What Causes Acne? Treatments, Medications and More

Acne isn’t just a teenage predicament; it can strike at any stage, from the tumultuous teen years to the stresses of adulthood. This common skin condition doesn’t discriminate by age and can significantly affect how we view ourselves and interact with the world; many people report social anxiety and depressive symptoms due to skin conditions like acne. 

However, many factors can impact the course of treatment you choose and how you work with a dermatologist. In this article, we’ll explore what acne is, what causes it, and how dermatologists can help alleviate acne problems.

What is acne?

Acne is the skin condition dermatologists see most, but there’s a difference between acne and an occasional pimple. While there’s no universal grading system for acne, The Canadian Dermatology Association categorizes the condition into three stages of acne for the general public — mild, moderate, and severe.

In order to determine the best course of treatment, a clinician may classify acne according to the number and type of lesions as well as their severity, where on your body they appear, if they’re accompanied by scarring, and if it’s impacting your overall quality of life.

Types of lesions can include:

• Open comedones (blackheads)
• Closed comedones (whiteheads)
• Papules (small, raised, red bumps that aren’t filled with pus)
• Pustules (inflamed, red, pus-filled bumps)
• Nodules, which are firmer bumps in the deeper layers of your skin. These can be painful and often don’t come to a head, resulting in scarring if you pick or squeeze them.
• Cystic acne, which are more painful, pus-filled bumps in the deeper layers of your skin. Picking or squeezing them may also lead to scarring.

In order to make an accurate diagnosis, your provider will also want to rule out other conditions that present with similar symptoms such as rosacea, dermatitis, folliculitis, or acneiform eruptions, to name a few. Moreover, they’ll be on the lookout for signs of complications such as psychosocial effects, gram negative folliculitis, acne fulminans, or solid facial edema to help guide treatment options.

What causes acne?

Acne often starts around puberty. Yet, while it may appear around age 13, it can emerge in children as young as 10. Contributing factors include stress, genetics, certain hair and makeup products, some medications, and improper skincare routines. However, the biggest reason teenagers tend to get acne is hormones.

Adults get acne for many of the same reasons as teenagers. Women, especially, may experience it as their hormone levels fluctuate around certain points in their menstrual cycle. Menopause and conditions like polycystic ovarian syndrome (PCOS) also cause hormonal fluctuations, which can contribute to acne. However, men aren’t immune either, as elevated testosterone levels can cause acne formation. 

Because of acne’s link to hormonal levels, transgender individuals undergoing gender-affirming hormonal treatment with estradiol or testosterone are also more likely to experience it. As a result, acne may be a side-effect of both feminizing hormone therapy (FHT) or masculinizing hormone therapy (MHT). In fact, one study found that between 6-31% of patients receiving MHT developed acne. 

Home treatments for acne

Many develop a skincare routine to deal with their acne. However, without clinical input, this can sometimes result in habits that make your acne worse. 

One of the worst offences is squeezing your pimples. While it may feel helpful, this often leads to scarring. Moreover, it can spread the infection into your surrounding pores, worsening the problem.

Beyond picking at acne, some ways you can compromise your skin health including: 

• Using the wrong skincare and makeup products such as oil-based or ones containing parabens or lanolin. Instead, reach for oil-free or products labelled non-comedogenic or non-acnegenic.
• Overwashing and over-scrubbing your skin. Acne does not mean you have dirty skin. You do not need to wash it more than once or twice a day with a gentle cleanser, even if you have oily skin.
• Not cleaning your makeup brushes regularly. Makeup applicators can harbour bacteria. Using a gentle soap, give your makeup brushes a clean and allow them to dry fully before reusing them.
• Sleeping on a dirty pillowcase. Your bedsheets and pillowcases absorb oil and hold onto dirt, remember to wash your bedding regularly. 
• Stressing out. Stress can impact your hormone levels, and indirectly worsen your acne. Practice healthy stress-relieving activities like yoga, journalling, or meditation. 

While diet remains an identified gap in current research, many also find that their diet can worsen acne, such as eating high-sugar foods, greasy foods, and too much dairy. Emerging data suggests this may be true as high glycemic index foods like simple carbohydrates may be associated with acne. Limited evidence suggests that dairy may influence acne as well, particularly skim milk consumption.

Moreover, seasonal shifts can contribute as hot, humid weather paired with sweat can worsen acne. Alternatively, colder, dryer temperatures may cause your skin to produce more sebum, its natural oil. As a result, certain individuals may find their acne flares up in the summer, while others experience worse acne during the winter months.

How to treat acne

Acne treatment depends partially on your skin type—oily, dry, normal, or combination. Since stress and hormones can play a role, addressing these by:

1. Getting enough sleep
2. Drinking lots of water may help. 
3. Exercising regularly (at least 150 minutes per week) and minimizing sedentary behaviour can help manage stress and regulate hormone levels

Beyond those, a proper skincare routine, including a cleanser, toner, and acne medication if needed, is key. For many, this may also include serums, as evidence shows that salicylic acid and vitamin C can help with acne, especially in milder cases.

However, one of the most effective ways to treat acne is by seeing a dermatologist. In addition to developing an appropriate skincare routine, dermatologists can prescribe topical or oral medications or hormonal agents such as the birth control pill to help control acne and treat or prevent complications from severe acne.

Which medications help acne?

Many women turn to oral birth control as a treatment for their acne. The combination pill contains the hormones progesterone and estrogen, which can help to reduce your body’s androgen levels — the hormone responsible for making your skin oily.

The combination pill can be a great way of preventing both acne and pregnancy, but it’s not for everyone. If you’re over 35 and smoke, or if you have a history of stroke or blood clots, for example, your provider may suggest another alternative. Likewise, if you were assigned male at birth, the birth control pill isn’t appropriate for treating acne.

While not all birth control pills have been approved to treat acne, a review of 30+ studies found that all combination pills were effective at reducing acne without much difference between brands. However, it’s important to note that this effect doesn’t extend to the progesterone-only pill, also known as “the mini pill.” Its lack of estrogen means it’s not effective for treating acne.

If your provider doesn’t recommend you take the combination pill, you have other options, including benzoyl peroxide, antibiotics like tetracycline or doxycycline, or a combination of therapies. These medications slow the growth of acne-causing bacteria on your skin’s surface while addressing inflammation.

Alternatively, you may be prescribed an oral acne medication such as isotretinoin. This medication works by reducing the size of the oil glands on your face, which decreases the amount of sebum they produce. At the same time, it functions as an anti-inflammatory and increases cell turnover, reducing pore clogging.

How to find a dermatologist
Appointments require a referral from a primary care provider. However, if you’re among the 6.5 million Canadians without a family doctor, this could result in long wait times at the walk-in clinic.

The average wait time to see a dermatologist in Canada is between six to 18 months, depending on where you live.

With Maple, Canada’s leading virtual care platform, you can book a  Canadian-licensed dermatologist appointment directly without a referral. Dermatologists on Maple are the same specialists you’d see in person, but they also practice outside of their own clinic hours to see patients virtually. 

Information presented here is for educational purposes, and not to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.