Acne occurs when pores in the skin get blocked by dead skin cells, and sebum — oil produced by skin glands — accumulates in the pores. Bacteria in the pores can contribute to pore clogging and inflammation. Acne can occur on the face or body — usually the back, chest, and shoulders.


How common is acne? And who gets it?

Acne often starts around puberty, with about 90% of adolescents being affected. But it can be a problem for many older people too, especially women. About 1 in 5 adult women suffer from the condition — often due to hormone fluctuations.

In all, acne affects about 20% of the population in Canada — about 5 million people. Acne can have significant effects on wellbeing. And having other people dismiss it as a teen rite of passage or as vanity doesn’t help.

Acne can evoke feelings of low self-esteem, depression, and thoughts of self-harm. It's especially important to treat acne if it's making you or your adolescent child experience significant psychological distress. If you treat acne early, it is less likely to develop into a more severe form, and less likely to lead to scarring.



What causes acne?

There are many factors involved in the development of acne:

  • Blocked pores
  • Oil production
  • Hormones
  • Inflammation
  • Genetics
  • Bacteria

Note that poor personal hygiene is not on that list! Acne is not caused by infrequent washing. In fact, washing too often or too vigorously can irritate the skin and make acne worse. 

Acne can fluctuate in severity over time, and different people have different triggers that can make their acne flare up. These include:

  • Physical pressure – Bra straps, headbands, or tight clothing can trigger an outbreak in the area of skin under pressure.
  • Cosmetics – Look for products labelled oil-free, non-comedogenic, or non-acnegenic to avoid contributing to pore clogging.
  • Sweat – Especially if trapped under damp clothing.
  • Medications – Corticosteroids and contraceptive pills with progestin can be triggers in some people.
  • Menstrual cycle – Some women and girls find they get premenstrual flare ups.
  • Picking or squeezing – This can spread the oil and bacteria to the surrounding skin, causing more swelling and redness.
  • Food – Reducing dairy intake and a diet with a lower glycemic index might help, although the evidence for a connection is weak. (There is no evidence that chocolate or greasy foods cause flare ups.)
  • Washing too often or vigorously – Gently wash your face once or twice a day with an acne cleanser.

What non-medication treatment is there for acne?

Regular washing and removing make-up – Gently washing your face every day helps remove oil, dead skin cells, and bacteria from the surface of the skin. Acne isn’t caused by infrequent washing, but regular washing can help keep it under control, especially if you use a cleanser that is designed for acne.


Reducing stress – Stress can increase the production of certain hormones that cause increased oil production. Practicing relaxation techniques may help reduce your acne flare ups.


Changing pillow cases/sheets – Hair products, for example, can transfer to your pillow case, and then end up as residue on your skin. Change your pillow cases frequently and, if you have long hair, consider wearing your hair up at night.


Dietary changes – There is some weak evidence that a low glycemic index diet, and eliminating dairy can help.


Laser and light treatment – The idea is that certain kinds of light can deactivate the bacteria in the pores. But there is not yet enough evidence to recommend this treatment.


What non-prescription medications are available for acne?

First, try a non-prescription topical (applied to the skin) medication. Look for creams, gels, or cleansers with either of these active ingredients:

  • Salicylic acid
  • Benzoyl peroxide

These medications treat acne in one or more of the following ways:

  • Removing dead skin cells and excess oil to help unclog the pores
  • Killing bacteria
  • Reducing inflammation

Benzoyl peroxide can make your skin more sensitive to the sun, so reduce your exposure, and make sure you use sunscreen.


Tretinoin - A derivative of vitamin A, this is available over-the-counter in various concentrations. It causes the outer layer of the skin to grow more quickly and to be replaced with new skin cells, which helps to reduce the formation of pimples


Azelaic acid - It works in part by stopping the growth of skin bacteria that cause acne, and by keeping skin pores clear.


Use caution

More isn't always better. Just because these medications are available without a prescription doesn’t mean that they can’t have side effects. Some of these medications can cause significant skin irritation. So it’s safer to start with a weaker dose and move up to a stronger dose only if necessary.


Any acne treatment requires a couple of months to see improvement — and the treatment may temporarily make your acne worse. So give it some time! If you don't notice improvement after six to eight weeks, see your doctor.


Prescription medications for acne

If the non-prescription medications don’t work for you, talk to your doctor about which prescription medication you should try using next to treat your acne.

There are topical products with the same ingredients as above, but in stronger concentrations, which are available only with a prescription.


Topical antibiotics - For mild to medium acne, doctors often prescribe gels or creams containing clindamycin, erythromycin, or sulfacetamide to destroy acne bacteria.


Oral antibiotics - These may be prescribed in cases of severe acne. There are a number of different antibiotic pills that may be prescribed:

  • doxycycline (which also has anti-inflammatory properties)
  • erythromycin
  • clindamycin
  • tetracycline
  • minocycline
  • trimethoprim
  • azithromycin

Antibiotic treatment should be restricted to a few months to prevent antibiotic resistance developing.


Corticosteroids - Synthetic versions of a hormone made in the body. Topical applications reduce inflammation.


Combined oral contraceptives - Can help improve acne for women by regulating hormones.


Spironolactone - This hormonal treatment reduces the levels of male hormones (testosterone, in particular) that are responsible for increased oil production in the skin.


Topical retinoids - Derived from vitamin A, these medications (including tretinoin, adapalene and tazarotene) help reduce pore blockage and lessen inflammation.

Retinoids can irritate your skin if used too often or if the dose is too strong.


Oral isotretinoin - Oral isotretinoin is the only oral retinoid indicated for acne. It is reserved for severe acne that is not responding to other treatments. It has many effects that improve acne, including unblocking pores and reducing oil production.


Questions about acne medication?

If you have questions about acne medication, ask your doctor or pharmacist. 

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Ashley Resnik
September 14, 2021
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