Acne
WHAT IS ACNE?
Acne is a common skin condition that causes spots, oily skin and can make skin feel hot or painful to touch. It occurs when oil, known as sebum, is produced by your sebaceous glands (the tiny glands near the surface of your skin that are attached to hair follicles) and blocks pores or follicles. When you have acne, the glands begin to produce too much sebum.
The excess sebum mixes with dead skin cells and both substances form a plug in the follicle. Bacteria can also grow inside the plug causing an infection which can lead to spots. It can cause several different types of spots, and range in severity from mild to severe.
TYPES & CAUSES OF ACNE
Anyone can be affected by acne, but it’s particularly common in teenagers when it’s linked to hormonal changes.
In adults, acne is also commonly linked to hormonal changes, particularly in people experiencing pregnancy, menopause or menstrual cycles. It’s also known to run in families, so if your parents had acne, it’s more likely that you’ll also have acne.
If you think you have acne, speak to your GP or your local Boots pharmacist. Boots have lots of products and services that can help you to manage acne. From skincare products suitable for acne-prone skin to Boots Online Doctor Acne Treatment*, there are lots of options available. Read on to find out more about the different types of spots that can be caused by acne, the differences between mild, moderate and severe acne and some of the best ways of treating acne.
There are six main different types of spots that can be caused by acne:
1. Blackheads are small black or yellowish bumps. They’re not filled with dirt but appear black because the inner lining of the hair follicle produces a colour called melanin, which is oxidised.
2. Whiteheads might look similar to blackheads but are often firmer and don’t empty if squeezed. It is not recommended to squeeze spots.
3. Papules small red bumps, which might feel sore or tender.
4. Pustules are similar to papules but have a white tip in the centre which is caused by pus building up.
5. Nodules are large, hard lumps that build up under the surface of the skin and can be painful.
6. Cysts these are large, pus-filled lumps that can look like boils. They’re the most severe type of spot caused by acne and are the most likely to lead to permanent scarring.
Acne is categorised based on the combination of types of spots, the number of spots and the area that the spots cover.
•Mild acne is usually made up of non-inflamed lesions, like whiteheads and blackheads, sometimes with a few papules and pustules
•Moderate acne has more widespread whiteheads and blackheads, with lots of papules and pustules
•Severe acne has lots of large, painful papules, pustules, nodules or cysts. You’re also more likely to have some scarring if you’ve experienced or currently have severe acne.
Whichever type of acne you have, treatment options are available. Speak to your GP or your local Boots pharmacist if you think you might have acne, as they’ll be able to recommend the most appropriate treatment for you. Prescribed treatment is also available for acne through the Boots Online Doctor Acne Treatment service* without the need for an appointment.
The Skin Scanning Service** at Boots is a private service, operated by ScreenCancer which costs £65 per consultation. Your Boots pharmacist will scan the area(s) of skin by placing a dermatoscopic imaging device over the skin. The scan is painless and the device will emit light to illuminate the area of skin you wish to be scanned. Another image will be taken using the device to identify the part of the body where the skin condition is located. The images help a ScreenCancer consultant dermatologist, to make their medical assessment. If you’ve already been diagnosed with a skin condition, the service can provide alternative dermatology care.
For more detailed information on treating acne, visit the Treatment & Support tab.
Teenage acne is really common, with 95% of people aged between 11 and 30 affected to some extent. It’s most common in girls aged 14 to 17, and boys aged 16 to 19.
During puberty, levels of testosterone increase, which stimulate the growth and development of the penis and testicles in boys and help to maintain muscle and bone strength in girls.
It’s believed that the increase in testosterone causes the sebaceous glands to produce more sebum than the skin needs, which in turn blocks pores and can lead to acne.
Although acne is very common in teenagers, it can cause people to feel embarrassed or distressed, and it can lead to low mood.
If you’re a teenager with acne, you might feel like you’re the only one who’s struggling with it, but remember, you’re not alone. There are treatment options available to you. Speak to your GP, or if you’re over 16 years old and have mild to moderate acne, you may be suitable for the Boots Online Doctor Acne Treatment* where you can access treatment without booking a GP appointment.
There are also products available that are suitable for acne-prone skin to help create a skincare regime. Keep an eye out for non-comedogenic products, with ingredients like salicylic acid, niacinamide and benzoyl peroxide.
If you’re the parent or guardian of a teenager experiencing acne, helping them to manage their acne can help support the way they are feeling about their acne and reduce the chances of skin scarring. Speak to your local Boots pharmacist or GP to find out what management strategies are most appropriate. Helping them to follow a skincare routine to help with acne can also be useful.
Try the following steps to help acne prone teenage skin:
1. Cleanse with a gentle cleanser designed for spot-prone skin, such as Boots Skin Clear Cleanser with salicylic acid.
2. Follow this with a non-comedogenic moisturiser that won’t clog pores, such as Clean & Clear Dual Action Oil-Free Moisturiser.
3. Finish with acne treatment, such as Acnecide 5% benzoyl peroxide gel (Always read the label) if required.
Find out more about the differences between adult and teen acne.
Whilst teenage acne is very common, it’s also possible for acne to continue into adulthood, or develop for the first time as an adult. About 3% of adults have acne over the age of 35.
There are several reasons you might experience acne as an adult, and one of the most common causes is hormonal changes. Adult acne is more common in women than in men, however, men can still experience adult acne.
Common causes of hormonal acne in women include:
• Periods: hormones fluctuate throughout the menstrual cycle, but it’s common to experience acne flare-ups just before a period. This is because levels of oestrogen and progesterone both drop, whereas testosterone levels stay about the same, so levels of testosterone are higher relative to oestrogen and progesterone. This can mean increased levels of sebum, which can clog pores. Find out more about periods.
• Pregnancy: lots of women have acne symptoms during pregnancy, often in their first trimester. This can be triggered by surges in progesterone, which increases oil production, leading to an increased likelihood of blocked pores. Find out more about pregnancy.
• Menopause: during menopause, the balance of oestrogen and male hormones (androgens) change as oestrogen levels begin to drop, which results in increased levels of sebum. Find out more about menopause.
• Polycystic ovary syndrome (PCOS): is a condition that affects how a person’s ovaries work, which can lead to an imbalance in certain hormones, and can include increased testosterone production, leading to oily skin and acne breakouts. Other common symptoms of PCOS include irregular periods, weight gain and excessive hair growth usually on the face, chest, back or buttocks. Find out more about polycystic ovary syndrome, or visit our Health Hub Fertility & Infertility page.
• Hormonal contraceptives: starting to take hormonal contraceptives, or switching the type you take, can lead to acne flare-ups.
Other possible triggers in adults can include:
• Stress: whilst stress isn’t recognised as a cause of acne, if you already have acne, it’s possible that a period of stress could cause an acne flare-up. Stress causes cortisol to be released, which in turn increases levels of testosterone. Testosterone increases sebum production and the likelihood of follicles becoming blocked, leading to acne flare ups.
• Certain medications: some medications can cause acne. If you have any concerns about any medication you are taking, then it is important you continue to take your medication and speak to your prescriber; this is the person who gave you your prescription for the medication you are taking.
• Cosmetic products: make sure you do not share cosmetic products and keep your cosmetics products clean. It’s possible for cosmetic products to cause acne flare-ups, but this is less common now as many products are formulated so that they don’t block pores.
• Smoking: it’s possible that smoking contributes to acne in older people, particularly in women. Smoking also impacts how long it takes wounds to heal, so it may take longer for spots and blemishes to go away. It is recommended to stop smoking. Boots has a range of products to help you stop smoking from gums to inhalators.† Giving up smoking can have crucial benefits for your health. Getting help to do so can significantly improve your chances of giving up for good and you can access stop-smoking treatment via the Boots Online Doctor Stop Smoking Treatment.*
• Diets with a high glycaemic index (GI): the glycaemic index is a rating system for foods containing carbohydrates, which shows how fast each food affects your blood sugar when eaten alone. High GI foods include: sugary foods, white bread, sugary soft drinks and white rice. It’s possible that a diet high in these foods may trigger acne flare-ups.
Whilst acne most commonly develops on the face, acne can also occur in other areas. More than half of people with acne develop it on their back, often known as “bacne”, and around 15% of people with acne develop it on their chest. This is because these areas have higher sebum levels. Find out more about back acne and how to treat it.
There are some simple steps you can take to help reduce the risk of developing body acne:
• Shower as soon as possible after sweating.
• Wear natural, breathable fabrics like cotton and avoid tight-fitting clothes.
• Use a body wash with ingredients that can help to reduce blemishes, like glycolic or salicylic acid such as frank body Everyday A Clearing Body Wash.
There are some conditions which might be mistaken for acne. We’ll talk you through some of the most common here.
1. Rosacea
Rosacea can often be mistaken for acne. It causes small red or pus-filled bumps to appear on the skin and gives the appearance of persistent redness across the nose, cheeks, forehead and chin. It can also be accompanied by a burning sensation, redness and swelling of the eyes and eyelids. If you think you might have rosacea or acne, speak to your GP. Alternatively, you can access the in-store Skin Scanning Service** operated by ScreenCancer to help understand if you have rosacea.
If you know that you have rosacea you can access prescription treatment to help treat your rosacea via Boots Online Doctor*, no appointment needed. Find out more about rosacea.
2. Hives
The main symptom of hives is an itchy rash, which can cause raised bumps or patches in many shapes and sizes anywhere on the body. Hives are an allergic response to a trigger. Possible triggers include certain foods, chemicals, animals and latex. Hives usually get better within a few minutes to a few days. If you think you might have hives, speak to your Boots pharmacist who can give advice about antihistamine treatment. Boots offers a wide range of antihistamines available online and in-store.
You should speak to your GP if: symptoms do not improve after 2 days, the rash is spreading, you have a high temperature or feel unwell, your child has hives and you are worried, the hives keep coming back, or if you have swelling under the skin in the area where the hives are.
You should call 999 or go to A&E if you have any of the following severe allergic reaction symptoms:
• wheezing
• tightness in your chest or throat
• trouble breathing
• trouble talking
• your mouth, face, lips, tongue or throat start swelling
3. Folliculitis
Folliculitis is inflammation or infection of the hair follicles. When infected, follicles swell into small pus-filled pimples, which look like rounded, yellow-red spots. It can happen anywhere on the body where there is hair, but can’t develop where there is no hair, and therefore no hair follicles (like the soles of the feet or the palms of the hands). It often occurs when the hair follicles has been damaged by shaving or friction. Folliculitis can look like acne, but the main difference is that in acne hair follicles are plugged by sebum and dead skin cells.
How you treat folliculitis depends on how severe it is. Mild cases often don’t need treatment and clear within 7-10 days, but it can help to use a moisturiser that has an antibacterial agent such as La Roche-Posay Cicaplast Soothing Face and Body Balm. If your folliculitis persists, you have localised areas of folliculitis or more severe or long-term folliculitis, speak to your GP. They may prescribe antibiotic creams or tablets.
A possible complication of acne, is scarring. This is more common when the more serious spots (nodules and cysts) burst and damage surrounding skin. It can also happen when any type of spot is picked or squeezed, so it’s important to avoid doing that.
1. Types of scarring
There are three main types of acne scars:
• Ice pick scars: small, deep holes in the surface of the skin that look like the skin has been punctured with a sharp object.
• Rolling scars: caused by bands of scar tissue forming under the skin, which give the skin a rolling and uneven appearance.
• Boxcar scars: are round or oval depressions in the skin.
2. Treating acne scarring
There are several different ways of treating acne scarring, but they’re usually regarded as cosmetic procedures and aren’t available on the NHS. In some cases, exceptions have been made when acne scarring was shown to be causing significant psychological distress. Speak to your GP if you’re considering having any procedures to address acne scars, for advice on whether it’s likely to be accessible through the NHS.
Treatments for acne scarring can include:
• Dermabrasion
• Laser treatment
• Punch techniques
• Subcision
The NHS has more information about the different treatments for acne scarring.
There are also products available from Boots to help with reducing acne scars. Here Heather Gwyther and Ayesha Mutucumaru talk about 11 of the best products to help you.
3. Hyperpigmentation
Although there can be many different causes of hyperpigmentation, the one associated with acne is called post-inflammatory hyperpigmentation. This is darkening of the skin caused by inflammation or trauma to the skin.
It’s due to an increase in melanin in the affected area, which is part of the healing process and leads to patches of darker skin. It’s different to scarring, which is linked to the production of collagen, and leads to the types of scars listed above. There are different cosmetic treatments available that can help to reduce hyperpigmentation caused by acne. Products that include niacinamide and retinols can help.
Find out more about treating hyperpigmentation.
The treatment most suitable for acne depends on the severity of the acne. It’s important to be persistent when treating acne because it can take several months of treatment before symptoms improve.
If you have mild acne, speak to your local Boots pharmacist, who will be able to recommend over-the-counter topical treatments, like gels or creams, that contain benzoyl peroxide. This works as an antiseptic to reduce the number of bacteria on your skin.
If you have moderate or severe acne, or over-the-counter medicines haven’t worked, speak to your GP or visit Boots Online Doctor* as you may need prescription medicine. Subject to availability.
Prescription medicines can include:
• Topical retinoids: these work by removing dead skin cells from the surface of the skin which stops them from building up in hair follicles.
• Topical antibiotics: which help to kill bacteria on the skin that can infect blocked follicles.
• Azelaic acid: which helps to get rid of dead skin and kills bacteria.
• Antibiotic tablets: which are usually used for more severe acne, in combination with topical antibiotics.
• The combined contraceptive pill: which can be used by women, for hormonal acne that flares up around periods or is associated with conditions like polycystic ovary syndrome.
• Isotretinoin: which is for more severe acne, and helps to reduce sebum production and decreases the amount of bacteria on the skin.
The NHS has more information about the different types of treatment for acne. You can also access acne treatment through Boots Online Doctor.* Simply complete a confidential online consultation (this takes between five and ten minutes), which will be reviewed by a clinician who will prescribe treatment, if appropriate. Then choose whether to collect your prescription in-store or have it delivered to your door.
You may also choose to access a Circle Health Group private dermatologist for face-to-face assessment and, if appropriate, treatment1.
If you have acne, finding a skincare regime that suits you and your skin is important. Everyone’s skin is different and responds differently to different products, but the following steps are a good starting point when building your regime.
1. Cleanse
If you have acne, you might be tempted to wash or cleanse your skin more frequently. But actually, this can disrupt the skin’s barrier, causing more irritation which can make acne worse.
The best option is to use a gentle, oil-free cleanser that’s designed not to block pores, once in the morning and once in the evening. Cleansers that include salicylic acid or benzoyl peroxide, such as Acnecide fash wash (Contains benzoyl peroxide. Always read the label) can help too.
2. Add a serum
After cleansing, you can add a serum, before moving on to moisturising. Ingredients to look out for to help with acne-prone skin include niacinamide (which can help to reduce redness and swelling), glycolic acid and salicylic acids. Apply after cleansing in the morning and allow to absorb before moisturising.
In the evening, use a retinol product. Retinoids increase cell turnover, which makes it harder for oil and dirt to block pores. If you’re new to retinol products, it’s best to start by using a low strength one, as your skin needs to adjust. No7 have a low strength retinol night concentrate at 0.3% and a higher strength at 1%, which you should only use after your skin is used to the lower strength formula. Plus, remember to always use a sun cream with a minimum of SPF 30 with a 4* UVA rating in the day if you’re using retinol at night, such as Soltan Brightening Protect & Moisturise Facial Suncare Cream with Vitamin C SPF50+.
3. Moisturise
If you have acne, you might be worried that using a moisturiser will make your skin oilier. However, making sure your skin is hydrated is still important, as it can help protect your skin’s barrier as well as helping with any dryness that can be caused by some acne medications.
Look for lightweight, non-comedogenic (one that won’t clog pores) moisturisers to apply after your serum or retinol. Ingredients to look out for in a moisturiser include hyaluronic acid, niacinamide and ceramides, which won’t cause congestion. There are also moisturisers called ‘gel moisturisers’, which may be suitable as they’re non-greasy such as No7 HydraLuminous Water Surge Gel Oil Free.
4. Apply SPF
Ensure that you wear sun cream in the day as well as your moisturiser, particularly if you’re using a retinol at night or any acne medications that may make your skin more sensitive to the sun. There are lots of options that are designed with oily skin in mind such as La Roche-Posay Anthelios Anti-Shine Sun Cream Gel SPF50+ or Soltan Hydrating Sensitive Protect Facial Suncare Cream With Niacinamide SPF50+
5. Products suitable for acne-prone skin
You can also add products for acne-prone skin, like spot stickers or gels to tackle specific blemishes.
• Spot stickers are designed to shield skin from bacteria, which can help them to heal faster, and to discourage picking or squeezing spots. Some are formulated with ingredients like salicylic acid, which can help to unclog pores. There are some spot stickers that are designed to be discreet such as Revolution Man Double Protect Spot Stickers or spot stickers that are designed to stand out like STARFACE hydr-star + salacilic acid blue start stickers.
• Spot gels are designed to be applied to specific spots and are formulated using ingredients to reduce spots and blemishes, like salicylic acid. Some stronger treatment gels are available to buy from the pharmacy or online. If you know you have mild to moderate acne you may be able to access Boots Online Doctor Acne Service in order to get prescription strength treatment which may be a gel.*
Acne, or acne scarring can have an impact on mental health, causing feelings of stress and anxiety, and it may make people withdraw socially. These factors can sometimes lead to depression.
Depression can range from mild to severe, and symptoms can include :
• Lasting feelings of unhappiness and hopelessness
• Losing interest in things you normally enjoy
• Feeling tearful
• Sleeping too little or too much
• Eating too little or too much
• Aches and pains
If you think you may be experiencing depression, it’s important that you speak to your GP.
Treatments for depression can include:
• Talking therapies, like cognitive behavioural therapy
• Antidepressants, including selective serotonin reuptake inhibitors (SSRIs)
If you’re registered with a GP, you might be able to access CBT and other talking therapies through the NHS. Or, you can explore the services available on the Boots Health Hub, such as on-demand talking therapy from SupportRoom*.**
Treatment for depression and anxiety is also available through Boots Online Doctor .** Simply complete a confidential online consultation (this takes between five and ten minutes) and then choose between a telephone or video appointment with a qualified medical professional.
Our Boots Online Doctor clinician will work with you to come up with the right treatment plan for you, which may include antidepressant medication, if appropriate, or signposting you to counselling or talking therapies. This service is for mild to moderate depression and anxiety. If you’re experiencing other mental health problems, speak to your GP.
Read more about mental health support.
LEARN MORE ABOUT ACNE
FREQUENTLY ASKED QUESTIONS
There’s not any conclusive evidence that exposure to sunlight, using sunbeds or sunlamps can help with acne.
A lot of medicines used to treat acne can make skin more sensitive to light, so if you’re taking one of these medicines, sun exposure or the use of sunlamps or sunbeds can put you at risk of painful damage to your skin, as well as potentially increasing your risk of skin cancer.
It is important to wear daily facial suncream throughout the year but particularly during spring, and summer, when travelling abroad to warmer climates or when using a retinol product.
No, acne is not contagious, and you can’t pass it on to other people.
If you are experiencing spots, one of the main questions you might have is what the difference between spots or pimples and acne is.
Spots and pimples are a symptom of the skin condition acne. If someone has acne, they’ll experience spots as part of their condition, but having the occasional spot or pimple doesn’t mean that you have acne or acne-prone skin. Acne is an ongoing condition that’s more persistent, painful and serious than having occasional spots.
*Access to prescription-only treatment is subject to an online consultation with a clinician to assess suitability. Subject to availability. Charges apply.
**Eligibility criteria apply. Charges apply.
***Subject to availability. Charges apply
†Stop smoking aids. Contain Nicotine. Require willpower. Always read the label
‡You must be signed in & have an Advantage Card assigned to your account to be able to shop savings. Normal Advantage Card terms & conditions apply. Excludes in-store orders. No Price Advantage at airport stores. Read more Advantage Card offer terms and conditions here.
1Subject to availability. Eligibility criteria may apply. Charges may apply.
