Breakouts and acne

What causes acne and spots?

Acne starts when a hair follicle gets blocked with oil and dead skin cells. Bacteria that live harmlessly on everyone's skin then multiply in the blocked follicle and the area becomes inflamed. Blackheads and whiteheads are the blocked-pore version. Red bumps and pus-filled spots are the inflamed version. Deep, painful lumps under the skin are nodules and cysts, and those are the ones most likely to leave scars.

What makes acne worse?

Hormones are the biggest driver of acne, which is why it usually starts at puberty and why many women notice a pattern around their cycle. Oil glands that are sensitive to hormones make too much oil, and that build-up lets the harmless bacteria on everyone's skin multiply and cause inflamed spots. Persistent adult acne with irregular periods and unusual hair growth is worth mentioning to a GP, as polycystic ovary syndrome can cause all three and can be treated. Beyond hormones: picking and squeezing, friction from helmets and straps, heavy occlusive products on skin that is already congested, and some medicines. Diet has a modest role at most. A 2022 systematic review found a modest effect from high-sugar, high-refined-carbohydrate diets and mixed evidence for dairy, including milk. Chocolate on its own has only a handful of small studies, and a review of the evidence to 2020 called its role unsettled.

Can skincare products help with acne?

Skincare products can help the look of mild congestion, but they are not a substitute for treatment when acne is moderate or severe. Salicylic acid is oil-soluble so it gets inside the pore, which is why it turns up in so many cleansers for congested skin. Niacinamide is well tolerated and helps the look of oiliness and uneven tone. Azelaic acid at cosmetic strength suits people who find stronger actives irritating. A light, non-comedogenic moisturiser matters more than people expect, and the NHS advises water-based, non-comedogenic products because oil-based ones are more likely to block pores. Give any of these at least twelve weeks before judging, which is what the British Association of Dermatologists advises. A MyAgenix read builds a routine around the cosmetic side.

What acne treatments can a pharmacist or GP give you?

A pharmacist can advise on benzoyl peroxide, and a GP can prescribe stronger creams, antibiotics and hormonal treatments. This is where the line sits between cosmetics and medicines. In the UK, benzoyl peroxide is sold in pharmacies as a medicine rather than a cosmetic, and a pharmacist can advise on whether it suits you. Stronger options come from a GP: topical retinoids such as adapalene or tretinoin, combination gels, a course of topical or oral antibiotics, and for some women the combined pill or spironolactone. For severe or scarring acne a dermatologist can prescribe isotretinoin, which is highly effective and requires proper monitoring, including pregnancy prevention. None of this is something a skincare routine substitutes for.

When should you see a GP about acne?

See a GP if spots are deep and painful, if you are getting scars or marks that last, if pharmacy products have made no difference after about three months of use, or if your skin is affecting how you feel day to day. The NHS advice is that nodules and cysts carry the greatest risk of scarring and need proper treatment to avoid it. Acne is treatable and waiting rarely improves it.

General information about skin, not medical advice. MyAgenix offers cosmetic guidance to help you choose products. It does not diagnose or treat any condition. For anything on this page that needs treating, see a pharmacist, your GP or a dermatologist.