Acne 101: Types, Causes & Treatments Explained by Dermatologist

Acne is one of the most common skin concerns worldwide. Whether you're a teenager, adult, or somewhere in between, breakouts can affect confidence, appearance, and skin health. But acne isn’t just one thing; it has many forms, causes, and treatment paths. Understanding them helps you choose the right strategy. Let’s dive in.

1. What Is Acne?

According to dermatology consensus, acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit (hair follicle + oil gland) that leads to lesions like comedones (whiteheads and blackheads), inflammatory bumps (papules, pustules), and in severe cases nodules and cysts. NCBI+1

Acne can also lead to complications: post-inflammatory hyperpigmentation (dark spots remaining after a pimple heals), scarring, and psychological stress. Yale Medicine+2NCBI+2

2. Types of Acne

Dermatologists classify acne based on lesion type, severity, and location. Here are the major forms:

 

3. What Causes Acne: The Biology & Triggers

Acne doesn’t appear for just one reason; it’s usually a mix. Major contributing factors:

• Sebum Overproduction: Oil glands become overactive, often influenced by androgens (male hormones), even in women. NCBI+1 
• Clogged Follicles (Comedone Formation): Dead skin cells + excess oil block pores. NCBI+1 
• Bacterial Growth: Cutibacterium acnes thrives in clogged follicles, leading to inflammation. Yale Medicine+1 
• Inflammation: Immune response amplifies redness, swelling, and pain. NCBI+1 

Common Triggers

• Hormonal changes (puberty, menstrual cycle, PCOS) NCBI+1 
• Genetic predisposition: Acne tends to run in families. NCBI 
• Diet & metabolic factors: High glycemic index foods, dairy, and insulin resistance may worsen acne. PubMed+2PMC+2 
• Poor skin hygiene or using occlusive/comedogenic cosmetics. NCBI+1 
• Stress and lack of sleep can spike hormones like cortisol, which increase inflammation and sebum production. NCBI+1 

4. Severity Assessments

Derms often assess acne using metrics like:

• Type & number of lesions (how many papules, pustules, nodules)
  
  
• Distribution (face, chest, back)
  
  
• Symptoms (painful, cystic, scarring)
  
  
• Psychosocial impact (how much it affects confidence, social life)
  

This guides treatment choice. Mild acne is usually comedonal or a few inflammatory lesions; moderate includes more pustules/papules; severe involves nodules/cysts or risk of scarring. Cleveland Clinic+2PMC+2

5. Evidence-Based Treatments

Here’s what dermatology guidelines and the Indian consensus recommend for treating acne. They follow a step ladder: start with gentler, topical care; escalate if needed.

First-Line Topical Therapies

• Topical retinoids (e.g., adapalene, tretinoin that are prescription based) – help normalize skin cell turnover, prevent comedone formation. American Academy of Dermatology+1 
• Benzoyl peroxide (BPO) – kills C. acnes, reduces inflammation. Often combined with other treatments. Cleveland Clinic+1 
• Topical antibiotics (clindamycin, erythromycin that are prescription based) – for moderate to inflammatory acne. To avoid resistance, often paired with BPO. Cleveland Clinic+2JAAD+2 

Systemic Treatments

Used in moderate-to-severe acne, resistant cases, or when there’s scarring/hormonal acne:

• Oral antibiotics (prescription based)  Cleveland Clinic+1 
• Hormonal treatments (prescription based): combined oral contraceptives, spironolactone (in appropriate patients) PMC+1 
• Oral isotretinoin (prescription based) – a powerful option for nodulocystic or severe acne, under dermatologist supervision. Cleveland Clinic+1 

6. Supportive & Non-Pharmacological Strategies

These help boost results and reduce side effects, and are often included in country-specific guidelines (e.g., India’s PRACT-India consensus) PubMed.

• Skincare regimen basics: gentle cleanser twice a day, non-comedogenic moisturiser, avoiding harsh soaps, and overwashing. Cleveland Clinic+1 
• Use of chemical exfoliants: mild AHAs/BHAs to help with comedones & clogged pores. JAAD 
• Sun protection: important to prevent hyperpigmentation post-acne and reduce inflammation. Yale Medicine 
• Lifestyle modifications: diet changes (lower GI foods, reduce dairy if sensitive), stress management, and sufficient sleep. Yale Medicine+2PMC+2 

7. Special Cases & When to See a Dermatologist

Some forms of acne require more urgent or tailored attention.

• Cystic acne or nodules: Painful, deep lesions risk permanent scarring. NCBI+2ijced.org+2 
• Lesions on the chest, back (body acne), especially if widespread.
  
• Acne in adult women with irregular periods is a sign of PCOS. Hormonal evaluation might help. PMC+1 
• Acne that leaves long-lasting dark spots (post-inflammatory hyperpigmentation) or scars.
  
• Acne with side effects from treatments, or when OTC / mild treatments are not sufficient.
  

8. Indian Context: Guidelines & Considerations

Because skin types, climate, access to treatments, and patient expectations vary in India, several Indian consensus documents give useful advice:

• The PRACT-India consensus (2025) emphasizes a combination of topical therapy, early intervention, patient education, and matching treatments to skin type and patient lifestyle. PubMed 
• The Acne in India: IAA Consensus Document by the Indian Journal of Dermatology, Venereology and Leprology (IJDVL) covers similar ground. IJDVL 
• Epidemiological studies from India (e.g., ~6,400+ patients) show that acne in Indian skin may present differently (more pigmentation issues, post-acne marks), and so treatment plans often need to account for aftereffects like hyperpigmentation. ijced.org 

9. Treatment Timeline & Expectations

One thing many people underestimate is how long acne treatment takes. Here’s what dermatologists often say:

It’s normal to still see occasional breakouts during treatment. What matters is a consistent routine, not perfection on day one.

10. Putting It All Together: A Dermatologist-Recommended Routine

Here’s a sample step-by-step routine you might follow based on your acne type & severity:

Morning:

• Gentle niacinamide based cleanser (non-soap, non-compressing)
  
  
• Topical treatment (e.g., salicylic acid)
  
  
• Lightweight, non-comedogenic moisturizer
  
  
• Broad-spectrum sunscreen SPF 30-50
  Evening:
  
• Double cleanse if wearing  makeup/mineral sunscreen
  
  
• Topical retinoid azelaic acid or other actives
  
  
• Optional pimple patches
  
  
• Moisturizer that supports barrier (includes ceramides, ectoin, niacinamide)
  
  Weekly / As Needed:
  
• Mild exfoliation once a week with BHA or AHA (if it suits you)
  
  
• Avoid picking/squeezing pimples
  
  
• Change pillowcases often; clean items that touch skin
  

11. Myths & Facts

 

Final Thoughts

Acne isn’t one-size-fits-all. What works for one person may not work for another because of differences in skin type, acne type, triggers, and personal history. But the principles remain consistent: identify your acne type, use treatments proven to work, support your skin barrier, and be patient.

Suppose you’re exploring science-backed solutions (formulations that understand your skin biology), or want to combine active ingredients with gentler care. In that case, that's where a well-formulated routine (like what Dr. Su aims to offer) adds value.

Always consult a dermatologist for moderate to severe acne, or if over-the-counter options aren’t improving the condition. Your skin deserves a plan, not guesswork.