Our favourite skin doctor, Dr Anahita Ghirbani, answers your most common questions about acne.

1. What is acne?

– Acne is a common skin condition and affects most people at some point. It causes spots, oily skin and sometimes skin that's red, hot or painful to touch. Almost everyone with acne has it on the face, while half of people with acne have it on the back and fewer on the chest.

2. Why do we get acne?

– In acne, the glands begin to produce too much oil (sebum) which mixes with dead skin cells and causes a plug in the opening of the hair follicle; our pores. This is seen as a whitehead or blackhead. Increased activity of skin bacteria causes inflammation and pus, creating pimples and cysts. 

3. What causes acne?

– Hormones and genetics are the biggest causes of acne. Hormonal changes  in puberty, pregnancy, the menstrual cycle, from use of contraceptive pills or in hormone disorders like polycystic ovarian syndrome (PCOS) can set off acne in the skin. The hormones stimulate an overproduction of sebum in the skin glands, and together with a build-up of dead skin cells on the skin surface, the pores get clogged. The abnormal oil production also increases the activity of a usually harmless skin bacterium which causes inflammation and pus. Acne has a strong genetic cause, so if your parents had acne it's likely that you'll also develop it.

– Other causes of acne are medication, contact with greasy oils or friction from tight helmets or caps. Stress does not cause acne, but research shows that it can worsen it.

4. Is acne normal?

– Yes. Acne is one of the most common skin conditions in the world. Acne is particularly common in teenagers and younger adults. About 85% of people aged 11 to 30 are affected by acne to some extent. During adolescence, acne is more common in males than in females. In adulthood, acne is more common in women than in men.

5. Why do teenagers get acne?

– During puberty, male sex hormones (androgens – which are actually present in both genders) rise and causes an increase of the size of the skin’s oil glands. These glands start making more sebum, which lead to changes that can clog the pores.

6. Are acne and pimples the same?

– Acne is a skin condition and pimples are seen as a symptom of acne. As dermatologists we look for several different types of acne changes on the skin.

A whitehead or closed comedone is a clogged pore that bulges out from the skin. If it has an opening it’s a blackhead or open comedone. Note that in a blackhead, the black is not dirt, but oxidized skin cells!

What we know as a typical pimple is either a papule if it's a red small bump or a pustule if it has a yellow top. Deeper, more inflamed and sometimes painful acne changes are called nodules or cysts. 

Depending on which type and how much acne you have it’s categorized into mild, moderate or severe acne.

7. How do I know if my acne is mild, moderate or severe?

– In mild acne there are mostly whiteheads and blackheads, and only a few papules and pustules.
Moderate acne has more whiteheads and blackheads, with many papules and pustules.
Lastly severe acne, is when there are alot of large, painful papules, pustules, nodules or cysts and perhaps some scarring.
You should always consult a dermatologist if your life or mental health is affected by acne.

8. Why do I get pimples before my period?

– Acne is triggered by androgens (male sex hormones) like testosterone, which women have in an stable amount no matter the time of the month. However, right before the period, levels of the female sex hormone estrogen drop, making testosterone relatively high. Progesterone, which rises after ovulation, also contributes by making skin more oily.

9. When will my acne go away?

– Great question! Most people get less acne after their 20s, and this is particularly true for males. Women more often have adult acne with 12 percent still having acne at the age of 25, and 5 percent at the age of 45.

10. When do I need to see a skin doctor/dermatologist?

– Generally a general practitioner (allmänläkare) can help you if you have mild acne. If you’re not seeing improvements after a few months or your acne is getting worse I recommend asking for a referral to a doctor that specialises in acne, a dermatologist. For acne that’s moderate or severe, meaning you have many red, painful and inflamed skin changes or you see scarring of your skin, you should see a dermatologist straight away as waiting too long can increase the risk of acne scars.

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