Acne:
Causes, Modern Treatment and Proper Skincare

At a glance

PrevalenceThe most common skin condition worldwide — primarily affects adolescents and young adults, but possible at any age
What happensSebaceous glands produce too much sebum, pores become blocked, bacteria (Cutibacterium acnes) trigger inflammation
FormsComedones (blackheads), papules, pustules, nodules, cysts — from mild to severe
Mild treatmentTopical creams/gels: retinoids, benzoyl peroxide, azelaic acid
Severe treatmentOral antibiotics, hormonal therapy, isotretinoin
ICD-10L70 (Acne)

Table of contents

  1. What is acne?
  2. Forms and severity
  3. Causes
  4. Treatment: topical (mild acne)
  5. Treatment: systemic (moderate to severe)
  6. Isotretinoin
  7. Skincare and daily life
  8. How brite helps you
  9. FAQ
  10. Related topics

1. What is acne?

Acne (Acne vulgaris) is a chronic inflammatory disease of the sebaceous glands and hair follicles. It develops when sebaceous glands produce too much sebum, pores become blocked by excess keratinocytes and bacteria (especially Cutibacterium acnes) multiply. The result: blackheads, pimples, inflamed papules, pustules and, in severe cases, nodules and cysts.¹

Acne is the most common skin condition worldwide. It primarily affects adolescents during puberty, but can also occur or first start in adulthood (acne tarda, adult-onset acne) — particularly in women.¹˒²

Acne is more than a cosmetic problem Acne can significantly affect quality of life, lead to scarring and is often associated with psychological burden — shame, social withdrawal and in some cases depression. Early and consistent treatment is important to avoid scarring.

2. Forms and severity

Comedonal acne (Acne comedonica)
Predominantly open and closed comedones (blackheads). Mild form. Little inflammation.
Papulopustular acne
Inflamed papules (red bumps) and pustules (pus-filled pimples) in addition to comedones. Moderate form.
Conglobate acne (Acne conglobata)
Severe form with deep nodules, cysts, fistulas and scarring. Typically requires systemic treatment.
Acne tarda (adult-onset acne)
Acne in adults, particularly in women. Often appears in the lower jaw and chin area. Can be hormonally driven.

3. Causes

  • Hormones (androgens): The most important trigger. Androgens — male sex hormones present in both sexes — stimulate sebum production. This is why acne typically appears during puberty.
  • Sebum overproduction: Sebaceous glands produce too much sebum.
  • Follicular hyperkeratosis: Excess keratinocytes block the pore opening — comedones (blackheads) form.
  • Cutibacterium acnes: Bacteria that multiply in the blocked follicle and trigger inflammation.
  • Genetics: Family predisposition plays an important role.
  • Diet: The link between diet and acne is increasingly being discussed. Foods with a high glycaemic index (sugar, white flour products) and, in some studies, dairy products may possibly worsen acne. There is, however, no general dietary ban.
What does NOT cause acne Acne is not caused by poor hygiene. Excessive washing and scrubbing can irritate the skin and worsen acne. The assumption "more washing = fewer pimples" is a persistent myth.

4. Treatment: topical (mild acne)

For mild to moderate acne, topical treatment (creams, gels) is the mainstay.¹

First line Topical agents
Retinoids (e.g. adapalene) — first-line treatment
Dissolve comedones, reduce inflammation and prevent new lesions.
Common initial reaction: dryness, redness — start slowly
Common combination: with benzoyl peroxide for stronger effect¹
Benzoyl peroxide (BPO)
Antibacterial and comedolytic. Can be combined with retinoids or topical antibiotics. Important: can bleach textiles (towels, pillows, clothing).
Topical antibiotics (clindamycin, erythromycin)
Active against Cutibacterium acnes. Generally NOT to be used as monotherapy — only in combination with benzoyl peroxide or retinoids to avoid resistance.¹
Azelaic acid
Anti-inflammatory and effective against comedones. Can also help with post-inflammatory hyperpigmentation after acne.
Patience pays off Topical acne treatments typically only show effects after several weeks. A temporary worsening at the start ("purging") is possible with retinoids and is no reason to stop treatment.

5. Treatment: systemic (moderate to severe)

For moderate to severe acne — or when topical treatment is insufficient — systemic treatments are used.¹

Oral antibiotics (doxycycline, minocycline)
Used for a limited period (typically three to six months) — always in combination with topical treatment. Long-term treatment is not recommended due to resistance development.
Important: Doxycycline should not be taken with milk, calcium or iron — this can significantly reduce its effectiveness.
Hormonal therapy
In women with hormonally driven acne, certain combined oral contraceptives or anti-androgens can be used. They specifically target the hormonal component of acne.
Isotretinoin
Separate section — see below.

6. Isotretinoin

Isotretinoin (a systemic retinoid) is the most effective acne medication. It is used for severe or treatment-resistant acne and can in many cases achieve long-term or permanent remission.¹

  • Inhibits sebum production, comedone formation, bacterial growth and inflammation — acts on all four causes of acne simultaneously
  • Treatment duration is typically several months
  • Common side effects: dry skin and lips (almost always), dry eyes, nosebleeds, muscle pain, elevated liver values and blood lipids — regular blood tests are required
  • Intensive lip care and sun protection are particularly important during treatment
  • Prescription only by experienced dermatologists
Strictly contraindicated in pregnancy Isotretinoin is strictly contraindicated in existing or planned pregnancy due to severe teratogenic effects (birth defects). Strict requirements apply to women of childbearing age: reliable contraception before, during and for at least one month after treatment ends, plus regular pregnancy tests. These requirements are discussed in detail by the prescribing dermatologist.

7. Skincare and daily life

  • Cleansing: Gentle, pH-neutral cleansing morning and evening. Do not scrub. No aggressive exfoliation. Water alone is usually not enough — but too much cleansing is counterproductive.
  • Moisturising: Non-comedogenic (pore-friendly), oil-free moisturiser — particularly important during retinoid or isotretinoin treatment, as these dry out the skin.
  • Sun protection: Skin is more light-sensitive under topical retinoids and isotretinoin — daily sun protection is recommended.
  • Do not squeeze: Do not pop pimples or blackheads yourself — this increases the risk of inflammation and scarring. Professional extraction at a dermatology practice is possible.
  • Make-up: Use non-comedogenic products. Remove make-up thoroughly in the evening.
  • Patience: Acne treatments take time. Improvement is typically only visible after weeks. Initial worsening ("purging") with retinoids is possible and not a reason to stop.
When to see a dermatologist? When over-the-counter products do not help, with inflammatory papules and pustules, with nodule formation, with scarring, or when acne affects quality of life. Early treatment is the best protection against permanent scarring.

How brite helps you with acne

Adapalene in the evening, doxycycline in the morning (not with milk!), the pill at the same time every day, plus sun protection and moisturiser — acne treatment is a routine job. brite helps you stick with it.

  • Intake reminder — isotretinoin with food, doxycycline not with dairy, the pill at the same time each day: brite reminds you on time.
  • Drug interaction check — isotretinoin with vitamin A supplements? Doxycycline with dairy products or iron? Check interactions for free before they become a problem.
  • Health journal — track skin condition, flare-up intensity, side effects like dry lips or skin dryness, and lab values (liver enzymes, blood lipids) clearly over time.
  • Digital medication plan — all medications and topicals clearly organised for dermatology, GP and pharmacy.
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FAQ: Common questions about acne

No. Acne can also occur or persist in adulthood. Adult-onset acne (acne tarda) particularly affects women and often appears in the lower jaw and chin area. It can be hormonally driven.¹
The link is increasingly being discussed. Foods with a high glycaemic index (sugar, white flour products) and, in some studies, dairy products may possibly worsen acne. There is, however, no general dietary ban. Individual testing can be useful.
The most effective acne medication. It is used for severe or treatment-resistant acne and acts on all four causes of acne simultaneously. Treatment requires regular blood tests and strict contraception requirements for women of childbearing age, since isotretinoin can cause severe birth defects in pregnancy.¹
No. Acne is not caused by poor hygiene. Excessive washing and scrubbing irritates the skin and can actually worsen acne. Gentle cleansing morning and evening is usually sufficient.
Topical antibiotics (e.g. clindamycin) promote the development of resistant bacteria when used alone. According to current guidelines they are therefore typically combined with benzoyl peroxide or retinoids.¹
Usually several weeks. With retinoids, there can initially be a temporary worsening ("purging"). Patience and consistency are key. Isotretinoin typically shows clear effects within the first few months.
Yes — particularly with severe acne, late treatment start and squeezing pimples. Early and consistent treatment is the best protection against scarring. Existing scars can usually be treated dermatologically (peels, laser, microneedling).
When over-the-counter products do not help, with inflammatory papules and pustules, with nodule formation, with scarring, or when acne affects quality of life. Early treatment prevents scars.
Depression Drug interactions Medication and sun exposure Preparing for a doctor's appointment Taking medication correctly Medication side effects

Sources

  1. S2k Guideline Acne (German Dermatological Society, AWMF Reg. No. 013-017, 2024). awmf.org
  2. NICE Guideline NG198: Acne vulgaris: management. nice.org.uk
  3. EDF/EADV Guidelines on Acne (European Dermatology Forum, 2024). guidelines.edf.one
  4. gesundheitsinformation.de (IQWiG): Acne. gesundheitsinformation.de
Medical disclaimer: This article is for general information only and does not replace medical advice, diagnosis or treatment. Acne medications — particularly isotretinoin — require careful medical supervision with regular monitoring. Isotretinoin must not be taken in existing or planned pregnancy, as it can cause severe birth defects. Treatment choice is always made individually by the treating dermatologist. Last updated: April 2026.