What is Acne?

Acne vulgaris is a common inflammatory skin disorder affecting the pilosebaceous unit—the hair follicle and its attached oil gland. While most prevalent in teens, acne can occur at any age.

Types of Acne

Acne appears on the face, chest, and back—areas with the highest concentration of oil glands. Lesions vary in severity:

• Grade 1: Comedones (mild acne)

• Whiteheads: Clogged, closed pores

• Blackheads: Open pores with oxidized debris

• Grade 2: Papules (moderate acne)

• Small, red, inflamed bumps

• Grade 3: Pustules

• Papules that develop white pus

• Grade 4: Cystic and Nodular Acne (severe acne)

• Deep, painful lesions with increased risk of scarring

Note: there can also be “acne imposters” like folliculitis, rosacea, and milia so it’s important to see a doctor for a diagnosis. The location and presentation can also be “hormonal pattern,” indicating that a different treatment approach may be needed.

What Causes Acne?

There is still a lot we don’t know about the underlying cause and because acne is a complex, multifaceted skin disorder - there probably isn’t just one answer.

Emerging Theories:

1. Insulin resistance or consuming high glycemic foods could result in excess Insulin-like Growth Factor-1, causing more inflammation and oiliness.

2. Lipid peroxidation from sun exposure may cause changes to the sebum composition in our skin.

3. Predisposing genetic factors likely play a role as men and younger people are more prone to acne. Deeper skin tones are also more likely to have increased acne severity.

Contributing Factors

While the underlying cause of acne requires further study, we know a lot about the pathophysiology of acne - or the physical changes to the skin that are happening when you have acne. And acne research has identified the contributing factors involved in how acne develops in the skin:

• Hormonal Fluctuations. Androgens in particular can increase sebum production, particularly in puberty and conditions like PCOS (polycystic ovarian syndrome).

• Sebum Overproduction. Being oily alone won’t cause acne but it does provide more “bacteria food” and we see changes in sebum composition with acne.

• Bacterial Overgrowth. When pores become blocked, the normally friendly skin microbe Cutibacterium acnes is able to thrive in the anaerobic environment and there is an overgrowth within the pore. 

• Inflammation. Acne causing bacteria will cause inflammation by triggering an immune response but it’s a “chicken or the egg” situation as inflammation may also contribute to acne occurring to begin with.

• Hyperkeratinization – Skin cells multiply more rapidly within the pores of acne-prone skin but they’re also more prone to clumping together and blocking the pore opening.

Acne and Skin Health

Acne is more than just active breakouts—it impacts overall skin function:

Acne-Prone Skin Characteristics

• Impaired Skin Barrier – Inflammation and depletion of barrier lipids like ceramides and linoleic acid compromise function.

• Dehydration – Poor barrier function increases water loss, resulting in dullness and buildup of dead skin cells on the skin surface.

• Increased Sensitivity – Acne medications, inflammation, and poor barrier health can heighten skin reactivity.

Post-Acne Marks

Even after achieving acne clearance, lingering effects include:

• Post-Inflammatory Hyperpigmentation (PIH): Brown or purple marks, common in deeper skin tones.

• Post-Inflammatory Erythema (PIE): Red spots, common in lighter skin tones.

Scarring: Severe acne (Grade 4) can cause atrophic (indented) or hypertrophic (raised) scars.

Acne Treatment

Acne is a medical condition and should be treated as such. Mild to moderate acne can be responsive to over-the-counter (OTC) treatments but if you don’t see improvement - or your acne is severe- consult a healthcare professional. Telehealth options have made acne treatment much more accessible if seeing an in-person dermatologist isn’t an option. 

Evidence shows that the most effective acne treatments target as many contributing factors as possible. For this reason, you’ll often see combination therapy with more than one acne medication.

Most Effective OTC Acne Medications

• Salicylic Acid – Unclogs pores and targets blackheads

• Benzoyl Peroxide + Retinoids – One of the most effective combinations available at home (for mild to moderate acne)

• Other Options: Mandelic acid, sulfur, azelaic acid

Prescription & In-Office Treatments

• Topical Treatments: Prescription retinoids, benzoyl peroxide, azelaic acid, antibiotics

• Hormonal Therapy: Spironolactone, clascoterone, oral contraceptives

• Oral Medications: Isotretinoin, oral antibiotics

• Other Options: Corticosteroid injections, chemical peels, light-based therapies

At Home Routine

Acne care should focus on gentle cleansing and barrier support while avoiding irritants. While skincare plays a role, cosmetic products alone won’t treat acne - and often consumers can feel discouraged because they’re using cosmetic ingredients like niacinamide and not seeing improvement. Skincare should support skin health alongside a treatment plan. 

Acne Skincare Priorities

✔ Effective but gentle cleansing

✔ Anti-inflammatory ingredients

✔ Hydration & barrier repair

Example Routine for Acne-Prone Skin

Morning:

• Gentle cleanser

• Soothing antioxidant serum

• Sunscreen

Evening:

• Double cleanse

• Hydrating toner or serum

• Barrier-replenishing moisturizer

*Acne Meds: Apply according to directions.

Stratia Skin Product Recommendations

• Soft Touch AHA (mandelic acid)

• Aqua Factory Toner (hydration)

• Rewind Serum (anti-inflammatory)

• Lipid Gold Moisturizer (barrier support)

• Interface Peptide Cream (repair)

Common Acne Myths

1.“Someone with acne must not wash their face or care for their skin.”

False. While not cleansing your skin may exacerbate existing acne, it’s not why someone has acne. And most acne-sufferers take better care of their skin than those without.

2. “I’ve been breaking out, I really need to eat better.”

False, mostly. A healthy diet and exercise is important for overall health but there isn’t a lot of evidence that diet plays a role in acne. There may be a link between high glycemic foods and acne so if you want to consume them in moderation, go for it. But you’re best served by seeing a dermatologist for treatment.

3. “Acne is your body trying to get rid of toxins and you should detox yourself.”

False. Not only is there no evidence for this but that’s not how our body works. Toxins are not excreted through pores or sweat glands. We have organs like the liver and kidneys for this and unless you have something serious going on (think poisoning or kidney disease), they don’t need help.

4. “I should try as much as possible, something will help.”

False. Acne is incredibly frustrating to deal with and can impact your self-esteem. As a result, it can be tempting to throw everything at it. The problem is, this can make it difficult to tell what is helping and what isn’t. Your skin can also become very irritated in the process, worsening acne due to increased inflammation. Ideally, work with a dermatologist and begin with what is most evidence-based and effective.

5. “Nothing has worked for my acne, I have tried everything.”

This may not be true. Acne treatments take time to work and when people report that nothing works, it may be because they didn’t give it enough time to work. If you still don’t see results, you’ll want to follow up with your doctor to adjust dosage or change medications as needed. It can take time and consistency but results are possible.

Mira is a skincare educator, blogger, and the content creator behind Skin Science by Mira and The Skincare Forum on Facebook. While skincare keeps her busy, she’s also pursuing her degree in Nursing and loves to spend her free time hiking.  As a content writer for Stratia Skin, Mira shares her evidence-based approach to skincare topics and a passion for making science accessible.  Mir