Understanding Acne: Causes, Treatments & Our Step-by-Step Approach

Understanding Acne: Causes, Treatments, and How We Approach It

Acne is one of the most common skin conditions, but it isn’t all the same. Learn about the four main factors behind active acne, how it differs from acne scarring, and the most effective treatment strategies — including topical treatments, antibiotics, blue-light therapy, and isotretinoin (Roaccutane).

The Four Elements of Active Acne

When we assess someone with acne, we look at four main processes happening in the skin:

• Excess sebum production – your oil glands are overactive and produce too much sebum. This oily layer traps dead skin cells and creates the perfect environment for acne bacteria to multiply.

Treatments that target this: topical or oral retinoids such as tretinoin, adapalene, or isotretinoin (Roaccutane). These normalise how the skin sheds and reduce oil production.

• Blocked pores (comedones) – when pores are clogged with oil and dead skin, blackheads and whiteheads appear.

Treatments that help: gentle exfoliating face washes such as those containing salicylic acid, glycolic acid, or treatments like HydraFacials and microdermabrasion to clear congestion.

• Bacterial infection – Cutibacterium acnes (formerly Propionibacterium acnes) thrives in blocked pores and causes spots to become inflamed or pus-filled.

Treatments that help: topical or oral antibiotics, and increasingly, blue-light therapy which kills acne bacteria without antibiotics.

• Inflammation – once bacteria take hold, the body’s immune response leads to redness, swelling, and tenderness.

Treatments that help: anti-inflammatory face washes such as salicylic acid cleansers, and dietary anti-inflammatories like turmeric and ginger supplements.

Active Acne vs Acne Scarring

It’s important to differentiate active acne from acne scarring:

• Active acne involves ongoing inflammation, blocked pores, or infection — you can still feel or see raised, red, or painful spots.
• Acne scarring is what remains after active acne has healed — including indentations, pigment changes, or thickened tissue.

Treating scarring while acne is still active is often ineffective. The priority is always to control the active inflammation first, then move on to resurfacing and scar-reduction treatments such as microneedling, chemical peels, or laser resurfacing.

Treatment Options and Their Side Effects

• Topical Treatments (retinoids, acids, cleansers)

These are often the first step in managing acne.

• How they work: they reduce oil production and speed up cell turnover to prevent blocked pores.
• Common examples: adapalene, tretinoin, salicylic acid, glycolic acid, and azelaic acid.
• Side effects: dryness, redness, peeling, and irritation, especially in sensitive skin.
• Effectiveness: moderate; they often help mild acne but may not be strong enough for more severe inflammation.

• Oral Antibiotics

Used to control bacterial overgrowth and inflammation.

• How they work: they reduce acne-causing bacteria and calm inflammation.
• Common examples: doxycycline, lymecycline, or erythromycin.
• Side effects: gut upset, sun sensitivity (photosensitivity), and interaction with other treatments (for example, antibiotics can interfere with wrinkle-relaxing injections such as Botox).
• Effectiveness: usually excellent in the short term, but acne often returns once antibiotics are stopped. Long-term use is avoided to prevent antibiotic resistance.

• Blue-Light Therapy

An increasingly popular option for patients who cannot tolerate medications.

• How it works: specific wavelengths (around 420 nm) kill acne bacteria and reduce inflammation.
• Options: in-clinic laser devices or at-home LED masks with blue-light settings.
• Side effects: minimal — possible temporary redness or dryness.
• Effectiveness: good for bacterial and inflammatory acne, though daily or regular sessions are needed for best results.

• Isotretinoin (Roaccutane)

Reserved for severe or persistent acne that hasn’t responded to other treatments.

• How it works: it acts on all four causes of acne — reducing sebum, preventing blocked pores, killing bacteria, and calming inflammation.
• Side effects: dry lips and skin, sun sensitivity, possible mood changes, and it cannot be used in pregnancy.
• Effectiveness: extremely high; most patients experience complete or near-complete clearance that lasts for years. However, it requires careful medical supervision and regular blood tests.

Our Step-by-Step Approach to Acne Treatment

Because no two cases of acne are identical, treatment must be tailored:

• Start gently – we often begin with appropriate cleansers and topical treatments to assess skin sensitivity.
• Add systemic therapy – if topical care isn’t enough, antibiotics or blue-light therapy may be introduced.
• Reserve isotretinoin – if the acne persists, isotretinoin offers the most powerful, long-lasting control.
• Treat scarring afterwards – once the skin is stable and clear of active acne, we address scarring with resurfacing or laser treatments.

We adjust each plan according to how your skin responds. If one step isn’t effective, we move to the next. The goal is always clear skin with the least side effects and the most sustainable long-term result.

Key Takeaway

Acne isn’t caused by one single factor — it’s the interaction of oil, bacteria, blocked pores, and inflammation. Understanding which elements are most active in your skin allows us to choose the right treatment strategy. With the correct balance of medical therapy, light treatments, and skincare, most patients can achieve lasting control and confidence in their skin.

Frequently Asked Questions

• How do I know if I need isotretinoin?

If you’ve tried antibiotics and topical treatments without improvement or your acne is leaving scars, isotretinoin may be the best next step under medical supervision.

• Is blue-light therapy safe for sensitive skin?

Yes. It’s one of the gentlest acne treatments available, with minimal side effects.

• Can diet affect acne?

Diet alone isn’t the main cause, but reducing high-glycaemic foods and dairy, and including anti-inflammatory foods like turmeric and oily fish, may help.

• What’s the difference between active acne and acne scars?

Active acne shows as red, inflamed spots or pustules. Scarring remains after these spots have healed and appears as indentations or discolouration.

• How long does it take to see improvement?

Most treatments take at least 6–8 weeks to show visible results, but consistency is key — acne management is a marathon, not a sprint.