Health Hub

In this Health Hub article, we explore discusses the causes, treatments and the different types of acne.


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In this Health Hub article, we explore discusses the causes, treatments and the different types of acne.


  • Acne vulgaris is a common skin disorder that causes spots – these may appear on some or all of the face, back, shoulders and chest.
  • It is not a disease or disorder, it is caused when the pores in the skin become blocked with sebum and dead skin cells.
  • Sebum is a natural oil produced by the skin, and during the teenage years, this is often produced excessively due to hormonal changes in the body.

Facts & Figures

  • About 8 in 10 people have acne at some point.
  • Usually, acne occurs between the ages of 14-19.
  • Acne may also occur in adulthood between the ages of 25-40, but this is less common.

What Can Cause Acne Breakouts?

There are several types of migraines including:

Hormonal changes in the body

  • Puberty is the most common
  • Pregnancy or menstruation
  • Polycystic ovary syndrome

Some medications may also cause acne;

  • Lithium
  • Corticosteroids
  • Testosterone-containing medicines

Certain lifestyle factors may worsen acne:

  • Diet
  • Sweating
  • Stress

Are There Different Types of Acne?

Acne is simply classed as being mild, moderate, or severe

Mild Acne

  • 20 or less non-inflamed blackheads (open clogged pores) or whiteheads (closed clogged pores)
  • Blackheads appear as small flesh-colored bumps with a dark center
  • Pimples are mildly uncomfortable and have a white center surrounded by a small area of reddened skin

Moderate Acne

  • More than 20 blackheads/ whiteheads
  • Pimples will be similar to those in mild acne; mildly uncomfortable with a white centre surrounded by reddened skin 

Severe Acne

  • Very large numbers of blackheads and whiteheads, pimples, and pustules or cystic (deep) acne.
  • Cystic acne, patients have 5 or more cysts, which are large, red, painful, pus-filled nodules that may merge under the skin into larger, oozing abscesses

Acne On The Back

There is no direct way of preventing acne from occurring on the back but there are certain ways of minimizing the likelihood of outbreaks

  • Wear loose-fitting clothing, generally cotton based as they are more breathable
  • Shower/wash immediately after sweating to avoid pores clogging with excess oil/ debris
  • Use anti-comedogenic products on the skin
  • Avoid corticosteroid use as they increase sebum production by the skin

Acne Treatments

Some or all of the following treatments may be used in order to control acne, depending on the level of severity

Self Care/ Non-Prescription Products

  • Use water-based cleansing products on the skin – this will not treat existing spots but may prevent new spots forming. Effaclar products in the La Roche Posay range are highly recommended.
  • Scrubbing the affected skin vigorously is not recommended as it aggravates the skin and will worsen the condition
  • Benzoyl peroxide containing products are used in mild to moderate acne. These products help to reduce the amount of acne-causing bacteria on the skin eg: Acneside
  • Salicylic acid products – when used on the skin, helps to correct the abnormal shedding of cells. Salicylic acid is available in many acne products, including lotions, creams, and pads

Topical Gels/Creams

  • Retinol works to keep pimples from being able to form- affects the growth of cells and decreases swelling and inflammation. Must be used for 8 weeks to see an effect an oftentimes symptoms worsen before they improve.
  • Azelaic acid will unblock the pores and kill bacteria, however, must also be used for a number of weeks to see results

Oral Antibiotics

  • Oral antibiotics are used to decrease the level of bacteria in the skin
  • Used in mild to severe acne
  • May make the skin more sensitive to sunlight
  • Not recommended for >6 months at a time due to antibiotic resistance
  • Commonly prescribed in Ireland eg: Minocin SA, Tetralysal, Zineryt

Combined-Oral Contraceptives

  • In women, certain combined- oral contraceptives (COCs) may be used as a way of controlling hormone levels in the body which will help control acne
  • A woman’s ovaries and adrenal glands normally produce a low level of androgens. Higher levels of androgens can lead to excess sebum
  • Taking a pill that contains both estrogen and progesterone lowers the amount of androgens in your body- leading to decreased sebum production and less severe acne
  • Examples of (COCs) used to treat acne are Dianette, Yaz etc


  • Oral tablets/ capsules are much more potent than the creams
  • Work by unblocking pores and reduce the amount of oil (sebum) produced by the skin which in turn will dry out the skin and lips
  • Oral tablets may only be prescribed by a dermatologist and treatment must be monitored regularly
  • May affect the patients’ mental health
  • Can have teratogenic effects in pregnancy, female patients must have routine pregnancy tests and also be using suitable contraception
  • Eg: Roaccutane

Will I Get Scars From Acne?

  • People who have regular cystic and nodular outbreaks are at increased risk as these rupture and damage nearby skin
  • The risk of scarring increases if you pick or irritate your skin by picking or squeezing spots

There are three different categories of scars:

  1. Ice-pick scars: small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object.
  2. Rolling scars: caused by bands of scar tissue that form under the skin giving the surface of the skin a rolling and uneven appearance.
  3. Boxcar scars: round or oval depressions, or craters, in the skin

Scar Treatment

  • Dermabrasion

Dermabrasion involves removing the top layer of skin. After the procedure, the skin will look red and sore for several months, but as it heals, the scars will have improved.

  • Laser Treatment

Laser treatment can be used to treat mild to moderate acne scarring by either stimulating the skin to repair some of the damage caused by the scarring or removing small patches of the skin in order to remove the scarred area.

  • Punch techniques

Punch techniques are a type of surgical treatment usually used to treat ice-pick scars and boxcar scars

  • Silicon gels

Transparent silicone gels are used to improve the appearance of scars. They soften and flatten raised scars as well as fading red or dark scars. Examples available in Ireland include Kelocote® and Dermatix®.

Advice From The Pharmacist

  • Self care should be your first stop if you have mild acne
  • See your GP if self-care measures are not helping
  • If you suffer from acne on your back, wear light breathable clothing- preferably cotton
  • Use water based products on your skin

Supports Available In Ireland