Acne

Dr. Wu's analysis

What is acne?

Acne is a common chronic skin condition in which the sebaceous glands become clogged and inflamed. The condition occurs when excessive sebum production, dead skin cells, and skin bacteria such as Cutibacterium acnes clump together in the hair follicles. This causes blackheads, pimples, and sometimes deeper inflammations such as cysts. Acne most often occurs on the face, back, and chest, because there are relatively many sebaceous glands present there.

Although acne is most common during puberty due to hormonal changes, it can occur at any age. Adults, especially women, can suffer from persistent or hormonal acne. The severity varies greatly: from mild comedones to severe inflammations with a risk of scarring. Therefore, timely and targeted treatment is essential to limit complaints and residual symptoms.

What causes acne?

Pimples can be caused by various factors, such as hormonal fluctuations, excessive sebum production, inflammation, and bacterial growth. Below are the most common causes.

Hormonal changes

Fluctuations in hormones, such as androgens, can lead to increased sebum production and clogged pores.

Excessive sebum production

When the skin produces too much sebum, this can clog pores together with dead skin cells and cause acne.

Inflammatory reactions

The immune system responds to clogged pores and bacteria with inflammation, resulting in red bumps and pimples.

Bacterial growth

The bacterium Cutibacterium acnes can multiply in clogged pores and cause inflammation.

Medication use

Certain medications can worsen acne, including lithium, corticosteroids, testosterone, and anticonvulsants.

Exposure to sunlight

Excessive sun exposure can dry out the skin, leading to increased sebum production and clogged pores.

Friction and clothing

Prolonged contact with face masks, headbands, backpacks, and underwire bras can worsen acne.

Endocrine disorders

Polycystic ovary syndrome (PCOS) and pregnancy can contribute to acne.

Nutrition and acne

Sugar- and carbohydrate-rich food is associated with an increased risk of acne.

Stress

Emotional stress plays a role in the development of adult acne in 25.7% of cases.

Cosmetic products

Certain ingredients such as lanolin, cetyl alcohol, and synthetic sunscreens can clog pores.

Who are susceptible to acne?

“It mainly occurs in puberty in both men and women. The Global Burden of Disease Study 2010 showed that acne vulgaris is the eighth most common skin disease, with an estimated worldwide prevalence (for all ages) of 9.38%. It is often said that you no longer get acne after puberty. From an extensive acne research among 1,013 men and women aged 20 and over, the following figures were published: 20-29 years: 50.9% (women) versus 42.5% (men) 30-39 years: 35.2% (women) versus 20.1% (men) 40-49 years: 26.3% (women) versus 12.0% (men) 50 years and older: 15.3% (women) versus 7.3% (men) These figures show that acne is not just a ‘teenage problem’, but can be a chronic skin condition where adult women in particular are at extra risk. Therefore, it is important to remain alert to symptoms and use appropriate skin care at a later age.”

Video: The connection between acne and sugar

How do you recognize and distinguish acne?

How can you recognize acne?

Blackheads

Blackheads

Dark spots caused by accumulated sebum and dead skin cells in pores.

Whiteheads

Whiteheads

Closed comedones covered by a skin layer, remain white due to lack of oxidation.

Papules

Papules

Red, painful bumps without pus. Initial stage of a pimple.

Pustules

Pustules

Bacterial infections that cause inflamed bumps with pus.

Cyst Acne

Cyst acne

Deep, painful inflammations that can cause scars.

Which skin problems look like acne?

Not all pimples on the face are acne. Pustules can also be caused by other skin conditions. The main differences lie in the cause and appearance of the pimples.

Here are some skin conditions that can also cause pustules:

Folliculitis – Inflammation of hair follicles due to a bacterial infection.
Perioral dermatitis (clown eczema) – Redness and small pimples, usually around the mouth, often caused by skin care products.
Rosacea – Accompanied by chronic redness and visible blood vessels on the cheeks and nose.
Impetigo (impetigo contagiosa) – Superficial bacterial infection, recognizable by yellow crust formation.

Although these skin conditions can cause pustules, they differ in underlying cause, external characteristics, and treatment.

What types of acne are there?

Different forms of acne and their causes

Acne comes in different forms. Below you can read more about the different types of acne, how to recognize them, and what the possible causes are.

Comedonal Acne

Characteristics: Closed comedones (subcutaneous, white bumps) and open comedones (blackheads). Little to no inflammation visible.

Excoriated Acne of Young Girls

Characteristics: Scratching spots, pimples or bumps, which causes skin damage and a restless skin image.

Neonatal Acne

Characteristics: Pustular rash with comedones in newborns.

Cause: Presumably due to androgen hormones produced by the mother or the baby itself.

Late Onset Acne

Characteristics: Late acne that appears after the age of 25, especially in women (11-12%).

Cause: Hormonal (DHEAS, testosterone), medication (corticosteroids, Mirena coil), genetic predisposition, PCOS and Cushing's syndrome.

Acne Inversa / Hydradenitis Suppurativa

Characteristics: Chronic inflammation in hair follicles, especially in armpits, groins, and the perianal area.

Cause: Smoking, genetic predisposition, overweight, sweating, and mechanical irritation. Associated with Crohn's disease and rheumatoid arthritis. Interesting study: A yeast-free diet may potentially help with acne inversa.

Conglobata Acne

Characteristics: Severe inflammatory acne with deep scars, continuing until the 40th year of life.

Cause: Possibly related to testosterone levels and anabolic steroids.

Fulminans Acne

Characteristics: Acute, severe inflammation of acne conglobata with painful pimples, fever, and general malaise.

Cause: Rare disease, possibly due to high doses of isotretinoin or increased testosterone levels.

Rosacea Acne

Characteristics: Not actual acne, but a red discoloration on the nose, cheeks, forehead, and chin.

Cause: Chronic skin inflammation, especially in women between 30 and 60 years old.

How do you effectively treat acne?

What can I do about it myself?

A good basic care is essential if you suffer from acne. By following a consistent skin routine, you support your skin barrier and minimize inflammation.

Step 1: Cleanse without irritating the skin

Cleanse your face twice a day with a mild, non-comedogenic cleanser that removes dirt and excess sebum without drying out the skin. Avoid aggressive foaming cleansers with sulfates, as they can dry out your skin and actually stimulate sebum production.

Step 2: Hydrate with the right ingredients

Use a light, oil-free moisturizer that is specifically designed for acne-prone skin. Choose formulas with niacinamide, hyaluronic acid, or ceramides, which soothe and repair the skin without clogging pores.

Step 3: Protection against the sun

Daily sun protection is crucial to prevent post-inflammatory hyperpigmentation (PIH), or dark spots after pimples. Opt for a mineral sunscreen with zinc oxide or titanium dioxide, which is gentler on the skin and less likely to cause irritation.

Why this routine works This daily routine cleanses, hydrates, and protects your skin without overloading it. It forms a solid foundation that you can supplement with specific acne treatments, such as salicylic acid or benzoyl peroxide, for optimal recovery.

What treatments are there?

The treatment of acne can vary. Below is a list of treatments based on different forms of acne.

Open comedones/black heads

Open comedones occur when sebum and dead skin cells accumulate in an open pore. The treatment focuses on facilitating the sebum drainage. Ingredients such as fruit acids (AHAs, for example glycolic acid), salicylic acid, benzoyl peroxide, retinol, tretinoin, and adapalene help cleanse the pores and remove blockages. As a result, existing blackheads are reduced and the formation of new comedones is prevented.

Closed comedones/white heads

It's very tempting to squeeze out the whiteheads, to pop them. Try to avoid this in order not to get scars and slow down the healing process. Just like with blackheads, the best treatment is to wash your face with, for example, glycolic acid and use oil-free, non-comedogenic products (skin and sun protection).

Pimples

Smaller pimples can disappear without treatment, but you can also use topical benzoyl peroxide, tretinoin or adapalene. It is mainly antibiotics that counteract the growth of bacteria. This can be topical such as clindamycin or erythromycin lotion or antibiotic tablets (minocin, doxycycline). For extensive and moderately severe acne, a combined treatment is chosen, for example adapalene and antibiotic tablets. Both can reduce inflammation and kill bacteria that grow in the follicle and on the skin surface.

Pimples

Here it is important to prevent further irritation in the area. Do not scrub your skin and be careful when cleaning with warm water. You can wash your face with a glycolic acid cleanser. It is wise not to apply makeup to papules, so that the area does not close off too much. Bacteria can thrive in a closed-off area and cause inflammation.

Cystic acne

In the case of cystic acne, treatment under the supervision of a dermatologist is essential to prevent permanent scarring. Depending on the severity, a course of antibiotics or the powerful drug isotretinoin may be used. Isotretinoin, a vitamin A derivative, reduces sebum production, inhibits keratinization in the sebaceous gland, and suppresses inflammation. A corticosteroid cream is sometimes used additionally to soothe the skin reaction externally. Due to possible side effects such as dry lips, eyes and skin, and elevated liver values or blood fats, regular blood tests are required. The drug should never be used during pregnancy due to serious risks.

What should you avoid with acne?

As a dermatologist, I advise avoiding certain habits and products that can worsen your acne. Common mistakes in skincare and lifestyle can lead to more inflammation, scarring, and a disrupted skin balance. Here are the main factors to watch out for:

Aggressive cleaning and scrubs: Avoid damaging the skin barrier.

The use of harsh scrubs and aggressive cleansers can dry out your skin and damage the natural protective layer. This actually stimulates extra sebum production and increases the risk of pimples. Instead, opt for gentle, pH-balanced products, specifically developed for acne-prone skin.

Non-squeezing of pimples: Prevent infections and scars

It can be tempting to squeeze pimples, but this worsens inflammation, spreads bacteria, and increases the risk of scarring. Especially in the "Triangle of Death" area (around the nose and upper lip) this can be dangerous, as bacteria can enter the bloodstream directly here. Squeezing can also lead to post-inflammatory hyperpigmentation (PIH), leaving behind dark spots, especially on dark skin.

Too hot water and excessive heat: Protect your skin barrier

Prolonged exposure to hot water, steam, or saunas can weaken the skin barrier and exacerbate irritation. Use lukewarm water when cleansing your face to prevent dehydration and redness.

Unhealthy lifestyle: Stress, nutrition and sleep

Chronic stress, an unhealthy diet, and insufficient sleep can intensify inflammation in the body and worsen acne. Maintain a balanced diet, rich in antioxidants and omega-3 fatty acids, and try stress management techniques such as yoga or meditation.

Tobacco and excessive alcohol use: Negative impact on skin health

Smoking and excessive alcohol consumption worsen blood circulation and increase inflammation, which can exacerbate acne and impair skin recovery. Want healthier skin? Consider reducing these habits.

Sun protection: Prevent damage and hyperpigmentation

Excessive exposure to UV radiation can worsen acne scars and pigmentation spots. Use a mineral sunscreen with zinc oxide or titanium dioxide daily. These filters are gentle on the skin and protect without clogging pores.

Iconic Elements products

The Iconic Elements skincare products are developed based on scientifically substantiated ingredients, have a skin-neutral pH of 5, and are free from microplastics. They were awarded the Best Dermatologist Developed Skincare Brand 2024 and Best Holistic Skincare Line 2022 awards. More about the background and studies used can be found on the respective product pages.

🛈 These products are cosmetic and intended for the care of healthy, sensitive, or out-of-balance skin. They are not intended as a medical treatment or to replace professional medical advice. For personalized skin advice, we recommend consulting a skin therapist or doctor.

General acne

A suitable skincare routine for blemished or acne-prone skin focuses on cleansing the skin without disrupting its balance and supports the natural skin barrier. By combining care products with mild ingredients, the skin remains better hydrated and balanced.

Image

Product

Description

Cleansingmilk Step 1

14.95

This soap- and alcohol-free cleansing milk removes makeup, skin impurities and excess sebum in a gentle way. The skin remains clean and hydrated without a tight feeling. Suitable for an acne-prone skin that quickly becomes unbalanced.

In shopping cart

Cleansinglotion Step 2

14.95

This lotion removes skin impurities and excess sebum without drying out the skin. Enriched with Cucumber, Lavender extract and Chamomile, this lotion provides a fresh and balanced feeling.

In shopping cart

Spotreducer (AWARD WINNING)

14.95

With niacinamide and ectoin, ingredients that have been researched for their calming properties on sensitive or unsettled skin. Helps to improve skin comfort without drying it out. In 2016, it won a Beauty Award in Hong Kong.

In shopping cart

Calming Cream

14.95

This cream contains ectoin and marshmallow root, ingredients known for their hydrating and soothing properties. They support the skin barrier and are particularly suitable for sensitive or unbalanced skin. When the skin reacts quickly to external stimuli or shows signs of dryness, it requires targeted, gentle care that helps restore the skin’s natural balance.

In shopping cart

Acne & sensitive irritated skin

An inflammation-prone and quickly irritated skin needs mild care to stay calm and balanced.

Image

Product

Description

Calming Cream

14.95

This cream contains ectoin and marshmallow root, ingredients known for their hydrating and soothing properties. They support the skin barrier and are particularly suitable for sensitive or unbalanced skin. When the skin quickly reacts to external stimuli or shows signs of dryness, it requires targeted, gentle care that helps restore the skin’s natural balance.

In shopping cart

Sensitive Cream

14.95

This cream provides extra comfort and care with a light, nourishing texture. Enriched with Avena Sativa, Jojoba oil and Shea butter, this cream hydrates and helps protect sensitive skin.

In shopping cart

Natural Moisturizer Cream

14.95

This nourishing cream combines three skin-friendly properties: the balm-like texture helps protect the skin, glycerin hydrates, and ceramide supports the skin barrier in retaining moisture. This combination makes the cream particularly suitable for dry or unbalanced skin.

In shopping cart

Lippenbalsem

14.95

This lip balm takes care of dry and sensitive lips without clogging pores. With shea butter, coconut oil, squalane and rice bran oil, the balm provides gentle care and comfort, even when the lips feel extra sensitive.

In shopping cart

Acne & dry, vulnerable skin

An isotretinoin treatment for acne or other dermatological conditions can make the skin more dry and sensitive. The right skin care helps support the skin barrier, reduce redness, and keep the skin hydrated without irritating it.

Image

Product

Description

Cleansinglotion Step 2

14.95

This lotion removes skin impurities and excess sebum without drying out the skin. Enriched with Cucumber, Lavender extract and Chamomile, this lotion gives a fresh and balanced feeling.

In shopping cart

Calming Cream

14.95

This cream contains ectoin and marshmallow root, ingredients known for their hydrating and soothing properties. They support the skin barrier and are particularly suitable for sensitive or unbalanced skin. When the skin quickly responds to external stimuli or shows signs of dryness, it calls for a targeted, gentle care that helps restore the skin’s natural balance.

In shopping cart

Spotreducer (AWARD WINNING)

14.95

With niacinamide and ectoin, ingredients that have been researched for their calming properties on sensitive or restless skin. Helps improve the comfort of the skin without drying it out. In 2016, it won a Beauty Award in Hong Kong.

In shopping cart

Natural Moisturizer Cream

14.95

This nourishing cream combines three skin-friendly properties: the balm-like texture helps protect the skin, glycerin hydrates, and ceramide supports the skin barrier in retaining moisture. This combination makes the cream particularly suitable for dry or unbalanced skin.

In shopping cart

Sensitive Cream

14.95

This cream provides extra comfort and care with a light, nourishing texture. Enriched with Avena Sativa, Jojoba oil and Shea butter, this cream hydrates and helps protect sensitive skin.

In shopping cart

Lippenbalsem

14.95

This lip balm cares for dry and sensitive lips without clogging pores. With shea butter, coconut oil, squalane, and rice bran oil, the balm provides gentle care and comfort, even when the lips feel extra sensitive.

In shopping cart

Acne & pigment

Acne can not only cause active inflammation, but also leave behind residual pigment spots and uneven pigmentation. An effective approach combines reducing impurities with fading unwanted pigment spots.

Image

Product

Description

Spotreducer (AWARD WINNING)

14.95

With niacinamide and ectoin, ingredients that have been researched for their calming properties on sensitive or restless skin. Helps improve skin comfort without drying out. In 2016, it won a Beauty Award in Hong Kong.

In shopping cart

Spotreducer (AWARD WINNING)

14.95

With niacinamide and ectoin, ingredients that have been researched for their calming properties on sensitive or troubled skin. Helps improve skin comfort without drying out. In 2016, it won a Beauty Award in Hong Kong.

In shopping cart

Targeted Pigment Serum

14.95

This serum contains arbutin, niacinamide, and malic acid, ingredients that have been studied in scientific research for their contribution to refining the skin surface and supporting an even complexion. The formula is suitable for normal to oily skin and fits within a care routine aimed at pigment-sensitive skin areas.

In shopping cart

Tinted Mineral Sunscreen SPF30

14.95

This tinted mineral sunscreen offers SPF 30 protection based on titanium dioxide, zinc oxide, and iron oxide. The formula helps protect the skin from both UVA and UVB radiation and visible light (HEV/blue light). This cosmetic protection supports the maintenance of an even complexion and contributes to the prevention of sun-related skin damage.

In shopping cart

Tips when you have acne

Tip 1: check your muscle building supplement

There are good indications that muscle-building supplements/shakes such as: whey powder, cow's milk protein powder, soy powder, egg protein, and wheat protein, can cause or worsen acne.

Advice: try to stop using these for at least 3 weeks, if the acne improves then stop with your protein supplement. Possibly that's where the cause lies.

If your acne doesn’t improve after at least three weeks without protein shakes, try reintroducing them. If the acne does not worsen after restarting, it’s likely safe to continue using them.

Tip 2: Niacinamide for your acne skin

Niacinamide, also known as vitamin B3, in a cosmetic skincare product can help reduce acne. Another beneficial effect is the reduction of pigment spots (post-inflammatory hyperpigmentation), caused by acne. Advice: use sun protection with mineral sunscreen during the day, combine a product with niacinamide 2 times a day. The niacinamide dosage in your skincare should be at least 4%.

Tip 3: chocolate is allowed, enjoy in moderation.

Chocolate has always been seen as a factor contributing to the spread of acne. However, studies on the effect of chocolate on this skin condition are controversial and inaccurate due to the extra ingredients such as milk and sugar in bars and other chocolate products. Advice: Dark chocolate is better, it contains less sugar and milk.

Tip 4: zinc supplement

A study from 2020 concluded that a zinc supplement can help reduce pimples.

Advice: stick to the recommended zinc supplement dose and try it for 3 months. It is wise to look for a combined zinc/copper supplement. Both minerals enhance each other.

Tip 5: Cleanse your skin 2 times a day with a mild facial cleanser.

A randomized study from 2006, investigated the effect of facial cleansing and acne vulgaris in men. In summary: the aggravation of acne showed a strikingly significant difference in the group that cleaned once a day. On the other hand, there was a significant improvement in acne visible in the group that used a mild cleanser twice a day for washing the face.

Advice: for both men and women, clean your skin twice a day with a mild facial cleanser.

Read our articles about acne here.

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