Skin · · 8 min read

Acne: causes, skincare basics and when to see a doctor

Acne is not a sign of dirty skin. It starts when hair follicles clog with oil and dead skin cells and bacteria grow inside, and it can affect teenagers and adults alike. Harsh scrubbing makes it worse, while a gentle routine and a proven ingredient or two do most of the work. Deep, painful or scarring acne is a job for a doctor, not for a longer shelf of products.

Illustration of three skincare products on a shelf: a pump bottle of cleanser, a jar of moisturizer and a bottle of sunscreen with a sun icon

In short

  • Acne comes from clogged follicles, extra oil, dead skin cells and bacteria, not from poor hygiene.
  • A basic routine is gentle washing, an active ingredient, a non-comedogenic moisturizer and sunscreen.
  • Harsh soaps, rough scrubs, picking and squeezing make acne and scarring worse.
  • Over-the-counter options include benzoyl peroxide and salicylic acid, and your pharmacist can advise.
  • See a clinician for deep, painful or scarring acne, or if acne is affecting your mood.

Why acne happens

The NHS explains that acne starts when hair follicles become blocked with excess oil and dead skin cells, and bacteria can grow in them. Researchers also point to hormones. The NIAMS notes that androgens rise in both boys and girls during puberty and enlarge the oil glands, and that hormone changes in pregnancy can also contribute.

Other triggers include hormone shifts around periods and menopause, conditions such as polycystic ovary syndrome, a family history of acne, and some medicines, including hormone-containing drugs, corticosteroids and lithium. Acne is most common in teenagers and young adults, but people of any age can get it.

A simple routine

  1. Cleanse gently.Wash with a mild cleanser in the morning, in the evening and after heavy exercise. Remove makeup at night. Avoid harsh soaps, astringents and rough scrubs.
  2. Use one active ingredient.Over-the-counter products with benzoyl peroxide or salicylic acid are the usual starting point. Ask a pharmacist which suits your skin. Add one new product at a time so you can tell what causes irritation.
  3. Moisturize.Pick oil-free, non-comedogenic products. These are less likely to clog pores, although the NIAMS cautions they may still worsen acne for some people.
  4. Wear sunscreen.Many acne medicines increase sun sensitivity, and sunscreen matters for preventing and fading the dark marks that can follow acne.

Be patient and consistent. Switching products every couple of weeks makes it hard to know whether anything works. Shave carefully with a sharp blade after softening the hair with soap and water, and choose oil-free makeup and hair products, since greasy products can contribute to breakouts.

What the main ingredients do

  • Benzoyl peroxide, sold over the counter, kills bacteria and may reduce oil production.
  • Salicylic acid helps break down blackheads and whiteheads.
  • Sulfur has a similar effect on blackheads and whiteheads.
  • Topical retinoids, which are vitamin A derivatives, treat lesions, reduce inflammation and help prevent acne and scarring. They are prescribed by a clinician.
  • Topical antibiotics are usually combined with other topical medicines.

The NIAMS warns that topical products can cause irritation, burning or redness. If your skin reacts, tell your pharmacist or clinician rather than layering more products on top.

Mistakes that make acne worse

  • Scrubbing the skin hard or using rough scrubs and harsh astringents.
  • Picking or squeezing spots, which can cause scars and dark spots.
  • Heavy, greasy skin or hair products.
  • Constant pressure on the skin from helmets, tight clothing or backpacks, which the NIAMS says can aggravate acne.
  • Starting several new actives at once, then giving up before any has a fair trial.

Diet and stress

MedlinePlus says chocolate, greasy foods and dirt are not supported as major causes of acne, and that stress does not cause acne but can make it worse. The NIAMS adds that some studies link certain foods to worse acne but that researchers are still studying the question. If you suspect a food, discuss it with your clinician instead of cutting out entire food groups on your own.

Dark marks and scars

Acne can leave scars, including shallow holes in the skin, and darker marks, which can be more noticeable on people of color. Sunscreen is especially important for treating and preventing these dark spots. For scarring that does not respond to medicine, a dermatologist may discuss options such as laser or light therapy, chemical peels, fillers, microneedling or surgery.

When to see a doctor

The NHS advises seeing a clinician if self-treatment is not working, if spots are numerous, deep, painful or scarring, if you show signs of skin infection, or if acne affects your mental health. Acne can bring anxiety, low mood and low self-esteem, and that is a good enough reason to ask for help. Dermatologists and primary care providers can diagnose and treat acne.

Red flag: swelling of the face, lips or tongue, or trouble breathing after a new product or medicine is an emergency, so call 911.

Prescription treatment in general terms

Prescription options include stronger topical retinoids and topical antibiotics. By mouth, a clinician may use antibiotics for moderate to severe acne, hormone therapy mainly in women, and isotretinoin, an oral retinoid, for more severe acne. Each comes with its own monitoring and precautions. Tell your clinician about pregnancy or plans for pregnancy, and about any other medicines you use. Do not stop or change a prescribed treatment without asking.

Questions for your clinician

  • What type of acne do I have, and what is the plan?
  • How long should I give a treatment before judging it?
  • How should I combine a prescribed product with my current routine?
  • Is this treatment safe if I am pregnant or planning a pregnancy?
  • What can be done about marks and scars?

Questions and answers

Should I wash my face more if my skin is oily?

Twice a day and after heavy exercise is the guidance from the NIAMS and NHS. Washing more often with strong products can irritate skin and tends to make acne worse.

Do I still need moisturizer with oily, acne-prone skin?

Yes. A non-comedogenic moisturizer helps balance the dryness and irritation that acne products can cause, which makes it easier to keep using them.

Does tanning clear acne?

No. Many acne medicines make your skin more sensitive to the sun, and sunburn is something to avoid according to the NIAMS. Sunscreen is the safer habit.

Can I pop a pimple?

It is better not to. Picking or squeezing can cause scars and dark spots. If a spot is large or painful, ask a dermatologist about treating it.

Can acne start in adulthood?

Yes. The NIAMS says people of any age can get acne, and hormone changes, some medicines and conditions like polycystic ovary syndrome can play a part. See a clinician if it starts suddenly or is severe.

Sources

  1. NHS — Acne
  2. NHS — Acne: treatment
  3. NIAMS — Acne
  4. NIAMS — Acne: Diagnosis, Treatment, and Steps to Take
  5. MedlinePlus — Acne

Sources checked on 29 October 2026.

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