Acne: Causes, Treatment and When to Get Help

Watch: Acne care and how we can help

Music: "Fretless" by Kevin MacLeod (incompetech.com), licensed under CC BY 4.0. Excerpted, level-adjusted, faded and mixed with soft transition sounds. Stock consultation footage is illustrative.

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Acne is treatable. Understanding your skin is the first step toward finding the right care.

Start with gentle cleansing, moisturizer and sunscreen. Avoid picking, and choose products labelled non-comedogenic.

Consistency matters. Treatments often take several weeks to work. Ask your pharmacist how to use yours.

The right treatment depends on your acne type, severity and health. Personalized advice can make a difference.

For mild acne, benzoyl peroxide may help pimples, while salicylic acid helps unclog pores. Both may irritate skin. Ask your pharmacist which option suits you.

Walk in during pharmacy hours. Our pharmacists can provide a free assessment for mild acne, with product and medication advice.

Painful, scarring or persistent acne? Your family doctor can assess your skin and refer you to our dermatologist when appropriate.

Care for your skin. Care for you. Visit our website at my Sina dot ca.

Acne is common, treatable and never a reason for shame. It is one of the most common skin conditions in Canada, affecting people of all ages and skin types. It can be uncomfortable, persistent and emotionally difficult, but it is also treatable. The right plan depends on the type and severity of acne, a person's health, pregnancy considerations, current medicines and how the skin responds over time.

How acne develops: a blocked follicle, bacterial growth and inflammation. Illustration: OpenStax College/Wikimedia Commons, CC BY 3.0.

Acne is a medical skin condition, not a sign of poor hygiene. It is not anyone's fault, and people deserve evidence-based care without blame or embarrassment.

Acne in Canada

The Canadian Dermatology Association estimates that acne affects about 5.6 million Canadians, or nearly one in five people. It affects about 90% of adolescents, and it can continue well beyond the teenage years: approximately 20% to 30% of adults aged 20 to 40 experience acne.[1]

What Canadian data tell us	Why it matters
About 5.6 million Canadians are affected.[1]	Acne is common and patients are not alone.
About 90% of adolescents experience acne.[1]	Early, supportive care may reduce discomfort, marks and scarring.
20% to 30% of adults aged 20 to 40 are affected.[1]	Acne is not only a teenage condition and adult acne deserves assessment.

Acne can affect confidence, mood, social participation and quality of life. The emotional effect does not always match the visible severity. Even acne that appears mild to someone else may feel very distressing to the person experiencing it.[5,6]

What causes acne?

Acne develops when hair follicles become blocked by oil and dead skin cells. Inflammation and the skin bacterium Cutibacterium acnes can then contribute to blackheads, whiteheads, red bumps, pustules or deeper painful lesions.[2,5]

Factors that may contribute

Hormonal changes: Puberty, menstrual cycles, pregnancy, perimenopause and some hormonal conditions can influence oil production and breakouts.
Family history: Genetics can affect a person's likelihood of developing acne and its severity.
Skin and hair products: Oily or pore-clogging products may worsen acne in some people. Look for products labelled non-comedogenic or oil-free.
Friction and pressure: Helmets, tight straps, masks, sports equipment and frequently touching the face may irritate acne-prone areas.
Medicines and supplements: Corticosteroids, testosterone or anabolic steroids, lithium and some other products can contribute to acne-like eruptions. Do not stop a prescribed medicine on your own. Ask a pharmacist or prescriber to review it.
Stress: Stress does not create acne by itself, but it can worsen existing acne for some people.

Common myths

Acne is not caused by dirty skin. Harsh scrubbing, abrasive brushes and frequent washing can irritate the skin and make inflammation worse. Acne is also not a reason to blame a person's diet, habits or hygiene. Research on diet continues, and any food-related pattern should be discussed without guilt or overly restrictive dieting.[5,8]

Types and severity of acne

How comedones and other acne lesions form when sebum and dead skin cells block a pore. Illustration: BedrockPerson/Wikimedia Commons, CC BY-SA 4.0.

Comedones (non-inflammatory acne): Closed comedones are whiteheads and open comedones are blackheads. The dark colour of a blackhead is caused by oxidation at the pore opening, not dirt.
Papules: Small, raised, red or tender inflammatory bumps that do not contain visible pus.
Pustules: Inflamed bumps with a visible white or yellow centre containing pus. Papules and pustules are often called pimples.
Nodules and cysts: Deep, painful lesions under the skin. These forms have a higher risk of permanent scarring and should be assessed by a doctor or dermatologist.
Facial and body acne: Acne may affect the face, chest, shoulders and back. Wider areas and body acne may require a different treatment plan than a few facial lesions.[1,5]

Acne severity is described as mild, moderate or severe according to the number, type, depth and distribution of lesions and the presence of scarring. Flat red, purple or brown post-acne marks are not active acne and differ from permanent indented or raised scars. Seek medical assessment sooner for deep painful lesions, rapidly worsening acne, scarring, widespread involvement, sudden-onset acne or possible hormonal symptoms.[1,5,6]

Daily care that can help

Cleanse gently. Wash acne-prone skin up to twice daily and after heavy sweating with lukewarm water and a mild, fragrance-free cleanser. Avoid scrubbing.
Moisturize. A non-comedogenic moisturizer can reduce dryness and make treatment easier to continue.
Use sun protection. Choose broad-spectrum SPF 30 or higher. Some acne medicines increase sun sensitivity, and sunlight can darken post-acne marks.
Do not pick or squeeze. Picking increases inflammation and the risk of infection, dark marks and scars.
Introduce products slowly. Starting several active products at once can cause irritation and makes it difficult to identify what is helping.
Give treatment time. Many acne treatments need several weeks of consistent use before improvement is visible. Early dryness or irritation may be manageable with adjusted frequency and moisturizer.
Keep products simple. Choose cosmetics, sunscreen and hair products labelled non-comedogenic or oil-free, and remove makeup gently before bed.

Acne treatments and commonly used medications

Treatment is selected according to acne type and severity, scarring risk, affected areas, previous response, other medicines, pregnancy or breastfeeding considerations and patient preference. Some products are available without a prescription; others require assessment and monitoring. The examples below are educational and are not a personal treatment recommendation.[1,5-7]

Non-prescription options

Benzoyl peroxide: Reduces acne-associated bacteria and inflammation and can help limit antibiotic resistance when used with an antibiotic. It may cause dryness or irritation and can bleach towels, pillowcases and clothing.[1,5,7]
Salicylic acid: Helps remove surface skin cells and unclog pores. It is available in cleansers and leave-on products and may cause dryness or irritation if overused.[1,7]

Prescription options

Topical retinoids: Adapalene, tretinoin, tazarotene and trifarotene help prevent clogged pores and reduce inflammation. They may initially cause dryness, peeling or irritation and require pregnancy-related precautions.[1,6,7]
Azelaic acid and topical dapsone: These may be considered for selected patients with inflammatory acne. Azelaic acid may also help post-acne discolouration.[1,6]
Antibiotics: Options may include topical clindamycin or erythromycin and oral tetracycline-class medicines such as doxycycline or minocycline. They are generally used for a limited period and with benzoyl peroxide rather than alone to reduce antibiotic resistance.[1,5,6]
Hormonal options: Selected combined oral contraceptives, spironolactone or topical clascoterone may be considered for appropriate patients after an individualized review of benefits, risks and pregnancy considerations.[1,6,7]
Oral isotretinoin: Reserved for severe, scarring or treatment-resistant acne. It requires an experienced prescriber, appropriate monitoring and strict pregnancy-prevention measures because exposure during pregnancy can cause severe birth defects or miscarriage.[5-7]

Medication safety matters

Tell your pharmacist or doctor about all prescription medicines, non-prescription products, vitamins and supplements. Mention pregnancy, plans to become pregnant, breastfeeding, allergies and previous reactions before starting acne treatment. Health Canada advises that oral retinoids such as isotretinoin must not be used during pregnancy, and topical retinoids also require pregnancy precautions.[7] Do not combine several strong exfoliating or acne products without guidance. More treatment is not always better: excessive irritation can damage the skin barrier and make it harder to continue an effective plan.

Skin texture and blemishes are common, and neither defines a person. Photo: Alexander Grey/Pixabay; the person shown is not a Sina patient.

How Sina pharmacists can help

A magnified view of facial acne. Photo: Kjerstin_Michaela/Pixabay; magnifier composition by Sina Health Centre. The person shown is not a Sina patient.

In British Columbia, pharmacists may assess eligible mild acne and prescribe eligible topical medicines when clinically appropriate. Sina pharmacists can also recommend non-prescription care, identify concerns that require a doctor, and support safe and consistent treatment use.[3,4] Our pharmacists can:

Assess the type, location, duration and severity of symptoms and ask about scarring or effects on daily life.
Review prescription medicines, non-prescription products and supplements that may contribute to breakouts or interact with treatment.
Determine whether acne appears mild and suitable for pharmacist care or needs assessment by a family doctor or dermatologist.
Recommend evidence-based non-prescription options and a gentle, non-comedogenic skin-care routine.
Prescribe an eligible topical treatment for mild acne when appropriate under B.C. pharmacy rules.
Explain how to apply treatment, reduce dryness or irritation, and use moisturizers and sunscreen appropriately.
Review response, adherence, side effects and realistic timelines, and advise when follow-up or escalation is needed.

Eligibility and treatment depend on an individual assessment. B.C. pharmacist prescribing for acne is limited to eligible mild acne and topical drugs. Moderate, severe, scarring, widespread or treatment-resistant acne should be assessed by a physician or dermatologist.[3,4]

When to see a family doctor or dermatologist

A family doctor or nurse practitioner can assess moderate, severe, persistent or complex acne, consider other possible diagnoses, review hormonal or medication-related factors and prescribe treatments outside pharmacist minor-ailment scope. Patients may book with their family doctor to discuss a referral to a Sina dermatologist when specialist care is appropriate. Sina dermatology consultations include acne and other medical skin concerns. Seek medical care if any of the following apply:

Sina dermatology services and appointments: sinamed.ca/derm

Acne is deep, painful, nodular or cystic.
Scars are developing or discoloration is significant.
Acne is widespread across the chest, shoulders or back.
A well-used treatment has not helped after an appropriate trial.
Acne began suddenly, is unusually severe, or comes with irregular periods, excess facial hair or other hormonal symptoms.
A medicine or supplement may be contributing.
Acne is affecting confidence, school, work, relationships, mood or mental health.
You may be pregnant, are planning pregnancy or are breastfeeding and need treatment advice.

How families and friends can help

Listen without minimizing. Avoid saying it is "just acne." Ask what kind of support would feel helpful.
Do not blame or criticize. Comments about hygiene, food or appearance can add shame without improving the condition.
Support professional care. Help arrange an appointment or pharmacy assessment if the person wants assistance.
Encourage consistency, not perfection. Treatment often takes time. Gentle reminders are more helpful than pressure.
Watch for emotional distress. Withdrawal, persistent sadness, severe anxiety, hopelessness or self-harm thoughts deserve prompt support.
Respect privacy. Let the person decide when and with whom to discuss their skin.

Mental health support is part of acne care

If acne is causing significant distress, please speak with a healthcare professional. If you or someone you know is thinking about suicide, call or text 9-8-8 anywhere in Canada, 24 hours a day. Call 9-1-1 if there is immediate danger.[9]

Talk with the Sina healthcare team

You do not need to navigate acne treatment alone. A Sina pharmacist can assess eligible mild acne, review products and medicines, and explain when medical care is needed. Sina physicians can evaluate persistent, painful, scarring or complex acne and develop an individualized plan. Contact Sina Health Centre or speak with our pharmacy team to arrange an assessment. Treatment recommendations are based on each patient's symptoms, health history and clinical needs. This article provides general health information and does not replace an assessment, diagnosis or treatment plan from a qualified healthcare professional.

References

Canadian Dermatology Association. Acne.
HealthLink BC. Acne.
Government of British Columbia. Pharmacy services in B.C..
Government of British Columbia. Minor Ailments and Contraception Service policy.
Asai Y, et al. Management of acne: Canadian clinical practice guideline. CMAJ. 2016;188(2):118-126.
Tan J, et al. Update to acne vulgaris treatment for Canadian practice.
Health Canada. Acne treatments. Government of Canada.
American Academy of Dermatology Association. Skin care tips for managing acne.
Public Health Agency of Canada. Mental health support: Get help.
BC Children's Hospital. Acne patient handout.

Media credits

Natural-skin photo: Alexander Grey/Pixabay, used under the Pixabay Content License. Magnified acne photo: Kjerstin_Michaela/Pixabay, adapted with a magnifying-lens composition by Sina Health Centre and used under the Pixabay Content License. Acne-formation illustration: OpenStax College/Wikimedia Commons, CC BY 3.0. Comedone illustration: BedrockPerson/Wikimedia Commons, CC BY-SA 4.0. Prepared by the pharmacists at Sina Pharmacy.