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Guide for
Acne Treatment Online

By Medical Editor: 
Dr. Francesco-Maria Serino, MD, PhD

September, 2024

Summary

Acne is a common skin condition that usually starts in adolescence and can continue into adulthood. It happens when hair follicles get clogged with oil and dead skin cells, causing pimples, blackheads, and inflammation. Acne often improves by the mid-20s, but for some, it can last longer or show up later in life.

Treatment depends on the severity—mild cases can often be treated with over-the-counter creams like benzoyl peroxide or retinoids, while more severe acne might need prescription medications like oral antibiotics or isotretinoin, which is known to tackle stubborn acne effectively.

What is acne?

Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically affects areas like the face, neck, chest, and back. There are different types of acne, each varying in severity and appearance:

1. Acne vulgaris: This is the most common form of acne, characterized by blackheads, whiteheads, papules, pustules, and nodules. It’s usually seen in adolescents and young adults.

2. Nodular acne: This severe form involves deep, painful nodules that develop under the skin. It often leads to scarring.

3. Cystic acne: Often confused with nodular acne, cystic acne includes large, inflamed, and pus-filled lesions that can be painful and result in significant scarring.

4. Hormonal acne: Frequently affects adults, particularly women, and is often linked to hormone fluctuations during menstruation, pregnancy, or conditions like polycystic ovary syndrome (PCOS).

5. Fungal acne: Caused by yeast rather than bacteria, this type leads to small, itchy pustules often on the chest, back, and arms.

6. Acne conglobata: This is a rare and severe form of acne vulgaris, involving interconnected nodules and cysts that can lead to extensive scarring. It often affects the trunk and is more common in males.

Each of these acne types has different triggers and treatment needs. Severe forms like cystic and nodular acne may require more aggressive treatments, such as prescription medications or even oral therapies like isotretinoin.

Areas where acne commonly appears

Acne can appear on various parts of the body, and the location of acne can sometimes indicate different triggers or causes. Here’s how acne affects specific areas:

  1. Back acne: Commonly known as “bacne,” back acne occurs due to the high concentration of sebaceous glands in this area. It is often triggered by sweat, tight clothing, and oil buildup from hair products.

  2. Scalp acne: This type of acne forms on the scalp and can be caused by hair care products that clog pores, excessive oil production, or irritation from hats or helmets.

  3. Forehead acne: Acne on the forehead is often related to oil production, hair products, or stress. It’s also common in people with bangs or who frequently wear hats.

  4. Chin acne: Chin acne is usually linked to hormonal fluctuations, especially in women. It can flare up during menstrual cycles, pregnancy, or conditions like polycystic ovary syndrome (PCOS).

  5. Chest acne: Like back acne, chest acne can be caused by excessive sweating, tight clothing, or irritation from fabrics. It’s also common after exercise or during hot, humid weather.

Each of these areas may require different approaches for treatment, but keeping skin clean, avoiding tight clothing, and using non-comedogenic products can help reduce breakouts.

What causes acne?

Acne is caused by a combination of several factors that lead to the development of skin lesions. Based on the provided document, the main causes of acne include:

  1. Excess oil production: Increased secretion of sebum by sebaceous glands is a critical factor in acne formation. This overproduction is often influenced by androgens (hormones)​.

  2. Follicular hyperkeratinization: This refers to the abnormal shedding of skin cells within the hair follicles, leading to clogged pores. The accumulation of sebum and keratinous material in the follicles forms comedones, either open (blackheads) or closed (whiteheads)​.

  3. Cutibacterium acnes (C. acnes): This bacterium, which is part of the skin’s natural flora, thrives in the anaerobic (low oxygen) environment of clogged pores. It contributes to the breakdown of sebum and triggers an immune response, leading to inflammation​.

  4. Inflammation: The immune system reacts to C. acnes, which causes inflammation. This leads to the formation of inflammatory lesions, such as papules, pustules, and nodules​.

The interplay of these factors results in the characteristic lesions of acne, which can vary in severity depending on the individual and environmental influences.

Did you know that...

One lesser-known fact about acne is that certain strains of bacteria living on the skin can actually help prevent acne, while others contribute to it. The bacterium Cutibacterium acnes (formerly Propionibacterium acnes) exists in different strains. Some strains are more commonly found in people with clear skin, while others are more prevalent in those with acne. So, not all acne-causing bacteria are bad—some strains may actually protect the skin from breakouts by keeping harmful bacteria in check. Researchers are studying these "good" strains to potentially develop new acne treatments in the future that promote healthy skin bacteria instead of just killing bacteria with antibiotics.

Acne symptoms

Here are the common symptoms of acne:

1. Whiteheads: Small, closed bumps with a white top that occur when pores are clogged with oil and dead skin.

2. Blackheads: Small, open bumps that look dark or black. These happen when pores are clogged but stay open.

3. Papules: Small, red, tender bumps that develop when the walls of clogged pores break down, causing inflammation.

4. Pustules: Red bumps with a white or yellow top filled with pus.

5. Nodules: Large, painful lumps deep under the skin. These are more severe and can cause scarring.

6. Cysts: Painful, pus-filled lumps under the skin that can lead to permanent scars.

Other symptoms can include redness, swelling, and tenderness around the affected areas, usually on the face, back, chest, and shoulders. Severe acne can leave behind scars and dark spots as it heals.

Acne diagnosis

The diagnosis of acne is primarily based on clinical examination and the appearance of lesions. According to the document, healthcare providers diagnose acne by recognizing specific types of lesions in areas like the face, chest, shoulders, and back. Here are the key steps in diagnosing acne:

  1. Physical examination: The diagnosis is made by identifying characteristic acne lesions such as:

    • Closed comedones (whiteheads)
    • Open comedones (blackheads)
    • Inflammatory papules
    • Pustules
    • Nodules
  2. Lesion distribution: Acne typically appears on areas with a high density of sebaceous (oil) glands, including the face, upper chest, back, and shoulders.

  3. Evaluation of lesion types: Acne lesions are often in various stages of development and resolution. The presence of a mix of lesion types helps distinguish acne from other skin conditions.

  4. Patient history: The medical history of the patient can also be helpful, especially if the acne is associated with triggers like medications, hormonal changes, or underlying conditions like polycystic ovary syndrome (PCOS). Family history and the use of comedogenic skincare products are also considered during evaluation.

Laboratory tests or imaging are generally not required for diagnosing acne unless there are signs of associated conditions like hyperandrogenism (e.g., irregular periods, hirsutism in females), in which case further tests might be done.

Common acne medications

Icon of a prescription cream

Benzoyl peroxide

topical gel

Icon of a pill bottle

Tetracyclines

oral antibiotics

Acne treatment online overview

Acne treatments vary based on how severe the acne is, and there are both topical (applied to the skin) and oral (taken by mouth) options. Here’s a simple breakdown:

  1. Topical treatments (applied directly to the skin):

    • Retinoids: These help unclog pores and stop new pimples from forming. They work well for blackheads, whiteheads, and mild acne.
    • Benzoyl peroxide: This is often used with antibiotics to kill bacteria and prevent antibiotic resistance, making the treatment more effective. It typically comes in concentrations ranging from 2.5% to 10%, with lower concentrations being less irritating and still effective for most people .
    • Topical antibiotics: These reduce inflammation and bacteria but are usually combined with benzoyl peroxide to avoid bacteria becoming resistant.
  2. Oral treatments (taken by mouth):

    • Antibiotics: Medications like doxycycline and minocycline help by reducing bacteria and inflammation, especially for more serious acne.
    • Isotretinoin: Used for severe acne, this medication is powerful because it can change how your skin behaves, reducing oil production and preventing future breakouts, even after treatment ends.
    • Hormonal treatments: For women, things like birth control pills or spironolactone can help balance hormones and control acne linked to hormonal changes.
  3. Procedures:

    • These include things like chemical peels, laser treatments, or cortisone injections, usually used alongside other treatments to help improve results.

The best treatment depends on how bad your acne is, what works for you, and what side effects you’re willing to manage. It’s important to consult a doctor as some of these medications can have severe side effects and contraindications. For example, If you’re pregnant, some treatments aren’t recommended. For example, it’s best to avoid oral isotretinoin, oral tetracyclines, birth control pills, and spironolactone during pregnancy.

 

Isotretinoin for acne

Isotretinoin is a powerful medication often used to treat severe acne that doesn’t respond to other treatments. It’s unique because it tackles all the major causes of acne: excess oil, clogged pores, bacteria, and inflammation. Isotretinoin works by dramatically reducing oil production, helping to keep pores clear, and reducing inflammation​.

A few key things about isotretinoin:

  • When it’s used: It’s usually prescribed for severe, stubborn acne but can also be used for moderate cases that haven’t improved with other treatments.
  • How it works: It’s typically taken for several months and can lead to long-lasting results, sometimes keeping acne away even after you stop taking it​.
  • Side effects: Common side effects include dry skin, changes in liver enzymes, and increased cholesterol. The biggest concern is that it can cause serious birth defects, so women taking isotretinoin must follow strict pregnancy prevention rules. In the U.S., this is managed through the iPLEDGE program, which ensures that patients take steps to prevent pregnancy while on the medication​​.

Did you know that...

In many countries, you need to take a pregnancy test in a medical setting, like a lab or your doctor's office, before you can get a prescription for isotretinoin.

How can Doctorsa Virtual Care help with an acne flare up?

No matter where you are, our platform quickly connects you with doctors for immediate virtual care, available 24/7. A doctor can assess your symptoms and discuss online treatment options to help with your acne symptoms. You can even receive prescriptions right in your email, along with follow-up care, all from the comfort of wherever you happen to be. It’s the ideal solution for international travelers looking for fast and reliable medical support.

References

Thiboutot, D., Zaenglein, A. L., Dellavalle, R. P., Levy, M. L., Owen, C., & Ofori, A. O. (2024). Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris. Journal of Dermatology. Updated July 2, 2024.

Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., & Thiboutot, D. M. (2024). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945-973.

Gollnick, H. P., & Zouboulis, C. C. (2023). Acne pathogenesis: The role of hormones, diet, and microbiota. Current Opinion in Dermatology, 30(3), 241-246.

Del Rosso, J. Q., & Levin, J. (2011). The clinical relevance of maintaining the acidic pH of facial cleansers in acne vulgaris. Journal of Clinical and Aesthetic Dermatology, 4(9), 22-28.

Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., & Thiboutot, D. M. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945-973.

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Just answer a few questions about your acne symptoms and choose a convenient time for your online session. It’s simple and hassle-free, with no need to sign up.

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Doctors respond in minutes. Select your preferred one and start your virtual consultation right from your web browser.

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A tourist in Europe taking a picture of a picturesque street, mobile phone shows Doctorsa intake questionnaire, a medication pill bottle

How does it work?

99% of our users solve their issue within 1 hour. No waiting, no language barriers, no insurance needed.

Answer a few questions

Just answer a few questions about your acne symptoms and choose a convenient time for your online session. It’s simple and hassle-free, with no need to sign up.

Select and connect

Doctors respond in minutes. Select your preferred one and start your virtual consultation right from your web browser.

7-day free follow-up chat

Reach out to your doctor with any questions you might have, at no extra cost for 7 days following your consultation.

Your questions answered

Studies have shown a possible link between consuming milk, particularly skim milk, and acne development. Diets rich in sugary snacks and processed carbohydrates, may increase insulin levels and promote acne. 

Acne typically begins during adolescence and often improves or goes away by the time a person reaches their mid-20s. However, for some individuals, acne can persist into adulthood or develop later in life. According to the document, acne often starts in the preadolescent period (ages 7 to 12) and usually resolves by the third decade (in the 20s), but it may persist or even appear for the first time in adulthood​.

Open the intake form and choose one of the following options:

  • Urgent Care: For immediate treatment of your acne via virtual care.
  • Set Up an Appointment: To schedule a same-day or future appointment.
  • Prescription Refill: Use this option if you have lost or forgotten your medication.

Next, select how you would like to receive appointment offers from doctors.
We recommend using WhatsApp as it is faster and more reliable. You will quickly receive various visit options. Choose the one that suits you best and proceed to online payment.

Video visits are browser-based, so no apps are needed. Simply click the link you receive to start your video visit in your browser.

After the consultation, expect to receive an invoice and an e-prescription via email. You can show or print the e-prescription to purchase medication at the pharmacy of your choice.

Following the consultation, the doctor will either email the e-prescription to you or send it via WhatsApp. You can then either print it out or show it directly to the pharmacist when purchasing the medication.

It’s important to understand that doctors must responsibly evaluate each case individually. They can’t simply prescribe medication solely based on a patient’s request or a recommendation from another doctor without confirming that it’s suitable for the patient’s specific condition.

The total cost may differ based on the providers. Each one competes for your request, offering a fair price tailored to your needs. On average, an online doctor visit costs 25 Euros. Prices for in-person appointments, specialists, and lab work vary by city. You can send a request to learn more—there’s no commitment to book, and you can select your provider.

Please note that the visit fee doesn’t cover medication expenses, but common antibiotics are quite affordable in Europe. The cost of antibiotic treatment typically ranges from 5 to 15 euros approximately.

Yes, whenever you submit your request it is instantly received by the doctors active at that time. Whether it’s late at night, on a Sunday morning, or on New Year’s Eve, there’s always someone on the other side who’s ready to see you. When you receive an option for an appointment, there’s a person behind it (a doctor) who’s read your request and is willing to assist you.

You can message your physician with follow-up questions at no additional cost for up to 7 days after the video visit.

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