Acne: Causes, Types, and Treatment from Oregon Dermatologists
Acne is a common skin condition that develops when hair follicles become blocked with oil, dead skin cells, and bacteria.
According to the American Academy of Dermatology, acne affects up to 50 million Americans each year, making it the most common skin condition in the United States.
At Goodskin Dermatology, our board-certified dermatologists diagnose and treat all types of acne at four Oregon-based locations.
What Is Acne?
Acne is an inflammatory skin condition that begins inside the hair follicle. It develops when excess oil, dead skin cells, bacteria, and inflammation combine to clog pores and create blemishes.
Acne most often appears on the face, chest, back, and shoulders because these areas contain more oil glands.
The process behind acne is often described as a four-part cycle: excess sebum production, abnormal buildup of skin cells inside the follicle, growth of Cutibacterium acnes bacteria, and inflammation. Together, these factors can lead to blackheads, whiteheads, red bumps, pustules, nodules, and cysts.
Acne is a follicular skin condition, not a sign of dirty skin or poor hygiene. In fact, overwashing or scrubbing too aggressively can irritate the skin and worsen acne.
Types of Acne Lesions
Different types of acne form at different depths in the skin. Identifying the type of blemish is important because treatment often depends on whether acne is non-inflammatory, inflammatory, or severe.
Non-Inflammatory Acne
Non-inflammatory acne includes blackheads and whiteheads.
Blackheads, also called open comedones, form when a clogged pore stays open and the material inside darkens after exposure to air. Blackheads are not caused by dirt.
Whiteheads, or closed comedones, form when the pore opening remains closed, trapping oil and skin cells beneath the surface.
Inflammatory Acne
Inflammatory acne develops when the blocked follicle becomes inflamed. Papules are small red, tender bumps without visible pus. Pustules are pus-filled bumps and are the type of blemish many people think of as a classic pimple.
This inflammation is tied to the skin’s immune response to acne-related bacteria and clogged follicles.
Severe Acne
Severe acne includes nodules and cysts. Nodules are large, painful, solid lumps deep under the skin. Cysts are deeper, pus-filled lesions that can be painful and carry a high risk of permanent scarring. Cystic acne should be evaluated by a dermatologist and should not be picked or squeezed at home.
Acne Severity: Mild, Moderate, and Severe
Acne is often described as mild, moderate, or severe based on the number and type of lesions present.
Mild acne usually includes mostly blackheads and whiteheads, with only a few papules or pustules.
Moderate acne includes a mix of comedones and inflamed breakouts, sometimes with early nodules.
Severe acne involves larger inflamed nodules or cysts and carries the greatest risk of scarring.
If your acne is moderate to severe, persists despite over-the-counter care, or leaves scars, a dermatologist evaluation is strongly recommended.
What Causes Acne?
Acne develops when several factors occur simultaneously.
Oil glands produce too much sebum, dead skin cells build up inside pores, acne-related bacteria multiply inside the blocked follicle, and inflammation follows.
Hormonal changes are one of the most common reasons this process speeds up, which is why acne often flares during puberty, around the menstrual cycle, during pregnancy, or with conditions such as PCOS.
Other contributing factors can include certain medications, such as corticosteroids or lithium, use of occlusive or comedogenic skin and hair products, friction from helmets or straps, and stress.
Research published in the National Library of Medicine also suggests that some people may notice acne worsening with high-glycemic diets or certain dairy intake, although evidence is still evolving and varies from person to person.
Acne is not caused by dirty skin, and harsh scrubbing may actually worsen inflammation by disrupting the skin barrier.
Who Gets Acne?
Acne is most common during the teenage years, but it can affect people of all ages. T
The American Academy of Dermatology notes that acne affects millions of Americans annually, and symptoms often begin around puberty. Acne affects about 85% of adolescents, but it can also continue or begin in adulthood.
Adult acne is especially common in women. Hormonal acne often appears along the jawline, chin, lower face, and neck.
Acne also affects all skin tones. In medium-to-dark skin tones, breakouts are more likely to leave post-inflammatory hyperpigmentation, which are lingering dark marks after acne heals.
Regardless of age, acne is treatable, and a board-certified dermatologist can help identify the underlying cause and build a treatment plan.
Acne Treatment Options
Acne treatment depends on the type and severity of acne, whether scarring is developing, and whether breakouts are driven by hormonal patterns, inflammation, or clogged pores.
Most treatment plans combine more than one approach because combination therapy is often more effective than using a single product alone.
Over-the-Counter Treatments
Mild acne often improves with consistent over-the-counter treatment for 6 to 8 weeks. Benzoyl peroxide helps reduce acne-causing bacteria. Salicylic acid helps unclog pores and reduce blackheads and whiteheads. Adapalene 0.1% gel is an over-the-counter retinoid that can help normalize skin cell turnover and reduce breakouts.
Prescription Topical Medications
Prescription topicals are often used when acne is persistent, inflammatory, or leaves marks. These may include tretinoin, prescription-strength topical antibiotics combined with benzoyl peroxide, dapsone gel, and azelaic acid. These treatments can target clogged pores, inflammation, and discoloration after acne heals.
Prescription Oral Medications
Moderate-to-severe acne may require oral treatment. Dermatologists may prescribe oral antibiotics for inflammatory acne, typically for a limited course and in combination with topical therapy.
Hormonal acne in women may be treated with certain oral contraceptives or spironolactone.
Severe nodular or cystic acne may require isotretinoin, which remains one of the most effective treatments for severe acne but has additional prescribing requirements.
In-Office Treatments at Goodskin Dermatology
Some patients benefit from in-office procedures in addition to medication. These may include:
- Chemical peels for acne
- Photodynamic therapy
- Laser and light-based treatments
- Corticosteroid injections for painful cysts or nodules
- Comedone extractions for stubborn blackheads and whiteheads
These options can be especially helpful for treatment-resistant acne, deeper inflammatory acne, or acne that is causing post-breakout discoloration.
Treatment options require evaluation by a licensed healthcare provider. Do not start, stop, or change any prescription medication without consulting your dermatologist. Outcomes vary by individual. Isotretinoin is subject to additional prescribing requirements.
Acne Scars: Prevention and Treatment
Acne scars form when deeper inflammation damages the skin, and the skin heals unevenly. Picking or squeezing acne can increase the risk.
Severe nodules and cysts are most likely to leave permanent scars, while post-inflammatory hyperpigmentation is not a true scar and may fade gradually over time.
Early, effective treatment of active acne is the best way to reduce long-term scarring.
In-office scar treatments may include chemical peels, laser resurfacing, microneedling, subcision, and dermal fillers for selected atrophic scars.
Concerned about acne scarring? Early treatment helps reduce long-term damage. Book an appointment at Goodskin Dermatology.
When to See a Dermatologist for Acne
You should consider seeing a dermatologist if:
- Over-the-counter products have not improved your acne after six to eight weeks of consistent use
- You have nodules or cysts
- Your acne is leaving scars or dark spots
- Breakouts are affecting your confidence, sleep, or daily life
Dermatologist care is also important when acne follows a hormonal pattern, such as repeated breakouts along the jawline and chin, or when acne is associated with irregular periods or symptoms suggestive of PCOS.
Patients with recurring inflammatory acne may also benefit from a full-body skin evaluation to assess overall skin health and discuss related skin concerns.
Goodskin Dermatology’s expert team provides personalized acne diagnosis and treatment at four locations in Oregon.
Acne Prevention: Building an Acne-Safe Routine
An acne-safe routine starts with gentle cleansing twice daily using a non-comedogenic cleanser.
Acne-prone skin still needs moisture, so an oil-free, non-comedogenic moisturizer is important.
Daily sunscreen is also essential, especially because many acne treatments increase sun sensitivity.
Avoid scrubbing, harsh exfoliants, and picking at blemishes, which can worsen inflammation and increase the risk of scarring.
Other helpful steps include changing pillowcases regularly, reviewing haircare products for ingredients that may clog pores, and avoiding heavy or greasy products around the hairline and face.
If you are unsure which products are safe for acne-prone skin, a dermatologist can help you build a personalized routine.
Why Choose Goodskin Dermatology for Acne Care?
Goodskin Dermatology provides treatment for the full spectrum of acne, from mild clogged pores to deeper cystic and hormonal acne.
Our board-certified dermatologists offer Medical and Aesthetic Dermatology care. They can recommend treatment plans that may include prescription medications, chemical peels for acne, photodynamic therapy, cortisone injections, laser-based treatments, and acne-related discoloration or scarring.
Patients across Oregon choose Goodskin Dermatology because we offer convenient access at four locations in Beaverton, Clackamas, Hillsboro, and Troutdale. We also accept most major insurance plans for medically necessary acne visits.
If you need acne treatment, hormonal acne care, cystic acne treatment, or support for acne scarring, book an appointment online today.
Frequently Asked Questions About Acne
What is the most effective acne treatment?
The most effective acne treatment depends on the type and severity of acne. Mild acne may improve with consistent use of benzoyl peroxide, salicylic acid, or adapalene. Severe nodular or cystic acne may require isotretinoin, which is considered one of the most effective treatments for severe acne according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
How long does acne treatment take to work?
Most topical acne treatments need about six to eight weeks of consistent use before noticeable improvement appears.
Oral antibiotics may work sooner for some people, while isotretinoin usually requires a longer course over several months.
Switching products too quickly is one reason acne often stays uncontrolled.
Can hormonal acne be treated without birth control?
Yes. Hormonal acne can sometimes be treated without birth control. Depending on the pattern and severity, dermatologists may recommend spironolactone, topical medications, or other prescription options. Treatment should be individualized based on your symptoms, health history, and goals.
Will my acne leave permanent scars?
Not all acne leaves permanent scars, but deeper nodules and cysts carry the highest risk, especially if they are picked or left untreated.
Dark spots after acne heals are often post-inflammatory hyperpigmentation rather than true scars. Early treatment is the best way to help prevent lasting marks.
Does Goodskin Dermatology treat acne in adults?
Yes. Goodskin Dermatology treats acne in both adults and teens. Adult acne, especially in women, often follows a hormonal pattern and may need a different treatment plan than teenage acne. Dermatologist evaluation can help identify the right approach.
Does insurance cover acne treatment at Goodskin Dermatology?
Medical dermatology visits for acne are often covered when treatment is medically necessary. Goodskin Dermatology accepts most major insurance plans.
