Acne: Causes, Types, and Treatment

Acne is a chronic inflammatory disease of the sebaceous hair follicles, characterized by the appearance of comedones, inflammatory papules, pustules, nodules, and often scars. Acne is now considered not just a cosmetic defect, but a fully fledged disease with its own international classification code and significant impact on quality of life. According to various sources, up to 80-90% of adolescents experience acne to some degree, with a significant percentage of these breakouts persisting into adulthood. [1]

The disease doesn't just affect teenagers. So-called late-onset acne is increasingly being described in adults, especially in women over 25-30 years of age. This group of patients typically presents with deep, painful lesions on the lower third of the face, chin, and jawline, often with a cyclical increase in breakouts before menstruation. Acne can accompany polycystic ovary syndrome and other hormonal disorders. [2]

Modern research emphasizes that acne affects not only the skin but also mental health. In some patients, the disease is associated with anxiety, depression, low self-esteem, social isolation, and even suicidal thoughts. Meta-analyses show that depression and anxiety associated with acne occur in tens of percent of cases, and suicidal thoughts occur in a significant proportion of patients, especially adolescents and young adults. [3]

It's important to understand that acne can and should be treated. International guidelines in recent years offer clear treatment algorithms based on severity, the patient's age, gender, comorbidities, and the psychosocial impact of the disease. With the right approach, it's possible not only to reduce the number of breakouts but also to prevent the formation of scars and persistent pigmentation. [4]

This article systematizes current knowledge about acne: why it occurs, how it manifests, the principles of diagnosis and treatment, the role of skin care, diet, and lifestyle, and when it is important to consult a dermatologist as soon as possible. The text is aimed at a general reader and is based on current international clinical guidelines. [5]

How acne develops

Acne is caused by several interconnected processes. First, sebum production increases and its composition changes. Sebaceous glands become more active under the influence of androgens and other factors, and the sebum lipids themselves become more viscous and easily clog the gland duct. Second, keratinization at the follicle opening is disrupted: epidermal cells shed more quickly, stick together, and form a plug that impedes the release of sebum. [6]

The third important component is changes in the microbiome. Cutibacterium acnes, formerly known as Propionibacterium acnes, lives in the pilosebaceous follicle. This is a common member of the skin's microflora, which normally helps maintain an acidic environment and suppress the growth of more dangerous bacteria. However, under certain conditions, certain strains of Cutibacterium acnes begin to form biofilms, produce virulence factors, and trigger a pronounced inflammatory response. [7]

The fourth link is local inflammation. Sebum breakdown products, mediators released by Cutibacterium acnes, and the destruction of follicle walls activate the innate and adaptive immune response. Neutrophils and lymphocytes appear at the site, triggering cytokine cascades, including interleukin-1, interleukin-17, and other inflammatory mediators. The result is the formation of red, painful lesions, and, if the follicle walls are destroyed and the process spreads into the dermis, nodules and cysts. [8]

Individual risk factors are superimposed on these basic mechanisms. In adolescents, physiological hormonal changes play a key role. In adults, fluctuations in sex hormone levels, polycystic ovary syndrome, chronic stress, certain medications, smoking, and exposure to occupational irritants are significant. Recent data point to the influence of a high glycemic load in the diet and excess dairy products, but the association is considered moderate, and individual susceptibility varies greatly. [9]

Finally, genetic and family factors play a role. In people with a family history, acne tends to begin earlier, progress more severely, and scar more often. The contribution of gene polymorphisms associated with the immune response, regulation of sebum production, and androgen receptor sensitivity is being studied. The exact "genetic formula" for acne has not yet been determined, but it is clear that heredity influences both the tendency to scar and the response to treatment. [10]

Table 1. The main links in the pathogenesis of acne and what influences them

Link	What's happening	What enhances	What is the treatment aimed at?
Seborrhea	The sebaceous glands produce a lot of sebum, and its composition changes.	Androgens, stress, certain medications, high-glycemic load diets	Topical retinoids, some systemic drugs, correction of hormonal imbalances
Hyperkeratosis of the follicle orifice	The keratinized cells clog the gland duct.	Genetics, local inflammation, irritating skin care products	Topical retinoids, acids, gentle cleansing
Microbiome and Cutibacterium acnes	Certain strains form biofilms and activate the immune system.	Uncontrolled antibiotics, aggressive cleansing, damage to the skin barrier	Benzoyl peroxide, azelaic acid, rational use of antibiotics
Inflammation	Cytokines are released, papules, pustules, and nodules are formed.	Stress, skin trauma, attempts to squeeze	Anti-inflammatory properties of retinoids, benzoyl peroxide, systemic therapy
Scarring	The destruction of the dermis is replaced by connective tissue	Severe degree, late start of treatment, spontaneous opening of elements	Early initiation of therapy, systemic isotretinoin, scar smoothing procedures

Clinical manifestations: types of rashes and severity

The classic elements of acne are comedones and inflammatory lesions. Comedones can be closed or open. A closed comedone appears as a small, whitish "bump" under the skin, while an open comedone resembles a blackhead. The dark color is not caused by dirt, but by oxidized melanin and lipids in the clogged comedone. Comedones represent the initial stage of the disease and can persist for months before some develop into inflammatory lesions. [11]

Inflammatory elements include papules (firm red bumps), pustules (pustules with purulent apexes), nodules, and cysts. Nodules and cysts are located deep in the dermis, are painful to palpation, often merge, and leave scars when healing. Different types of elements can coexist in the same person, and the severity depends not only on their number but also on their depth and tendency to scar. [12]

International guidelines distinguish several degrees of acne severity. Mild acne is characterized by a predominance of comedones and a small number of superficial inflammatory lesions. Moderate acne has more papules and pustules, which extend beyond the face, often affecting the back and chest. Severe forms include numerous nodules, cysts, confluent lesions, and a high risk of scarring. There are also special, rare forms, such as acne conglobata and acne fulminans, which require urgent treatment. [13]

Late-onset acne in women is considered separately. It is characterized by breakouts on the lower third of the face, associated with the menstrual cycle, and often combined with excessive male-pattern hair growth, menstrual irregularities, and weight gain, necessitating the investigation of endocrine pathologies, particularly polycystic ovary syndrome. In such cases, hormonal adjustments are often the key to lasting skin improvement. [14]

It's also important to remember about post-acne. Even after active breakouts resolve, persistent erythema, areas of increased or decreased pigmentation, and atrophic and hypertrophic scars may remain. The longer acne goes untreated, the higher the risk of such changes. Therefore, the doctor's goal is not only to eliminate the current breakouts but also to halt the scarring process as soon as possible. [15]

Table 2. Acne severity levels and suggested treatment strategies

Degree	Clinical picture	Risk of scarring	Basic tactics
Light	Comedones predominate, with a few papules and pustules, mainly on the face	Low if treatment is started on time	Topical treatments: retinoids, benzoyl peroxide, azelaic acid, proper care
Average	Many papules and pustules on the face, sometimes on the back and chest	Average	Combination of external therapy, if necessary, addition of systemic antibiotics in a course of limited duration
Heavy	Nodes, cysts, confluent lesions, pronounced inflammatory elements on the face and body	High	Systemic isotretinoin or other regimens under the supervision of a dermatologist, possible involvement of a psychotherapist
Late-onset acne in an adult woman	Elements in the lower third of the face, connection with the cycle, possible signs of hormonal imbalances	Medium or high	Examination for hormonal imbalances, possibly combination therapy with the participation of a gynecologist endocrinologist
Rare severe forms	Sudden onset, fever, painful nodes, severe inflammation	Very tall	Emergency care, systemic drugs, sometimes hospitalization

Psychological and social consequences of acne

Acne significantly impacts self-esteem, especially during adolescence, when appearance is central to one's value system. Teenagers with acne are more likely to experience feelings of shame, avoid social interactions, and refuse sports, social gatherings, and photographs. In adult patients, the condition can complicate professional and personal life, especially in areas where appearance is important. [16]

Modern research shows that acne is associated with an increased risk of depression and anxiety disorders. Systematic reviews demonstrate that signs of depression are observed in approximately one in five or even one in four individuals with acne, with anxiety being even more common. Some studies also document an increased incidence of suicidal ideation compared to the general population. This is particularly noticeable in young people, who experience skin conditions along with other stressors. [17]

The psychological burden of acne does not always correlate with the objective severity of the breakouts. Sometimes, a few noticeable lesions on the face are more distressing than a more pronounced but habitual course in another person. Therefore, it is important for the physician not only to assess the number and severity of lesions but also to ask the patient about how the disease affects self-perception, communication, and academic or work performance. In some cases, collaborative management with a psychologist or psychotherapist is warranted. [18]

Importantly, effective acne treatment can reduce symptoms of depression and anxiety. Study participants whose acne significantly improved with modern treatments were more likely to report improved mood, self-confidence, and social functioning. This is another argument in favor of not delaying a visit to a dermatologist and not relying on randomly selected "advertised treatments." [19]

Loved ones of someone with acne should remember that phrases like "you'll outgrow it," "don't make things up," or "everyone gets acne" can only exacerbate the situation. It's much more helpful to offer support, help arrange a visit to a specialist, and remind them that the condition is treatable and that scarring can be prevented with timely treatment. In some families, discussing a care and nutrition plan together can be helpful, so the person isn't left alone with their problem. [20]

Acne Diagnosis: How the Examination Is Performed

In most cases, acne diagnosis is based on clinical presentation. A dermatologist examines the skin of the face, back, and chest, assessing the type of lesions, the degree of inflammation, the presence of scars, and post-inflammatory pigmentation. It is important to determine the duration of the condition, the presence of flare-ups, the influence of the menstrual cycle in women, medication use, skin care habits, and cosmetics used. [21]

Laboratory tests are generally not required for typical acne. However, they may be necessary if there are signs of endocrine disorders, such as irregular menstruation, male-pattern hair loss, weight gain, or signs of insulin resistance. In such cases, the doctor may order tests for sex hormones, glucose, insulin, lipid profile, and other lab work. When planning systemic therapy, complete blood counts and biochemical parameters are sometimes ordered to assess the safety of treatment. [22]

Bacteriological cultures of the skin's contents or microbiome analysis are rarely necessary. They are typically considered when an atypical infection is suspected, when there is significant resistance to standard treatment, or when planning long-term antibiotic therapy, especially if there are signs of other skin diseases. Testing for the presence of Demodex mites is performed when indicated, but the Demodex mite itself is not considered a primary cause of acne. [23]

Sometimes differential diagnosis is required with other skin conditions: rosacea, perioral dermatitis, folliculitis, drug rashes, and granulomatous diseases. In complex cases, a dermatologist may use dermatoscopy, and if rare forms are suspected, a skin biopsy may be ordered; however, this is the exception rather than the rule. [24]

A separate aspect is assessing the patient's mental state. Given the high prevalence of depression and anxiety in acne, guidelines increasingly emphasize the importance of asking patients simple questions about their mood, sleep, and stress levels, and, if necessary, offering the help of a psychologist or psychotherapist. This is especially relevant in severe cases and when prescribing systemic retinoids. [25]

Table 3. What a doctor does when diagnosing acne

Stage	The doctor's tasks	What is important from the patient?
Collection of anamnesis	Find out the duration, provoking factors, influence of the cycle, medications, care and cosmetics	Be honest about your habits, the remedies you use, and any attempts at self-medication.
Skin examination	Assess the type of elements, their quantity, location, and presence of scars	Do not cover up rashes with heavy makeup before the appointment.
Evaluation of accompanying features	Suspect hormonal imbalances, metabolic problems, mental health issues	Report any cycle irregularities, weight gain, or mood swings
Prescribing tests if necessary	Confirm or exclude endocrine and other pathologies, assess the safety of treatment	Complete the tests within a reasonable time frame and bring the results to your follow-up appointment.
Treatment planning	Choose a regimen taking into account the severity, age, gender, and concomitant diseases	Ask questions, clarify the plan and duration, discuss the expected effect

Acne treatment

Current clinical guidelines emphasize several basic principles of acne treatment. First, therapy should be comprehensive and address multiple pathogenetic factors simultaneously: hyperkeratosis, seborrhea, the microbiome, and inflammation. Second, it is important to begin treatment as early as possible and maintain the results to prevent scarring. Third, the regimen is individualized, taking into account age, gender, disease severity, and psychosocial influences. [26]

International guidelines in recent years strongly emphasize the use of topical retinoids and benzoyl peroxide, as well as the cautious and limited use of antibiotics. The most authoritative guidelines recommend fixed-dose combinations of a retinoid and benzoyl peroxide, sometimes with the addition of a topical antibiotic, as the basis for the treatment of mild to moderate acne. Systemic antibiotics are considered an option for moderate to severe acne, but courses should be limited in time, and antibiotics should never be used as the sole treatment. [27]

For severe acne, acne with a tendency to scar, and when standard regimens are ineffective, systemic isotretinoin is prescribed. This highly effective drug addresses virtually all stages of the disease, but requires strict monitoring due to potential side effects and high teratogenicity. Women of childbearing age should strictly adhere to contraceptive measures during this treatment. The decision to prescribe isotretinoin is always made by a dermatologist after a thorough examination and discussion of the risks. [28]

An important goal is to minimize the risk of antibiotic resistance in Cutibacterium acnes and other bacteria. To achieve this, antibiotic monotherapy should be avoided, always combined with benzoyl peroxide, the duration of treatment courses should be limited, and, whenever possible, maintenance therapy without antibiotics should be rapidly transitioned. New research shows an alarming increase in the proportion of Cutibacterium acnes strains resistant to clindamycin and erythromycin, making rational use of antibiotics critically important. [29]

A separate set of recommendations concerns long-term maintenance treatment. Even after improvement in the skin's condition, therapy is usually not discontinued completely, but rather switched to a maintenance regimen with lower intensity, most often using a topical retinoid, sometimes in combination with azelaic acid or benzoyl peroxide. This helps reduce the risk of relapse and keep the disease under control. [30]

Table 4. Main goals of acne treatment

Target	What is meant	How is it achieved?
Reduction in the number of rashes	Reduction of the number of comedones and inflammatory elements	External agents, systemic drugs if necessary
Prevention of scarring	Prevention of deep inflammatory processes and destruction of the dermis	Early initiation of therapy, isotretinoin when indicated, avoidance of squeezing
Improving the quality of life	Reduction of shyness, anxiety, and depressive symptoms	An effective plan, support from a doctor and loved ones, and psychotherapy if necessary
Minimizing side effects	Maintaining the integrity of the skin barrier, controlling systemic reactions	A competent choice of drugs, gradual introduction, monitoring of tests during systemic therapy
Reducing the risk of resistance	Preventing the growth of resistant strains of Cutibacterium acnes	Limiting antibiotics by time, combining with benzoyl peroxide, focusing on retinoids and other groups

Topical Acne Treatments: What Really Works

Topical retinoids (adapalene, tretinoin, tazarotene, and trifarotene) are considered key agents for the treatment of comedonal and combination acne. They normalize keratinization at the follicle opening, reduce the number of comedones, have an anti-inflammatory effect, and partially influence scarring. Retinoids can cause irritation and dryness of the skin at the beginning of treatment, so they are introduced gradually, taking into account individual tolerance. [31]

Benzoyl peroxide is another key component of topical therapy. It exhibits pronounced bactericidal activity against Cutibacterium acnes and does not cause resistance due to its oxidative mechanism. The drug also reduces inflammation and has a mild keratolytic effect on the stratum corneum. Benzoyl peroxide is often used in combination with retinoids and antibiotics, which helps reduce the risk of resistance and enhance treatment effectiveness. [32]

Azelaic acid has numerous beneficial effects, including comedolytic activity, anti-inflammatory action, effects on Cutibacterium acnes, and reduction of hyperpigmentation. It is well suited for patients with sensitive skin, pregnant and breastfeeding women, and those with post-inflammatory hyperpigmentation. Some guidelines consider azelaic acid as a first-line treatment option for mild to moderate acne. [33]

Topical antibiotics (most commonly clindamycin, less commonly erythromycin) are used sparingly and always as part of combination therapies with benzoyl peroxide or a retinoid. Long-term use of antibiotic-based monotherapy is now considered unacceptable due to the high risk of developing resistance. Fusidic acid- or mupirocin-based medications, although they have antibacterial activity, are not included in modern acne treatment regimens and are used for other dermatological conditions. [34]

A new class of topical agents is the topical antiandrogen clascoterone, which blocks androgens in the skin and reduces sebum production. It is approved for the treatment of acne in adolescents and adults in several countries and is considered a promising option, particularly for severe seborrhea and hormonally induced acne. However, the drug's availability and cost currently limit its widespread use. [35]

Table 5. Topical acne treatments: what works for what

Group	Main action	What forms is it suitable for?	Features of application
Topical retinoids	Normalizes keratinization, reduces comedones, and reduces inflammation	Mild to moderate acne, comedonal form, maintenance therapy	Apply in the evening, introduce gradually, irritation and dryness are possible
Benzoyl peroxide	Kills Cutibacterium acnes and reduces inflammation.	Mild and moderate inflammatory forms	Often combined with retinoids and antibiotics, may discolor tissue
Azelaic acid	Comedolytic, anti-inflammatory and lightening action	Mild to moderate acne, sensitive skin, post-inflammatory hyperpigmentation	Suitable for long-term therapy, slight tingling may occur
Topical antibiotics	Inhibit bacterial growth	Inflammatory forms if necessary	Used only in combination, the course is limited in time
Clascoterone	Blocks the action of androgens in the skin	Severe seborrhea, hormonal acne	New product, not available in all countries, requires evaluation by a dermatologist

Systemic treatment and special situations

Systemic antibiotics are used for moderate to severe acne when topical therapy is insufficient. Tetracycline antibiotics, most commonly doxycycline and minocycline, are most commonly prescribed. They reduce inflammation and inhibit the growth of Cutibacterium acnes. The course is limited to a few months, after which the patient is transitioned to maintenance topical therapy. It is important not to combine systemic and topical antibiotics with the same spectrum of therapy to avoid increasing the risk of resistance. [36]

Hormonal therapy in women may include combined oral contraceptives and androgen-reducing medications. These are used for acne associated with hormonal imbalances and are particularly useful when acne is combined with seborrhea, hyperandrogenic symptoms, and polycystic ovary syndrome. The decision to prescribe such medications is made jointly by a dermatologist and a gynecologist-endocrinologist, taking into account all contraindications and risks. [37]

Systemic isotretinoin is the "gold standard" for the treatment of severe, nodular, conglobate, and acne with severe scarring, as well as disease resistant to other treatments. It affects sebum production, reduces the size of sebaceous glands, normalizes keratinization, and significantly reduces the number of Cutibacterium acnes. When used correctly, a significant proportion of patients achieve long-term remission. However, the drug requires strict monitoring, regular laboratory testing, and the exclusion of pregnancy in women. [38]

A special approach is necessary when treating young children and pregnant women. For children, gentler regimens are used, focusing on topical agents in lower concentrations and volumes. For pregnant and breastfeeding women, the choice of treatments is limited: azelaic acid and some other safe medications are permitted, but most retinoids and systemic medications are contraindicated. In these patient groups, therapy is always individualized and should be administered under the supervision of a physician. [39]

In patients with severe psychoemotional burden from acne, it is reasonable to consider both skin treatment and mental health support. For some people, acne can be a risk factor for depression and other conditions, and effective dermatological treatment combined with psychotherapy or medication can significantly improve quality of life. [40]

Table 6. Systemic acne therapy: main options

Group	When is it prescribed?	Main advantages	Important limitations
Systemic antibiotics	Moderate and severe degree with insufficient external therapy	Quickly reduce inflammation	The course is limited, there is a risk of resistance, gastrointestinal side effects and photosensitivity are possible.
Hormonal therapy in women	Acne due to hormonal imbalances, polycystic ovary syndrome	It addresses the root of the problem and improves other symptoms of hyperandrogenism.	It is selected individually; there are contraindications; joint supervision by specialists is required.
Systemic isotretinoin	Severe, scarring acne, resistant to other regimens	High probability of long-term remission, impact on all links of pathogenesis	Strict control, teratogenicity, a number of side effects requiring monitoring
Symptomatic psychiatric therapy	Severe depression, severe anxiety against the background of acne	Improves quality of life, helps cope with illness	Prescribed by a psychiatrist or psychotherapist, long-term work is possible

Skin care, cosmetics and treatments

Proper basic skincare plays a vital role in successful acne treatment. Gentle facial cleansing twice daily with products specifically designed for oily and combination skin, free of harsh surfactants and alcohol, is recommended. Over-washing, soap, and harsh brushes only damage the skin barrier and increase inflammation. After cleansing, it's important to use non-comedogenic moisturizers, especially when using retinoids and benzoyl peroxide. [41]

Sun protection is another essential skincare routine. Many acne medications increase the skin's sensitivity to UV rays, and inflamed areas are prone to darkening and the development of post-inflammatory hyperpigmentation. Therefore, daily use of a non-comedogenic sunscreen with sufficient protection and a lightweight texture helps prevent unwanted side effects and maintain treatment results. [42]

Choosing makeup for acne-prone skin is also important. Lightweight products labeled "non-comedogenic" are preferable; they don't leave a thick film and are easily removed with a gentle cleanser. Heavy, long-lasting creams and powders applied in thick layers can increase occlusion and promote the formation of new breakouts, especially if not removed properly. It's important to regularly replace sponges and brushes to prevent them from becoming a reservoir of bacteria. [43]

Cosmetic procedures are considered a complement to basic therapy. These include professional cleansing, superficial chemical peels, and certain types of laser and light treatments. They can reduce the appearance of comedones, smooth out post-inflammatory pigmentation, and mild scars, but do not replace medication. The decision to choose a procedure is made jointly by a dermatologist and a cosmetologist, taking into account skin type, acne severity, and current therapy. [44]

One of the most common mistakes remains attempting to squeeze out comedones on your own. This significantly increases the risk of deep injury, spreading inflammation, and scarring. Current recommendations strongly advise against this approach and, if necessary, discussing safe methods for correcting comedones and residual effects with a doctor. [45]

Table 7. Common Acne Care Mistakes and Better Alternatives

Error	What is dangerous?	What to replace it with
Frequent washing with soap and hot water	Damage to the skin barrier, increased inflammation and dryness	Twice a day, a gentle gel or foam for acne-prone skin
Wiping your face with alcohol	Severe irritation, compensatory seborrhea	Alcohol-free lotions, preparations with azelaic acid or niacinamide
Self-extrusion of elements	Scars, post-inflammatory pigmentation, spread of infection	Medication and, if necessary, specialist procedures
Using heavy makeup that is difficult to remove	Occlusion, new rashes	Non-comedogenic foundation or correctors, thorough gentle cleansing
Irregular use of medications	Lack of stable effect, frequent exacerbations	Adherence to the prescribed regimen and discussion of difficulties with the doctor

Nutrition, lifestyle and prevention

The relationship between diet and acne has long been a subject of debate, but large reviews in recent years confirm a moderate association between high glycemic load and excess consumption of certain dairy products and a more severe course of the disease. Diets high in rapidly digestible carbohydrates increase insulin and insulin-like growth factor levels, which may increase sebum production and hyperkeratosis. However, the effect varies from person to person, and strict restrictive diets without medical supervision are not recommended. [46]

There is growing evidence about the potential benefits of a low-glycemic load diet and elements of the Mediterranean diet for skin: plenty of vegetables and fruits, whole grains, fish, healthy fats, and limiting highly processed foods and sweets. Review studies suggest that such dietary patterns may reduce inflammation and positively impact hormonal balance and the gut microbiome, which indirectly impacts skin health. [47]

The impact of chocolate and certain beverages is discussed separately. Some studies show a link between the consumption of certain types of chocolate and acne flare-ups, but the data is mixed, and the role of associated factors is significant. Overall, experts agree that it's not a single food item that's more important, but the overall balance of the diet and the consumption of excess sugar and saturated fat. [48]

Lifestyle in general also influences the course of acne. Chronic stress, lack of sleep, and smoking are associated with a more severe course and a poorer response to therapy. Conversely, adequate sleep, regular physical activity, stress management, and smoking cessation help stabilize the body's overall condition and may indirectly improve the course of the disease. [49]

Acne prevention includes prompt treatment of early signs, gentle skin care, conscious cosmetic choices, and a balanced diet. If close relatives have a history of severe acne with scarring, it makes sense to consult a dermatologist at the first sign of the condition rather than waiting for it to "go away on its own." This is especially important for teenagers, who sometimes have a limited window of opportunity to prevent scarring. [50]

Table 8. Diet and lifestyle: what can affect acne

Factor	Probable impact	Comment
High glycemic load	May aggravate acne	It is beneficial to reduce the amount of sweets and white baked goods, while increasing the proportion of vegetables and whole grains
Excessive consumption of dairy products	Possible increase in rashes in some people	It is not necessary to completely exclude it, it is reasonable to reduce the excess and monitor the skin reaction
A diet close to the Mediterranean	Potentially protective effect	Low glycemic load, high in antioxidants and healthy fats
Chronic stress and lack of sleep	Acne and mental health worsen	It is important to manage stress and normalize sleep patterns.
Smoking	Associated with more severe disease and poor response to therapy	Quitting smoking is good for your overall health and skin condition.

Frequently asked questions about acne

Is it possible to cure acne once and for all?

In some people, acne disappears after puberty, but in many adults, the disease continues to manifest itself to varying degrees. Modern treatments can achieve sustained remission, reduce the frequency and severity of flare-ups, and prevent scarring. It's impossible to completely eliminate the risk of future outbreaks, but with proper maintenance therapy, acne ceases to be a dominant problem. [51]

Will cosmetic procedures alone help without medication?

These procedures can improve skin condition, especially with mild scars and post-inflammatory pigmentation, but they don't sufficiently address the underlying mechanisms of the disease. Without drug therapy, acne usually returns. Therefore, the modern approach suggests that these procedures are a complement to the basic treatment regimen, not a replacement for it. [52]

Should you completely give up sweets and dairy?

A complete ban is usually unnecessary and can be psychologically difficult. It's more rational to moderately reduce the amount of high-glycemic-load foods and excess dairy products, while monitoring your skin. The diet should be based on vegetables, fruits, whole grains, fish, nuts, and vegetable oils. If you have significant dietary issues, it's best to discuss your diet with a doctor or nutritionist. [53]

Is systemic isotretinoin dangerous?

This is a powerful and highly effective drug that does have significant side effects and requires strict monitoring. However, when prescribed and monitored correctly, it significantly improves the prognosis for patients with severe acne. Strict adherence to contraception and regular blood tests are crucial for women. The decision to treat with isotretinoin is always individualized and should be made with a dermatologist after a thorough discussion. [54]

When should you urgently see a doctor?

Immediate consultation is necessary if painful nodules suddenly appear, accompanied by a deterioration in general condition, a rise in temperature, a sharp drop in mood, and obsessive thoughts about one's own worthlessness or loss of will to live. Urgently seek help if, during treatment, unusual mental symptoms, severe pain, marked weakness, or other alarming signs develop. In other cases, it is advisable to schedule a scheduled appointment with a dermatologist if the rash persists, scars appear, quality of life significantly deteriorates, and self-treatment is ineffective. [55]