Acne (Acne Vulgaris)

Key Takeaways

• Acne is one of the most common skin conditions worldwide and affects people of all skin tones. 

• In people with darker skin tones, the dark spots left behind after acne (post-inflammatory hyperpigmentation or PIH) are often more bothersome than the acne itself. 

•  Early treatment can reduce the risk of dark spots, scarring, and long-term skin changes. 

•  Picking or squeezing pimples can worsen hyperpigmentation and increase the risk of scars. 

• Most acne treatments require 6–8 weeks before noticeable improvement occurs.

What Is Acne Vulgaris?

Acne vulgaris is a common inflammatory skin condition that develops when hair follicles become clogged with oil, dead skin cells, and debris. These clogged pores can become inflamed and lead to blackheads, whiteheads, pimples, nodules, or cysts. 

Although acne is most common during the teenage years, it can affect people of all ages. Many adults continue to experience acne well into their 20s, 30s, and beyond. 

Acne is more than a cosmetic concern. It can affect confidence, leave permanent scars, and cause longlasting pigment changes that persist after breakouts have healed.

Fast Facts

• Who gets acne?

  Teenagers and adults

• Where does acne occur?

  Face, chest, back, and shoulders

• Can acne cause scaring?

  Yes

• Is acne contagious?

  No

What Does Acne Look Like?

Acne can appear in several different forms.

Whiteheads Small flesh-colored or white bumps that develop when pores become clogged and remain closed. 

Blackheads- Open pores filled with oil and dead skin cells. The dark color is caused by oxidation, not dirt. 

Papules- Small red or tender bumps caused by inflammation. 

Pustules- Inflamed pimples that contain visible pus. 

Nodules- Large, painful bumps that develop deeper within the skin. 

Cysts- Deep inflammatory lesions that may lead to permanent scarring.

Understanding How Acne Develops

1. Excess Oil Production- Hormonal changes can increase oil production and make pores more likely to become clogged. 

2. Clogged Pores- Dead skin cells can accumulate inside hair follicles and block normal drainage. 

3. Bacteria- A naturally occurring skin bacterium called Cutibacterium acnes can contribute to inflammation.

4.  Inflammation- plays a major role in acne and is responsible for many of the red bumps, painful lesions, and long-term skin changes associated with the condition. 

   • Other factors that may contribute include: 

     Genetics 

   • Hormonal fluctuations 

   • Pregnancy

   •  Polycystic ovary syndrome (PCOS) 

   • Certain medications 

   • Stress 

   • High-glycemic diets in some individuals
     

Skin of Color Perspective

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Skin of Color Perspective |

Why Acne Can Feel Different in Skin of Color?

For many people with darker skin tones, the most frustrating part of acne is not the pimple itself—it is the dark spot left behind after the breakout heals.

These marks are known as post-inflammatory hyperpigmentation (PIH).

PIH develops when inflammation stimulates the skin to produce excess pigment. The acne lesion may disappear within days or weeks, but the resulting dark spot can remain visible for months.

Many patients seek treatment for these marks even after their acne has improved

What Does PIH Look Like?

PIH often appears as: 

• Brown spots

•  Dark brown patches 

• Gray-brown discoloration 

• Purple-brown marks 

The color depends on a person's skin tone and the depth of pigmentation.

How Long Does PIH Last?

PIH may persist for several months and occasionally longer. The deeper the pigment and the more inflammation that occurred, the longer it may take to fade.

Why Does It Occur More Frequently in Skin of Color?

Melanin-producing cells (melanocytes) are more reactive in darker skin tones. Even minor inflammation can trigger increased pigment production, making dark spots more likely to develop.

Additional Concerns

People with skin of color may also experience: 

• More persistent discoloration 

• Keloids 

• Hypertrophic scars

How Can You Prevent PIH?

• Treat acne early 

• Avoid picking or squeezing pimples

• Use sunscreen daily

• Follow a consistent treatment plan

• Seek medical care before scarring develops

Sunscreen Matters

Daily broad-spectrum sunscreen with SPF 30 or higher helps prevent dark spots from becoming darker

Tinted sunscreens containing iron oxides may provide additional protection against visible light, which can worsen hyperpigmentation.

Why Acne Matters

Acne affects more than skin. Research has shown that acne can negatively affect quality of life and self-esteem, particularly when scarring or pigment changes occur.

Potential complications include:

• Permanent scars

• Dark spots after acne heals

• Changes in skin texture

• Reduced self confidence

• Anxiety or social embarrassment

Treatment Options - Depends on acne severity

• Mild Acne

  • Benzoyl peroxide

  • Adapalene

  • Tretinoin

  • Azelaic acid

  Azelaic acid is particularly useful for individuals with skin of color because it may improve both acne and hyperpigmentation.

• Moderate Acne

  • Combination topical therapy

  • Oral antibiotics

  • Hormonal therapies in appropriate patients

• Severe Acne

  • Dermatology referral

  • Isotretinoin

  • Scar-prevention strategies

What to Expect

Most acne treatments require patience. Many people begin noticing improvement after 6–8 weeks, while some treatments require several months to reach their full effect. Stopping treatment too early is one of the most common reasons people fail to see results.

Building a Simple Acne Routine

Morning

1.  Gentle cleanser

2.  Moisturizer 

3. Broad-spectrum sunscreen (SPF 30+) 

Evening

1. Gentle cleanser 

2. Acne treatment (retinoid or prescribed medication) 

3. Moisturizer 

4. Consistency is more important than using many products.

Common Acne Mistakes to Avoid

• Picking or squeezing pimples 

• Using harsh scrubs 

• Changing products too frequently 

• Stopping treatment too early 

• Skipping sunscreen 

• Using too many active ingredients at once

When Should You See a Dermatologist?

Consider seeing a dermatologist if:

• Acne is causing scars

• Dark spots are developing

• Acne is painful

• Over-the-counter treatments are not helping

• Acne is affecting your confidence or quality of life Y

• You are developing nodules or cysts

Early Treatment can help prevent permanent skin changes.

FAQ

• Does chocolate cause acne?

  Current evidence does not support chocolate as a major cause of acne.

• Is acne caused by poor hygiene?

  No. Excessive scrubbing may actually worsen acne by irritating the skin

• Can makeup cause acne?

  Many people can safely wear noncomedogenic makeup products without worsening acne.

• Can acne scars be prevented?

  Early treatment of inflammatory acne can significantly reduce the risk of permanent scarring.

• Does sunscreen help acne?

  Sunscreen does not directly treat acne, but it can help prevent dark spots and discoloration from becoming more noticeable.

References

1. American Academy of Dermatology

2.  DermNet NZ

3. Mayo Clinic 

4. Skin of Color Society 

5. Peer-reviewed dermatology literature

Medical Disclaimer

This article is intended for educational purposes only and should not replace professional medical advice. Always consult a qualified healthcare professional regarding diagnosis or treatment of a medical condition.