The Complete Guide to Acne: Causes, Types, Treatments & How to Get Rid of Acne for Clear Skin

Acne affects nearly 85% of people at some point in their lives, making it the most common skin condition worldwide. Yet despite its prevalence, acne remains widely misunderstood—surrounded by myths, ineffective treatments, and frustration. This comprehensive guide cuts through the confusion with science-backed information on what actually causes acne, the different types you might be dealing with, treatments that actually work, and how to build an effective skincare routine for clearer skin.

Introduction: Understanding Acne

Acne isn't just a teenage problem. While it often begins during puberty, acne affects people of all ages—including a growing number of adults who never had breakouts as teenagers or who experience acne returning in their 20s, 30s, or beyond. The impact extends beyond the physical; acne can significantly affect self-esteem, social interactions, and mental health.

Key facts about acne:

• Affects approximately 85% of people between ages 12-24
• Adult acne affects up to 15% of women and 5% of men
• Can range from occasional breakouts to severe, scarring acne
• Has a strong genetic component
• Is influenced by hormones, diet, stress, and skincare habits
• Is highly treatable with the right approach
• Early, effective treatment prevents permanent scarring

Understanding acne—what it is, what causes it, and how to treat it effectively—empowers you to take control of your skin. This guide will give you that understanding and the tools to achieve clearer skin.

What Is Acne?

Acne (acne vulgaris) is a chronic inflammatory skin condition that occurs when hair follicles become clogged with oil (sebum) and dead skin cells. While often called "pimples" or "breakouts," acne encompasses a range of lesion types, from minor blackheads to deep, painful cysts.

Acne most commonly appears on the face, but it can also affect the chest, back, shoulders, and upper arms—anywhere there are sebaceous (oil) glands.

How Acne Forms: The Science

Acne develops through a four-step process:

Step 1: Excess sebum production

Sebaceous glands attached to hair follicles produce sebum (oil) to lubricate skin and hair. Hormones, particularly androgens, can trigger overproduction of sebum, creating an oily environment where acne thrives.

Step 2: Abnormal skin cell shedding

Normally, dead skin cells shed and are cleared from follicles. In acne-prone skin, these cells stick together and accumulate inside the follicle rather than being shed normally. This process is called hyperkeratinization.

Step 3: Clogged pores

The combination of excess oil and sticky dead skin cells creates a plug (called a comedone) that blocks the hair follicle. This is the beginning of an acne lesion—either a whitehead (closed comedone) or blackhead (open comedone).

Step 4: Bacterial growth and inflammation

Cutibacterium acnes (C. acnes, formerly called P. acnes) is a bacterium that naturally lives on skin. Inside a clogged, oxygen-poor follicle, C. acnes thrives and multiplies. The immune system responds to this bacterial overgrowth with inflammation—causing the redness, swelling, and pus associated with inflammatory acne (papules, pustules, nodules, and cysts).

Types of Acne

Not all acne is the same. Understanding what type you have helps determine the most effective treatment approach.

Non-Inflammatory Acne

These are clogged pores without significant inflammation. They're the mildest form of acne.

Blackheads (Open Comedones):

• Pores clogged with oil and dead skin, open to the surface
• Dark color comes from oxidation of melanin, not dirt
• Typically small and flat
• Most common on nose, chin, and forehead (T-zone)
• Respond well to salicylic acid and retinoids

Whiteheads (Closed Comedones):

• Pores clogged beneath the skin surface
• Appear as small, flesh-colored or white bumps
• Skin has closed over the clog
• Can develop into inflammatory acne if bacteria enter
• Respond to retinoids and chemical exfoliants

Inflammatory Acne

These involve immune response and inflammation—they're red, swollen, and often painful.

Papules:

• Small, red, raised bumps
• Result from inflammation around a clogged pore
• Tender to touch
• No visible pus
• Can cluster together

Pustules:

• Similar to papules but with visible white or yellow pus at the center
• The "classic pimple" appearance
• Red, inflamed base with pus-filled tip
• Tempting to pop (but you shouldn't!)

Severe Acne Types

These are deeper, more severe forms that carry significant risk of scarring.

Nodules:

• Large, hard bumps deep under the skin
• Very painful
• Do not come to a head
• Can last for weeks or months
• High risk of scarring
• Often require prescription treatment

Cysts:

• The most severe form of acne
• Large, soft, painful, pus-filled lesions deep under the skin
• Can reach several centimeters in diameter
• Very high risk of permanent scarring
• Require dermatological treatment
• Should never be picked or squeezed

What Causes Acne?

Acne is multifactorial—rarely caused by just one thing. Understanding the various contributing factors helps you address acne comprehensively.

Hormones & Acne

Hormones are the primary driver of acne, which is why breakouts often begin at puberty and fluctuate with hormonal changes:

Androgens (testosterone and DHT):

• Stimulate sebaceous glands to produce more oil
• Increase during puberty in both sexes
• Women with elevated androgens (PCOS) often have persistent acne
• DHT (dihydrotestosterone) is particularly potent for stimulating oil glands

Estrogen and progesterone:

• Fluctuations during menstrual cycle trigger breakouts
• Many women break out 7-10 days before their period when progesterone rises
• Estrogen has some protective effect; declining estrogen (perimenopause) can trigger acne

Cortisol (stress hormone):

• Chronic stress elevates cortisol
• Cortisol triggers increased sebum production
• Explains the stress-acne connection

Insulin and IGF-1:

• High-glycemic diets spike insulin
• Insulin increases androgen production and sebum
• IGF-1 (insulin-like growth factor) also stimulates oil production
• This is how diet influences acne

Genetics

Acne has a strong hereditary component:

• If both parents had acne, you're more likely to have it
• Genetics influence sebum production, skin cell turnover, and inflammation
• You can't change your genes, but you can modify other factors
• Genetic predisposition doesn't mean acne is inevitable—it means you may need to work harder at prevention and treatment

Diet & Acne

The diet-acne connection, once dismissed, is now supported by research:

High-glycemic foods:

• White bread, sugary foods, processed carbs spike blood sugar
• This triggers insulin and IGF-1, increasing sebum and androgen production
• Multiple studies link high-glycemic diets to increased acne

Dairy (controversial):

• Some studies link dairy (especially skim milk) to acne
• May be due to hormones in milk or its insulin-spiking effect
• Not everyone is affected—individual sensitivity varies
• Worth eliminating temporarily to see if it helps

Whey protein:

• Associated with acne in some individuals
• May increase insulin and IGF-1
• Common issue for gym-goers

Chocolate:

• Research is mixed
• May be the sugar, not the cocoa, that causes problems
• Dark chocolate with minimal sugar less likely to cause issues

Stress & Acne

The stress-acne connection is real and well-documented:

• Stress elevates cortisol, which increases sebum production
• Stress impairs wound healing, making acne slower to resolve
• Stress can trigger skin picking and popping behaviors
• Stress disrupts sleep, which affects skin health
• Studies show acne worsens during exam periods and stressful life events

Managing stress with techniques and supplements like Relora can help reduce stress-related breakouts.

Skincare Products & Acne

What you put on your skin matters:

Comedogenic ingredients:

• Some oils and ingredients clog pores
• Look for "non-comedogenic" products
• Common offenders: coconut oil, cocoa butter, certain silicones
• What's comedogenic for one person may not be for another

Over-cleansing and harsh products:

• Stripping skin of oil can trigger rebound oil production
• Harsh products damage skin barrier, increasing sensitivity
• Damaged barrier can worsen inflammation
• Gentle is often better

Not cleansing enough:

• Sleeping in makeup clogs pores
• Sweat and dirt accumulation can contribute
• Twice-daily cleansing is standard

The Gut-Skin Connection

Emerging research reveals a strong gut-skin axis:

• Gut dysbiosis (bacterial imbalance) is linked to acne
• Intestinal permeability ("leaky gut") may contribute to systemic inflammation affecting skin
• Probiotics have shown benefit in some acne studies
• Antibiotics that treat acne also alter gut bacteria (for better and worse)

Supporting gut health with Bowtrol Probiotic may help address acne from the inside out.

Other Contributing Factors

• Friction and pressure: Helmets, phone screens, chin straps can cause acne mechanica
• Humidity and sweating: Creates environment for bacterial growth
• Certain medications: Steroids, lithium, some anticonvulsants can trigger acne
• Hormonal contraceptives: Can improve or worsen acne depending on formulation
• Environmental pollution: Air pollution linked to increased acne in urban areas

Hormonal Acne: A Deep Dive

Hormonal acne is acne driven primarily by hormonal fluctuations. It's particularly common in women and has distinct characteristics.

Signs of Hormonal Acne

• Location: Primarily along the jawline, chin, and lower cheeks
• Timing: Flares around menstrual period, often 7-10 days before
• Type: Often deep, painful, cystic lesions
• Age: Common in adult women (20s, 30s, 40s)
• Associated symptoms: May accompany irregular periods, excess hair growth, or other hormonal symptoms

Treating Hormonal Acne

• Topical treatments: Standard acne treatments help but may not fully resolve hormonal acne
• Oral contraceptives: Certain birth control pills can significantly improve hormonal acne
• Spironolactone: An anti-androgen medication effective for hormonal acne in women
• Lifestyle factors: Blood sugar control, stress management, adequate sleep
• Spearmint tea: Some evidence for mild anti-androgen effects
• Low-glycemic diet: Reduces insulin and androgen stimulation

Adult Acne: Why It Happens

Adult acne is increasingly common, especially in women. It can be frustrating to deal with "teenager skin" in your 30s or 40s.

Why adult acne occurs:

• Hormonal fluctuations: Menstrual cycles, pregnancy, perimenopause
• Chronic stress: Adult responsibilities elevate cortisol
• PCOS: Polycystic ovary syndrome causes elevated androgens
• Stopping birth control: Can trigger acne that was previously suppressed
• Diet and lifestyle: Processed foods, lack of sleep, stress
• Using wrong products: Anti-aging products that clog pores
• Masks: "Maskne" from face coverings trapping moisture and bacteria

Adult acne considerations:

• Adult skin is often drier and more sensitive than teenage skin
• May need to balance acne treatment with anti-aging concerns
• Hormonal approaches often more effective than in teenagers
• Scarring may be more pronounced on aging skin

Cystic Acne: Causes & Treatment

Cystic acne is the most severe form of acne, characterized by large, painful, pus-filled cysts deep under the skin. It requires aggressive treatment to prevent permanent scarring.

What causes cystic acne:

• Same basic process as other acne, but more severe
• Deeper inflammation and larger lesions
• Strong hormonal and genetic components
• The cyst wall can rupture, spreading infection and inflammation

Treatment approaches:

• See a dermatologist: Cystic acne almost always requires prescription treatment
• Isotretinoin (Accutane): Most effective treatment; often curative
• Cortisone injections: Can rapidly shrink individual cysts
• Oral antibiotics: Reduce bacteria and inflammation
• Hormonal therapies: Birth control, spironolactone for women
• Never squeeze or pick: Dramatically increases scarring risk

After cystic acne clears, Revitol Scar Removal Cream can help minimize the appearance of resulting scars.

Acne Treatments: What Actually Works

With countless products and treatments available, it's important to focus on what's actually proven to work.

Topical Treatments

These are applied directly to the skin and are the foundation of most acne treatment regimens.

Benzoyl Peroxide

One of the most effective over-the-counter acne treatments:

• How it works: Kills C. acnes bacteria with oxygen; also has mild comedolytic effect
• Strengths: 2.5% is as effective as 10% with less irritation
• Best for: Inflammatory acne (papules, pustules)
• Caution: Can bleach fabrics; start slowly to assess tolerance
• Tip: Short-contact therapy (wash off after 5-10 minutes) reduces irritation while maintaining efficacy

Salicylic Acid

A beta-hydroxy acid (BHA) that penetrates into pores:

• How it works: Exfoliates inside the pore, breaking up clogs; anti-inflammatory
• Strengths: 0.5-2% in most products
• Best for: Blackheads, whiteheads, and mild inflammatory acne
• Benefit: Gentler than benzoyl peroxide for many people
• Tip: Leave-on products (serums) more effective than cleansers

Retinoids

Vitamin A derivatives—the gold standard for acne prevention:

• How they work: Normalize skin cell turnover, prevent clogs, reduce inflammation
• OTC options: Adapalene (Differin) 0.1%, retinol
• Prescription: Tretinoin, tazarotene—more potent
• Best for: All types of acne; especially comedonal acne
• Caution: Can cause purging initially; increases sun sensitivity
• Tip: Start 2-3 nights per week and build up; always use sunscreen

Niacinamide

A versatile ingredient with multiple benefits:

• How it works: Regulates sebum, anti-inflammatory, strengthens skin barrier
• Strengths: 2-5% is effective; higher concentrations may irritate
• Best for: Mild acne, reducing redness, post-acne marks
• Benefit: Well-tolerated; can combine with most other actives
• Tip: Great for those who can't tolerate harsher treatments

Azelaic Acid

An underrated acne fighter:

• How it works: Antibacterial, anti-inflammatory, normalizes keratinization
• Strengths: 10% OTC; 15-20% prescription
• Best for: Inflammatory acne, rosacea, post-inflammatory hyperpigmentation
• Benefit: Safe during pregnancy; helps with dark spots too
• Tip: Excellent option for sensitive skin

Oral Treatments

For moderate-to-severe acne, oral medications may be needed:

Antibiotics:

• Doxycycline, minocycline—reduce bacteria and inflammation
• Typically used short-term (3-6 months) to avoid resistance
• Best combined with topical treatments

Hormonal therapies (women):

• Birth control pills (especially those containing drospirenone or norgestimate)
• Spironolactone—anti-androgen medication
• Effective for hormonal acne patterns

Isotretinoin (Accutane):

• The most effective acne treatment available
• Often produces long-term remission or cure
• Reserved for severe or treatment-resistant acne
• Significant side effects require monitoring
• Absolutely contraindicated in pregnancy

Professional Treatments

• Chemical peels: Glycolic or salicylic acid peels accelerate cell turnover
• Cortisone injections: Rapidly reduce large, painful cysts
• Extractions: Professional removal of comedones
• Light and laser therapy: Blue light kills bacteria; some lasers reduce oil production
• Microneedling: Can help with acne scars

Building an Acne-Fighting Skincare Routine

A consistent, well-designed routine is essential for clear skin. Here's how to structure yours.

Morning Routine

1. Gentle cleanser: Remove overnight oil without stripping skin
2. Treatment serum: Niacinamide or azelaic acid work well in morning
3. Lightweight moisturizer: Yes, even acne-prone skin needs hydration
4. Sunscreen: SPF 30+ essential, especially with retinoids; choose non-comedogenic

Evening Routine

1. Double cleanse (if wearing makeup/sunscreen): Oil-based cleanser first, then water-based
2. Primary treatment: Retinoid, benzoyl peroxide, or prescription
3. Moisturizer: May be richer than morning product
4. Spot treatment (if needed): Benzoyl peroxide on active pimples

Weekly Treatments

• Chemical exfoliation: AHA or BHA mask 1-2 times weekly
• Clay mask: Can help absorb excess oil
• Hydrating mask: Balance drying acne treatments

Key principles:

• Be consistent—results take 6-12 weeks
• Introduce new products one at a time
• Don't overdo it—more products isn't always better
• Listen to your skin—if it's irritated, scale back
• Treat your skin barrier with care—healthy barrier = better acne healing

Support your skin barrier with Phytoceramides, which help restore the skin's natural protective barrier from within.

Supplements for Acne

Certain supplements can support clearer skin from the inside out.

Zinc

• One of the most-studied supplements for acne
• Reduces inflammation and sebum production
• Has antibacterial properties
• Studies show significant improvement with supplementation
• Dose: 30-50mg zinc (as zinc gluconate, citrate, or picolinate)
• Take with food to avoid nausea; balance with copper for long-term use

Probiotics

• Address the gut-skin connection
• May reduce systemic inflammation affecting skin
• Some studies show improvement in acne severity
• Particularly relevant if you've taken antibiotics
• Bowtrol Probiotic provides comprehensive gut support

Omega-3 Fatty Acids

• Anti-inflammatory effects may benefit acne
• Balance out pro-inflammatory omega-6s in modern diet
• Studies show improvement in inflammatory acne
• Dose: 2-3g EPA+DHA daily
• Fish oil or algae-based for vegetarians

Other Helpful Supplements

Vitamin D: Deficiency linked to acne; many people are deficient

Vitamin A: Retinoids work topically; adequate vitamin A supports skin health (but don't megadose)

Evening primrose oil or borage oil: GLA (gamma-linolenic acid) may help hormonal acne

Spearmint: May have mild anti-androgen effects for hormonal acne

DIM (Diindolylmethane): Helps metabolize estrogen; may help hormonal balance

Curcumin: Powerful anti-inflammatory that may help reduce acne-related inflammation from within

Diet for Clear Skin

Foods That May Trigger Acne

• High-glycemic foods: White bread, sugary cereals, candy, soda, white rice, pastries
• Dairy: Particularly skim milk; cheese and yogurt may be less problematic
• Whey protein: Common acne trigger for gym-goers
• Chocolate: May be the sugar rather than cocoa; dark chocolate less problematic
• Processed foods: Often high-glycemic with inflammatory oils
• Fried foods: Inflammatory oils may worsen acne

Foods That Support Clear Skin

• Low-glycemic vegetables: Leafy greens, broccoli, peppers, tomatoes
• Fatty fish: Salmon, mackerel, sardines—anti-inflammatory omega-3s
• Nuts and seeds: Zinc, selenium, healthy fats
• Berries: Antioxidants and low glycemic
• Green tea: Anti-inflammatory and antioxidant
• Probiotic foods: Sauerkraut, kimchi, yogurt (if dairy doesn't trigger you)
• Zinc-rich foods: Oysters, beef, pumpkin seeds, chickpeas
• Turmeric: Anti-inflammatory spice

Lifestyle Factors for Clear Skin

• Sleep: Aim for 7-9 hours; skin repairs during sleep
• Stress management: Meditation, exercise, adequate downtime
• Exercise: Improves circulation and reduces stress (shower after sweating)
• Clean pillowcases: Change weekly or use silk (less friction, less bacterial buildup)
• Don't touch your face: Hands transfer bacteria and oil
• Clean your phone: Phones harbor bacteria that transfer to skin
• Wash makeup brushes: Weekly to prevent bacterial growth
• Shower after sweating: Don't let sweat sit on skin

Treating Acne Scars

Acne scars are permanent changes to skin texture that occur when acne damages the deeper layers of skin. They're different from post-inflammatory hyperpigmentation (dark marks), which fade over time.

Types of Acne Scars

• Ice pick scars: Deep, narrow, pitted scars; most difficult to treat
• Boxcar scars: Wide, rectangular depressions with defined edges
• Rolling scars: Wavy, undulating appearance
• Hypertrophic/keloid scars: Raised scars (less common on face)

Scar Treatment Options

At-home treatments:

• Retinoids—increase cell turnover and collagen
• Vitamin C—supports collagen production
• AHAs—resurface skin
• Revitol Scar Removal Cream—combines copper peptides, glycolic acid, and hydroquinone to improve scar appearance
• Kollagen Intensiv—supports collagen production for skin texture improvement

Professional treatments:

• Microneedling—stimulates collagen remodeling
• Laser resurfacing—ablative and non-ablative options
• Chemical peels—resurface skin
• Subcision—releases tethered scars
• Fillers—can raise depressed scars
• TCA CROSS—for ice pick scars

Post-Inflammatory Hyperpigmentation (Dark Marks)

These are dark spots left after acne heals—not true scars. They fade over time but can be accelerated with:

• Sunscreen (prevents darkening)
• Vitamin C serums
• Niacinamide
• Alpha arbutin
• Azelaic acid
• Retinoids
• Revitol Skin Brightener—designed to fade dark spots and even skin tone

Common Acne Treatment Mistakes

1. Expecting overnight results: Acne treatments take 6-12 weeks to show full effects. Switching products too quickly doesn't give them time to work.

2. Over-treating: Using too many actives, too often, damages skin barrier and can worsen acne. Less is often more.

3. Skipping moisturizer: Even oily skin needs hydration. Dehydrated skin can produce more oil and impair healing.

4. Picking and popping: Dramatically increases risk of scarring and hyperpigmentation. Hands off!

5. Not using sunscreen: Many acne treatments increase sun sensitivity. Sun also worsens dark spots.

6. Using harsh, stripping products: Damaging your skin barrier makes acne worse, not better.

7. Ignoring diet and lifestyle: Topical treatments alone may not be enough if internal factors are driving acne.

8. Stopping treatment when skin clears: Acne is a chronic condition. Maintenance treatment is often necessary.

9. Not seeing a dermatologist for severe acne: Waiting too long increases scarring risk.

10. Believing acne myths: Acne isn't from dirty skin, and scrubbing harder doesn't help.

When to See a Dermatologist

• Moderate-to-severe acne (especially cystic/nodular)
• Acne that's not responding to over-the-counter treatments after 8-12 weeks
• Acne that's scarring
• Acne causing significant emotional distress
• Suspected hormonal acne (may need testing)
• Sudden onset of severe acne in adults
• Acne accompanied by other symptoms (irregular periods, excess hair growth)

Acne Myths Debunked

Myth: Acne is caused by dirty skin.
Reality: Acne is caused by hormones, genetics, and bacteria—not dirt. Over-washing actually makes acne worse.

Myth: Only teenagers get acne.
Reality: Adult acne is common and increasing, especially in women. Acne can occur at any age.

Myth: Sun exposure clears acne.
Reality: While sun may temporarily dry pimples, it damages skin, worsens dark spots, and can trigger rebound breakouts. Always wear sunscreen.

Myth: You need to dry out oily skin.
Reality: Stripping skin of oil triggers more oil production. Balanced hydration is key.

Myth: Toothpaste is a good spot treatment.
Reality: Toothpaste can irritate and burn skin. Use proper acne treatments.

Myth: Makeup causes acne.
Reality: Non-comedogenic makeup is generally fine. Not removing makeup properly is the problem.

Myth: Acne will go away on its own.
Reality: Some acne persists without treatment. Early treatment prevents scarring.

Myth: Diet has nothing to do with acne.
Reality: Research now supports diet-acne connections, especially high-glycemic foods and dairy.

Conclusion: Your Path to Clear Skin

Acne is frustrating, but it's also highly treatable. The key insights from this comprehensive guide:

1. Acne is multifactorial: Hormones, genetics, diet, stress, and skincare all play roles. Address multiple factors for best results.
2. Know your acne type: Treatment approaches differ for blackheads vs. cystic acne vs. hormonal acne. Tailor your approach accordingly.
3. Proven topical treatments work: Benzoyl peroxide, salicylic acid, retinoids, niacinamide, and azelaic acid are all evidence-based. Start with one and build your routine.
4. Be patient: Acne treatments take 6-12 weeks to show full results. Don't give up too soon.
5. Don't over-treat: More products isn't always better. Protect your skin barrier.
6. Diet matters: Low-glycemic eating and potentially reducing dairy can help. Consider elimination to identify your triggers.
7. Support from within: Supplements like zinc, probiotics, omega-3s, and curcumin can complement topical treatment.
8. Manage stress: The stress-acne connection is real. Relora can help manage cortisol levels.
9. Don't pick: Picking causes scarring. Keep your hands off your face.
10. Treat scars after acne clears: Revitol Scar Removal Cream and Revitol Skin Brightener can help minimize scarring and dark marks.
11. See a dermatologist for severe acne: Prescription treatments can prevent permanent scarring. Don't wait too long.

Clear skin is achievable. It takes the right approach, consistency, and patience—but with the knowledge in this guide, you have everything you need to get there.

Start today. Be consistent. And remember: every journey to clear skin takes time, but every day of proper care is a step in the right direction.