Acne

Signs and symptoms

The acne presents varied lesions, often coexisting in the same skin. Recognizing the type of injury helps the dermatologist decide the treatment plan.

• Open meats (black spots) — dilated pores with oxidized sebum.
• Closed edibles (white spots) — small white nodules or skin colour.
• Papules — small red and inflamed elevations, sensitive to touch.
• Pustules — lesions with purulent content ("classical bubbles").
• Nodules — deeper, more painful inflammatory lesions.
• Cystos — deep, painful nodules with a higher risk of scarring.
• Post-inflammatory stains — dark or reddish marks that remain after the injury disappears.
• Scars — permanent depressions or projections, more frequent in untreated cases.

Types of acne

The classification guides the treatment. These are the most common frames:

• Comedonic acne — black and white dots predominate, with little inflammation.
• Acne papulopustulous — combination of comedies, papules and pustules; the most frequent pattern.
• Nodulocystic acne — deep, painful lesions with a high risk of scarring.
• Hormonal acne — outbreaks aligned with the menstrual cycle, especially in the chin and jaw area.
• Late acne (adult) — it arises or persists after 25 years, more common in women.
• Mechanical acne — caused by friction or pressure (capacettes, masks, backpacks).

CAUSES AND RISK FACTORS

Acne results from the combination of several mechanisms that occur simultaneously in the hair follicle:

• Increased production of tallow, often stimulated by androgen hormones.
• Obstruction of the follicle by keratin, forming the comet.
• Colonization by bacteria (Cutibacterium acnes), which amplify inflammation.
• Local inflammatory response — which explains the papules, pustules and nodules.

In addition to these mechanisms, there are individual factors that increase the probability or intensity: family history, hormonal changes (puberty, polycystic ovarian syndrome, pregnancy), stress, some medicines (e.g. corticosteroids), commedogenic cosmetics, prolonged moisture and friction. Food — in particular dairy products and foods with a high glycaemic index — has a possible role in some cases, although it is typically secondary.

Diagnosis

The diagnosis is clinical — that is, made by the observation of the lesions and the patient's clinical history. No routine tests required.

In an online consultation, the dermatologist analyzes 3 photographs of affected areas (at different angles, with good lighting) and a short questionnaire on the evolution of lesions, treatments already experienced, hormonal cycle (when applicable) and skin care habits. With this information it classifies the type and severity of acne and proposes a personalized treatment plan.

In particular situations — suspected endocrine cause, resistance to previous treatments, or associated signs outside the standard — the dermatologist may request additional tests or recommend a face - to - face assessment.

Options for treatment

The treatment of acne is individual: it depends on the type of injury, severity, age, skin type and psychological impact. There are three major categories of intervention:

It is important to know that the treatment takes time: the first results usually occur after 6-8 weeks and the condition may deteriorate transiently at the beginning. Adhering to the plan and maintaining follow-up with the dermatologist are the factors that most influence success.

Prevention

There is no guaranteed way to prevent acne — many factors are individual and hormonal. But there are habits that reduce the frequency and intensity of outbreaks, and that help to control the disease already installed:

• Smooth skin cleaning, twice a day, with non-abrasive product.
• Avoid comedogenic products — on the skin, on the hair (if it reaches the forehead) and makeup.
• Daily photoprotection with non-comedogenic formulations.
• Not squeezing or pinning the lesions — increases the risk of infection and scarring.
• Review the use of devices that make prolonged friction (cap, mask, handles).
• Seek assessment by a dermatologist as soon as the pictures gain persistence or intensity.

Home care and frequent myths

Some home care is useful; others — repeated in forums and social networks — have no evidence and can worsen the skin:

• Do not wash the skin with aggressive soaps or several times a day — the skin barrier deteriorates and inflammation worsens.
• Do not use alcohol, lemon, or toothpaste as a home remedy — they irritate and can stain.
• Tanning the skin does not treat acne — it temporarily maskes the lesions and increases the risk of post-inflammatory spots.
• Not all acne is "food"—food changes can help in some cases, but they rarely resolve on their own.
• Simple and consistent cosmetic routines work better than many products simultaneously.

Frequently asked questions