Understanding Acne: types, causes, and treatments

Acne is a skin condition that can take various forms depending on several factors, including severity, age, stage of progression, or specific contexts (such as pregnancy).

This guide offers a practical overview to help identify the different types of acne and their specific characteristics. Regardless of its type, acne is a significant concern for those who experience it.

However, effective treatment strategies must be tailored to each individual case.

Types of acne and their characteristics

Polymorphic juvenile acne

This is the classic adolescent acne that often begins during puberty. It is termed « polymorphic » because the skin lesions can present in multiple forms:

• Comedonal acne: Blackheads (open comedones) and microcysts (closed comedones) primarily appearing on the face.
• Mild inflammatory acne: Red papules and pustules, often fewer in number.

These manifestations result from follicular hyperkeratinisation and excessive sebum production (hyperseborrhea), triggered by hormonal fluctuations typical of adolescence

Inflammatory acne in adults

Inflammatory acne can coexist with comedonal acne. This type is characterised by:

• Red, painful papules and pustules caused by inflammation.
• A frequent localisation on the cheeks, jawline, chin, and occasionally the chest or back.

The bacterium Cutibacterium acnes (formerly Propionibacterium acnes), a natural resident of the skin, plays a central role. It interacts with sebaceous lipids, triggering an immune response and inflammation. In adults, this type of acne can be chronic and often requires dermatological management, including topical, systemic, or hormonal treatments.

Cystic acne

Cystic acne is a severe, often painful form, characterised by:

• Deep skin lesions such as nodules and cysts.
• Potential scarring (atrophic or hypertrophic) if left untreated.

Cysts, which feel like small hard lumps beneath the skin, necessitate prompt dermatological consultation. Treatments frequently include systemic medications, such as isotretinoin.

Hormonal acne

Hormonal acne, while it can affect anyone, is particularly common in adult women. All types of acne are influenced by hormones since sebum production is hormonally regulated. However, certain specific imbalances can exacerbate acne, including:

• Excess androgen production (male hormones) stimulating the sebaceous glands.
• Hormonal fluctuations related to the menstrual cycle, with outbreaks occurring 7–10 days before menstruation (observed by ~50% of adult women with acne).
• Hormonal changes during pregnancy, affecting approximately 42% of pregnant women. While acne may resolve post-pregnancy in some cases, others continue to experience it.

Despite advances, the hormonal mechanisms behind acne are not yet fully understood. Research focuses on persistent acne in adult women to better tailor treatments.

Aggravating factors and other forms of acne

Beyond the types mentioned above, various factors can exacerbate or influence acne outbreaks:

• External factors: Stress, diets high in sugars or dairy products, or the use of comedogenic cosmetics.
• Specific medical conditions: Polycystic ovary syndrome (PCOS) or certain medications (e.g., corticosteroids, contraceptives).
• Skincare habits: Poor skin cleansing routines or picking at lesions.

Management and treatments

Acne management depends on its severity and type:

• Mild (comedonal) acne: Topical treatments such as benzoyl peroxide, retinoids, or salicylic acid.
• Moderate (inflammatory) acne: A combination of topical treatments and, in some cases, short-term oral antibiotics.
• Severe (cystic) acne: Oral isotretinoin under strict medical supervision.
• Hormonal acne: Hormonal contraceptives or anti-androgens as appropriate.
• Consulting a dermatologist is crucial for accurate diagnosis and to prevent ineffective treatments.

Prevention and practical tips

• Gentle cleansing: Use dermatological waters or soap-free cleansers suitable for your skin type.
• Avoid comedogenic products: Opt for non-greasy, non-clogging skincare.
• Do not pick at spots: This can worsen inflammation and lead to scarring.
• Adopt a balanced diet: Reduce high-sugar and dairy intake if these correlate with outbreaks.
  
  

Acne is a complex condition influenced by various factors, including hormones, age, and lifestyle habits. While often mild, it can significantly impact quality of life and self-esteem. Proper management, guided by an accurate dermatological diagnosis, is essential to restore healthy skin and prevent scarring.

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