Acne is one of the most common skin complaints out there, and one we’ve pretty much all had to deal with at one time or another. Some people are lucky and get away with a few spots in their teens, but for others it can be a nightmare experience lasting 10 or 20 years and resulting in significant scarring. While there’s no cure for acne, there are a number of treatments which effectively manage it. Scroll down the page for answers to all the FAQs about acne, and also for the answers to questions about acne that have come in via the Ask Alice section.

Medically speaking, acne vulgaris is an inflammatory skin condition characterised by excess sebum (oil) production; follicular hyperkeratinisation (abnormally rapid shedding of skin cells); proliferation of the bacteria Propionibacterium acnes; and inflammation. But what does that all mean? Sebum is the oil that your body naturally produces to keep your skin lubricated; follicular hyperkeratinisation is a disorder where skin cells are shed abnormally rapidly and become sticky, which means they get stuck in the hair follicle; P. acnes is an innocuous bacterium that we all have on our skin all the time… but the problems, and the inflammation, occur when you mix those three things together. The trapped oil, skin cells and bacteria begin festering in the follicles, resulting in the skin blemishes we associate with the acne. That’s a lot of science in one sentence, but read over it until you get it, because an understanding of these elements is vital in knowing how to win the war with this condition.

When you hear talk of ‘blemishes’ and ‘spots’, those are just other words used to describe acne. If you only have a couple of spots breaking out on your face, you might think, “that’s not acne”, but to a dermatologist it’s all acne, whether you have one blemish or a hundred.

We tend to think of the acne blemishes we know all too well just as ‘spots’ or ‘zits’ but they also have quite specific definitions, depending on their characteristics:

  • Comedones – these are blackheads (blocked, open pores) and whiteheads (blocked, closed pores);
  • Papules – tender, little red bumps that occur when the P. acnes bacteria infection takes hold in a comedone and causes the initial inflammation;
  • Pustules – papules that have become more infected and are now filled with pus;
  • Nodules – large, painful and hard-to-the-touch lumps underneath the skin’s surface;
  • Cysts – like nodules, but filled with pus, these are the ones that are most likely to cause scarring.

Most people will experience acne vulgaris at one point or another and, while it can be unsightly, embarrassing and annoying, it is usually something that can be effectively dealt with through good skincare and topical medications.

You may also struggle with acne mechanica, which appears at sites of increased heat and friction, for example under the band of a baseball cap. The heat and friction causes blockage of the pores, leading to comedones, papules and pustules—but not nodules or cysts.

Then there are much more severe forms of acne, such as acne conglobata and acne fulminans, which fall under the umbrella of “nodulocystic acne” and are characterised by severe outbreaks of large, thick, painful cysts, deep under the skin, some of which connect to each other in pus-filled channels. These are systemic forms of acne and require serious medical intervention, so if you think this sounds like what you’re experiencing, book a doctor’s appointment.

Acne is sometimes also confused with rosacea, but they’re different conditions (although they present with similar symptoms and have some similar causes, such as overactive oil glands). The key differences are that, with rosacea, you don’t tend to get blackheads and the skin appears to be dry and peeling, as opposed to overly oily.

In the first section, ‘What is acne?’, I listed the four factors that lead to acne: excess sebum, follicular hyperkeratinisation, the P. acnes bacteria and inflammation. But what causes those factors to come about in the first place?

Hormones (specifically, androgens)

Androgens, or male hormones, cause the skin to produce more sebum (skin oil) and enlarge the sebaceous glands, where the sebum comes from. The most well-known androgen is testosterone. It is most commonly linked with male development  – in fact andros is Greek for ‘man’ – so you could be forgiven for thinking that androgens, such as testosterone, wouldn’t be a factor for women, but they are. Women produce testosterone too, just less of it.

The correlation between hormone activity and the occurrence of acne is most obvious in teenagers. Hormone production ramps up during puberty and the skin often goes haywire as a result. Without androgens, the body is unable to produce significant quantities of sebum – men who have been castrated or women who have been through the menopause do not develop acne for example. In fact, during menopause, when hormone production tails off rapidly, women tend to have much drier skin.


Every prescription medication seems to come with a list of possible side effects that’s as long as your arm. Squirrelled away in the small print of certain medications, you’ll often see acne listed. The reason for this is that some medicines affect your hormone levels. But which medicines do you have to watch out for? Here are some of the more common ones that may contribute to acne:

  • Contraceptives, such as the pill, injectables and intrauterine devices (IUDs), all of which work by changing hormone levels. You may be thinking, “But I’ve heard that the pill can your skin?” You’d be right – it can, however, side effects vary from person to person. While one brand of the pill might clear up your friend’s skin, there’s no guarantee it will do the same for you. If you’re on the pill and find that your acne has become worse, talk to your doctor about changing brands to find one you tolerate better.
  • Steroids. Whether being taken as a legitimate prescription (corticosteroids) or as part of a misguided bodybuilding routine (anabolic steroids), significant steroid use makes the body think that testosterone levels are on the rise, which results in overactive sebaceous glands and more sebum production. Steroid abuse can lead to the severest forms of nodulocystic acne, like . If you’re considering steroid use without oversight from a doctor, please don’t do it – if you need convincing just look for images of “acne fulminans” and decide whether bigger muscles are worth the risk.
  • Testosterone. This can be prescribed as a medicine to treat certain conditions and works in the same way as naturally produced testosterone, increasing sebum production and worsening acne.


There is some controversy surrounding the relationship between nutrition and acne. The traditional view is that diet can neither cause nor cure acne, and in my opinion this is accurate. However, that is not to say that diet has no effect on acne at all. There is clinical research evidencing that vitamins A and D have an important role to play in the behaviour of keratin and that fatty acids have an effect on skin conditions. Omega-3 and omega-6 imbalances are also commonly accepted to aggravate inflammation. Vitamin E is also thought to be a useful tool for inhibiting inflammation. Studies appear to suggest that people who drink a lot (ie, more than a pint, or half a litre a day) of cow’s milk, and people who eat a lot of foods with a high glycemic index, such as sugar, or white flour, have worse acne than those who don’t, but these are suggestions from a number of trials, rather than concrete facts.

Dairy, and more specifically cow’s milk, has also been linked to acne because, by its very nature, like all milk, it contains hormones. Researchers suggest that, because many cows are also now given artificial hormones too, this may affect their milk supply and in turn impact the hormonal balance of your skin when you consume it.

In fact, one study showed that women who drank two or more glasses of skimmed milk per day were 44% more likely to have acne.

However it is widely acknowledged that more research is needed into the exact reasons why cow’s milk may worsen acne. Interestingly, no studies have shown that yogurt or cheese lead to more breakouts.

Nutrition of course impacts our overall health and wellbeing, so it would be foolhardy to write off the effect of nutrition completely. Put it this way: I definitely wouldn’t indulge in unhealthy foods if I had acne. Concentrate on eating the sort of food groups that you know to be healthy – plenty of fresh vegetables, enough protein, healthy fats, wholegrains and see whether it has any effect on your skin. Look for foods that boost your levels of vitamins A, D and E and make changes to get some more omega-3 in your life, whether through supplements or diet changes. Anecdotally, people have found that cutting out foods, for example milk or sugar, has worked wonders on their acne, so why not give that a try and see whether it works for you?


This isn’t a direct cause of acne, per se, but it certainly has a role to play in making acne worse. Stress results in activity in the adrenal glands, which has the knock-on effect of increasing activity in the sebaceous glands and therefore the production of sebum. While sebum production alone doesn’t cause acne, if your skin is churning out a lot of it, it may make it more likely to kick off and break out in spots.

Heat and Friction

This is the cause of a specific type of acne called acne mechanica and occurs when something (usually clothing, or more recently face masks) is tight against the skin and rubs against it. This heat and friction leads to blockages within the pores, resulting in comedones, papules and pustules.

Yes, normal acne, or acne vulgaris, is caused by hormones, specifically androgens such as testosterone. This is why acne is so often associated with teenagers, since they are on the business end of some seismic hormonal changes, which sends the body into overdrive in many ways. Take a look at the ‘What causes acne?’ section above for more information.

Acne, oh, the never-ending battle! Acne vulgaris, the most prevalent form, is primarily caused by hormone activity. Typically, teenagers going through puberty face acne due to the hormonal changes. However, acne isn’t exclusive to teenagers alone. Many individuals who experience acne during their teenage years may continue to deal with it well into their 20s or even 30s. Surprisingly, acne can also affect children and even infants.

Interestingly, adult onset acne is becoming more common, particularly among women who didn’t experience it during their teenage years. These women may suddenly encounter acne breakouts in their 30s, 40s, or even later. Middle-aged women might witness acne flare-ups triggered by approaching menopause and the hormonal disruptions it brings. Additionally, acne can occur at any stage of life when it is induced by medication or a condition called acne mechanica.

In conclusion, acne is an enduring battle that can strike at any age. Whether you’re a teenager or an adult, hormonal changes can wreak havoc on your skin, leading to pesky breakouts.

Acne can be frustrating, especially when it pops up unexpectedly. Whether you’re dealing with occasional flare-ups or persistent breakouts, understanding the reasons behind them is key to finding effective treatment options. Here are a few factors to consider:

Sudden hormonal changes: Hormonal fluctuations can wreak havoc on your skin. Drinking more water can actually stimulate your immune system, triggering a battle against the bacteria that causes acne. This fight often leads to inflammation, redness, and swelling. So, if you’ve increased your water intake or tried a detox regime, don’t be surprised if breakouts follow. Just remember, it’s your body’s way of purging and adjusting.

New environmental factors: Sometimes, the culprit behind your breakouts might be a new perfume, shampoo, or laundry detergent. These products can irritate your skin and lead to acne. Consider eliminating any recently introduced items from your routine if you suspect they’re causing the problem.

Using the wrong skincare products: Have you recently incorporated new skincare products into your routine? Be cautious of anything that’s excessively drying or too heavy and oily. Products that strip your skin of moisture can initially give positive results, but they can also trigger increased sebum production, making your skin even oilier and worsening your acne. Meanwhile, heavy and oily products can further clog your pores.

UV exposure: While a little sun can temporarily improve the appearance of acne, it’s not a long-term solution. Sun exposure can dry out your skin, but this can lead to an increase in sebum production later on. Additionally, the sun can mask the redness associated with acne through tanning, creating the illusion of improvement. However, relying on the sun for acne treatment is not recommended.

Understanding these factors can help you make more informed decisions about your skincare routine and long-term acne management. Remember, everyone’s skin is unique, so finding the right approach may require some trial and error

Sunshine can have both short-term benefits and long-term consequences for acne-prone skin. While it may initially improve the appearance of acne by suppressing the immune response and reducing inflammation, it can also make your skin more susceptible to UV damage, premature aging, and even skin cancer in the future. Therefore, it is crucial to always protect your skin by wearing lightweight, oil-free sunscreen.

In addition to sunlight, other factors can contribute to breakouts. Stress, for example, can elevate your stress levels and potentially lead to acne flare-ups. Similarly, dietary changes can also play a role in your skin’s condition. While nutrition alone doesn’t cause acne, it is believed to influence it to some extent. Consider what you’ve been eating recently to identify any potential triggers for your breakout.

While these are the most common factors, any change in your routine or lifestyle can impact your skin health. Take the time to reflect on what has changed in the past few weeks. If you can pinpoint a specific factor, it is likely what triggered the breakout.

By understanding these factors and making informed choices, you can better manage and improve the health of your skin.

Your chin has more sebaceous glands compared to other parts of your body. These glands are larger as well, making your chin prone to acne. Hormonal changes are usually the reason for this. Whether it’s hormonal fluctuations during puberty, medication side effects, menstrual cycle, or the onset of menopause, these factors can contribute to acne on your chin.

To maintain clear and healthy skin, follow these tips:

Cleanse your face regularly: Be sure to cleanse your face daily to remove dirt and impurities.
Be mindful of exfoliation: While exfoliating can be beneficial, avoid over-exfoliating, as it can strip away natural oils.
Keep your hair clean: Ensure that your hair is clean, as it can transfer oils and dirt to your face.
Minimise touching your face: Avoid touching your face excessively, as your hands carry bacteria that can spread and cause breakouts.
Change your pillowcase regularly: Regularly changing your pillowcase helps prevent the buildup of dirt and oils that can lead to skin issues.
Limit phone contact with your face: Try not to hold your phone against your face for prolonged periods, as it can transfer bacteria.
Consider makeup during breakouts: During breakouts, it’s best to avoid makeup if possible. When wearing makeup, make sure to clean your brushes regularly to prevent bacterial growth.
Seek professional help: If you’re experiencing persistent acne, consider consulting a qualified dermatologist for expert advice on managing hormonal acne.

Remember, while you can’t control your hormones, taking these steps and seeking professional help can contribute to healthier skin.

If you’re looking to address acne, one effective approach is to incorporate a skincare routine. A well-established routine can effectively clear up milder cases of acne, leaving you with the task of maintaining the regimen and managing occasional blemishes that push through.

However, if skincare alone doesn’t give you better results, it may be necessary to supplement your regimen with professional interventions. While antibiotics are an option, they come with potential drawbacks like increased antibiotic resistance and heightened sensitivity to UV rays. For example: someone who, despite being Greek and never having experienced sunburn in 22 years, developed a severe sunburn within just 10 minutes while on antibiotics for acne. Instead of antibiotics, you can explore alternative treatments on our website.

Certain types of contraceptive pills can actually improve acne. This is because some pill brands contain ethynyloestradiol (EO), a chemical that increases the levels of a substance called sex hormone binding globulin (SHBG) in the body. You see, SHBG acts as a “binding protein” for free testosterone, which is the type of testosterone responsible for triggering the oil-producing glands to go into overdrive. So, SHBG attaches itself to free testosterone, rendering it harmless.

In addition to EO, birth control pills often contain other ingredients that can benefit those with acne. These include levonorgestrel, norethindrone, norgestimate, drospirenone, cyproterone acetate, chlormadinone acetate, dienogest, or desogestrel.

When it comes to specific pills to help acne, two well-known options are Yasmin and Dianette.

When it comes to acne, it’s important to be cautious and avoid aggressive treatments, even if they sound like a natural skin hack. Using tea tree oil, lemon juice, witch hazel, or rosewater toner may seem like a good idea, but they are highly astringent and can excessively dry out your skin. This can trigger your body to produce more sebum, which is the last thing you want when dealing with acne.

Instead of relying on natural products, there are certain lifestyle changes that you can make to help improve your skin.

Pimple patches can work wonders for your skin. These little semi-transparent sticking plasters are designed to be applied directly over spots or breakouts. When left on overnight, they can effectively reduce inflammation in budding pimples or whiteheads.

There are two types of pimple patches available. One type features a hydrocolloid dressing, which not only absorbs moisture from the affected area but also helps draw out impurities. The other type contains spot-busting ingredients like salicylic acid, which are cleverly compressed into tiny dissolvable needle-shapes that penetrate the surface of the pimple.

For optimal results, it is recommended to leave the patch on for several hours, preferably overnight. One added benefit of these patches is that they act as a protective barrier, preventing you from scratching, picking, or absentmindedly touching the spot while it heals.

With their ability to reduce inflammation and discourage unwanted habits, pimple patches are a game-changer for achieving clearer, healthier skin.

Certain types of light treatment can indeed help with acne. Modern techniques though, not the outdated sunlight exposure therapy from the 1950s. LED light therapy has shown great promise in treating acne.

You may consider trying a home-use LED light mask. Although these masks provide lower light intensities compared to professional machines, they can still yield results if used consistently. Using it every other day for 10 minutes should suffice. However, it is important to make sure that you can commit to the regular usage of these masks for it make a change.

First and foremost, it is not advisable to disturb or tamper with your spots. These areas are already infected, and by lancing or popping them, you expose them to the external environment, increasing the risk of further bacterial contamination. Although a spot may not be visually pleasing, it is actually sealed off, and puncturing it creates a convenient pathway for additional contaminants to enter. Moreover, when you squeeze a spot, you may think you are effectively getting rid of all the pus, but in reality, you are also forcing some of the infected substances deeper into the pore, potentially worsening the situation. Having said that, many of us may find it difficult to resist the urge, and it is easy to succumb to popping spots regardless of if we should or shouldn’t.

Yes, you should. When it comes to acne, we have a great range of professionals who can help you manage it. After all, acne is a condition that affects many people.

Toothpaste should not be used as a topical application on the skin, as it is meant to be scrubbed onto teeth protected by hard enamel. Leaving toothpaste on sensitive skin is not a clever skin hack. It may give the impression of working and help dry out a spot, but it can also dry out the surrounding skin. Furthermore, in more severe cases, it may lead to contact dermatitis and chemical burns.

The time it takes for acne to go away depends on the type and underlying cause. Acne vulgaris, triggered by hormonal changes, typically resolves within four to eight weeks after discontinuing the medication causing the changes. If breakouts are tied to your menstrual cycle, expect clearer skin within eight to 10 days after the first spot appears. However, longer-term hormonal changes, like those during puberty, which account for most acne cases, make it difficult to predict how long it will take for your acne to disappear. It could range from one to 25 years. Don’t wait for it to go away on its own.