Acne: what teenagers and adults should know — explained by a dermatologist-venereologist in Tbilisi

Acne is not simply a cosmetic issue — it’s a chronic inflammatory skin condition that can affect physical health, self-esteem, and quality of life. Affecting up to 80% of people at some stage, it remains one of the most widespread dermatological disorders worldwide.
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Acne is not “just a teenage problem”. It can appear at any age, and when left untreated, it may lead to permanent scarring and long-term complications. The good news? Modern dermatology offers powerful, evidence-based treatments that can stop acne in its tracks. Let’s break down the facts.
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What is Acne?
Acne develops when hair follicles become clogged with sebum (oil), dead skin cells, and bacteria, leading to different types of lesions.
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Why do we have Acne?
The exact cause of acne is still not fully understood. What we do know is that it develops through several overlapping factors:

• Hormones (androgens) → stimulate sebaceous glands, increasing oil production. This is why acne often flares during puberty, menstrual cycles, pregnancy, or hormonal disorders, like PCOS
  

• Excess sebum and clogged pores → oil and dead skin cells accumulate inside follicles, forming open and closed comedones
  

• Inflammation → the immune system reacts to clogged pores and bacteria, causing red, swollen, painful pimples
  

• Genetics → family history strongly increases susceptibility
  

• Bacterial overgrowth (Cutibacterium acnes) → thrives in blocked pores, contributing to inflammation
  

• Lifestyle and environmental factors → comedogenic cosmetics, stress, certain medications (steroids, lithium), and diet (still controversial; high-glycemic foods or excessive dairy may aggravate acne in susceptible individuals)
  

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  In other words, acne is not caused by poor hygiene. It results from complex interactions between hormones, skin biology, genetics, and environment.
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  **Types of Acne **
  Acne can present in different forms depending on the types of lesions:

• Comedonal acne → blackheads and whiteheads (open and closed comedones); non-inflammatory, mild form
  

• Papulo-pustular acne → red elevated pimples and pus-filled spots (papules and pustules); inflammatory, mild to moderate severity depending on lesion count
  

• Nodulo-cystic acne → deep, painful nodules and cysts that often cause scarring; severe form
  

• Acne conglobata →  interconnected nodules and abscesses; severe form
  

• Acne fulminans → a rare, sudden, very severe form with systemic symptoms (fever, malaise)
  

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  Why differentiating Acne types matters?
  Not all acne is the same - and neither is its treatment.

• Comedonal acne → usually responds well to topical retinoids and keratolytic agents
  

• Inflammatory acne (papulo-pustular) → often requires topical + systemic antibiotics or hormonal therapy
  

• Nodulo-cystic acne → requires systemic retinoids (isotretinoin) to prevent permanent scarring
  

• Severe forms (acne conglobata and acne fulminans) → need systemic therapy under close medical supervision
  

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  For all forms of acne, supportive care is essential: gentle cleansers, non-comedogenic moisturizers, and lotions formulated for acne-prone skin.
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  Acne is a medical condition that deserves proper attention. Because it varies from person to person, personalised treatment is essential. A dermatologist can tailor therapy based on your acne type, severity, and individual factors — ensuring the most effective care and reducing the risk of scarring.