsh scrubbing can irritate the skin and make breakouts worse.

Although acne may seem like a temporary nuisance, untreated acne can leave scars and dark marks that last a lifetime. Beyond physical effects, the condition can take an emotional toll, leading to lowered confidence and even social withdrawal. While mild acne may improve with over-the-counter products, more persistent or severe acne often requires professional treatment.