Acne (blemishes) – causes, treatment, and the most effective skincare routine for pimples
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In this article, you will get answers to:
- What is acne?
- Why do you get acne?
- What is hormonal acne?
- How is acne treated?
- What is the best treatment for acne?
- How do you remove acne scars?
- What is the difference between PIE and PIH?
Acne is one of the world's most common skin diseases. Nevertheless, it is also one of the skin conditions surrounded by the most myths.
Many still believe that acne is caused by poor hygiene, too much chocolate, or a lack of cleansing. The reality is far more complex.
If you struggle with pimples, blackheads, clogged pores, or adult acne, it is important to understand what is actually happening in the skin. Only when you treat the biological causes behind acne can you achieve lasting results.
What is acne?
Acne vulgaris is the medical term for common acne.
Acne occurs in and around the skin's hair follicles and sebaceous glands. Each hair follicle contains a sebaceous gland that produces sebum – the skin's natural oil.
Sebum has the task of protecting the skin and preventing it from drying out. The problem arises when production becomes too high, or when the exit from the hair follicle becomes blocked.
When sebum, dead skin cells, and bacteria accumulate in the pore, the following can occur:
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Blackheads
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Whiteheads
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Pimples
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Inflamed nodules
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Cystic acne
What is the difference between pimples and acne?
Dermatologically, there is no real difference.
A single pimple is acne.
Several pimples are acne.
Blackheads are acne.
Whiteheads are acne.
The difference lies solely in the severity.
The longer a blockage is allowed to develop, the greater the risk of inflammation, scarring, and pigmentation changes.
Why do you get acne?
Today we know that acne is not caused by a single factor.
Modern research points to four primary mechanisms:
1. Hyperkeratinization
The skin's cell renewal process becomes disrupted.
Dead skin cells accumulate around the hair follicle and form a plug.
This blockage is often the first step in the development of acne.
2. Increased sebum production
Hormones – particularly DHT (dihydrotestosterone) – can stimulate the sebaceous glands to produce more sebum.
The more sebum that accumulates in the pore, the greater the risk of breakouts.
3. Inflammation
Many believe that inflammation only occurs when the pimple becomes red.
In reality, the inflammation often starts long before you can see it with the naked eye.
Inflammation is one of the main causes of:
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red marks after acne (PIE)
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dark marks after acne (PIH)
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acne scars
4. Disrupted microbiome
Billions of microorganisms live on the skin.
Cutibacterium acnes is a natural part of the skin's microbiome and is found in both people with and without acne.
The problem is therefore not necessarily the bacterium itself, but the balance between bacteria, sebum production, inflammation, and blockages.
What are blackheads?
Blackheads are also called comedones.
A blackhead is called an open comedo.
A whitehead or sebum plug is called a closed comedo.
Both types occur when sebum and dead skin cells accumulate in the hair follicle.
Blackheads are often the first visible sign that pores are becoming clogged.
If the blockage progresses, it can lead to inflammation and later develop into pimples and acne.
Therefore, treating blackheads is an important part of any effective treatment for acne and impure skin.
Who gets acne?
Almost all teenagers experience acne to a greater or lesser degree.
But acne is far from just a teenage problem.
Adult acne is becoming increasingly common and is seen especially in women between 25 and 45 years of age.
Typical causes can be:
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hormonal fluctuations
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stress
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lack of sleep
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inflammation
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genetic predisposition
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incorrect skincare products
That is why we often see adults with impure skin around:
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the chin
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the jawline
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the neck
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the cheeks
even if they never had problems as teenagers.
Why do standard acne products often not work?
Many acne products only attempt to dry out the skin.
The problem is that acne is not just caused by bacteria.
Modern research shows that acne arises as an interplay between hyperkeratinization, inflammation, sebum production, and the skin's microbiome.
If you only treat one of these mechanisms, you often achieve temporary improvements, after which the outbreaks return.
Raz Signature treatment for acne
When I help people with acne, the goal is not just to remove the visible pimples.
The goal is to treat the four mechanisms behind acne:
✔️ Hyperkeratinization (clogging)
✔️ Overproduction of sebum
✔️ Inflammation
✔️ Disturbed microbiome
Many products focus on only one of these mechanisms. Therefore, many experience that their skin improves for a period, after which the problems return.
Raz Signature treatment is formulated to work on all four mechanisms simultaneously.
Morning routine
The first step is a thorough but gentle cleanse.
Many people with acne make the mistake of using aggressive cleansing products that dry out the skin. When the skin is dried out, it often tries to compensate by producing even more sebum.
The result is often:
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more blackheads
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more clogs
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oillier skin
Powder to Mousse has been developed to cleanse the skin without damaging the skin barrier.
It removes:
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excess sebum
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pollution
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dead skin cells
while allowing the skin to maintain its natural balance.
A healthy skin barrier is crucial for controlling acne in the long term.
2. Mdh
If I had to highlight one product in the range that most acne clients do not expect the effect of, it is Mdh.
Many treatments attempt to fight the bacteria.
Mdh instead works on some of the mechanisms that occur before the pimple arises.
Mdh helps, among other things, to:
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regulate sebum production
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reduce the tendency for blackheads
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reduce congestion
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improve the flow of sebum through the pores
The more freely sebum can move through the hair follicle, the lower the risk of the pore becoming blocked.
This is why Mdh is used both morning and evening.
3. Young Balancing Face Gel
One of the biggest misconceptions in acne is that oily skin does not need moisture.
The reality is the opposite.
Many with acne have a skin barrier that is stressed, inflamed, and dehydrated.
Young Balancing Face Gel contains, among other things, ingredients such as:
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Niacinamide
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Sodium PCA
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Panthenol
These ingredients help to:
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reduce inflammation
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reduce redness
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strengthen the skin barrier
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improve the skin's moisture balance
At the same time, the product has been developed without the heavy greasy film that many classic creams leave behind.
This makes it particularly suitable for skin prone to:
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pimples
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blackheads
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clogged pores
Many skip sunscreen.
That is a mistake.
When the skin is inflamed by acne, it becomes much more susceptible to developing:
PIH
(Post Inflammatory Hyperpigmentation)
Brown marks after pimples.
PIE
(Post Inflammatory Erythema)
Red marks after pimples.
Acne scarring
Permanent structural damage to the skin.
At the same time, both retinoids and chemical exfoliation make the skin more sensitive to UV radiation.
That is why daily sun protection is essential.
Not all sunscreens are equally suitable for acne.
Many traditional sunscreens are developed for dry skin and can feel heavy and occlusive.
Occlusive products can in some cases contribute to further clogging in people with acne-prone skin.
That is why I recommend a lightweight sunscreen that protects effectively without leaving the skin feeling heavy, greasy, or uncomfortable.
The best sunscreen is the one you actually want to use every single day.
Evening routine
Cleanse the skin thoroughly to remove:
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sunscreen
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sebum
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makeup
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pollution
Clean skin provides the best working conditions for active ingredients.
Mdh is used again in the evening.
This is because sebum production happens around the clock.
Continuous regulation yields the best results over time.
3. Young Balancing Face Gel
Young is used again to:
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reduce irritation
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maintain moisture balance
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support the skin barrier
A strong skin barrier is essential for tolerating the active ingredients in the treatment.
4. A-Retinoid
A-Retinoid is, in my assessment, the most important active product in the entire acne treatment.
Retinoids are among the best-documented ingredients in modern dermatology.
They help, among other things, to:
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normalize cell turnover
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reduce blockages
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diminish blackheads
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improve acne scarring
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reduce uneven skin texture
A large part of acne starts with hyperkeratinization.
Retinoids help normalize this process, thereby reducing the risk of new blockages forming.
Therefore, it is not just a product for existing pimples.
It is a product that helps prevent new breakouts.
Many only experience the full effect after 8-12 weeks of continuous use.
Patience is therefore crucial.
Why is A-Retinoid so important for acne?
A-Retinoid contains Hydroxypinacolone Retinoate (HPR), which is a modern retinoid.
Retinoids are among the best-documented ingredients in the treatment of:
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acne
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pimples
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blackheads
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clogged pores
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adult acne
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acne scarring
While many acne products attempt to treat a pimple once it has already appeared, retinoids work at the stage where the blockage is formed.
This means that A-Retinoid not only helps with existing pimples – it also helps to prevent new breakouts.
This is why retinoids are considered by many dermatologists to be one of the cornerstones of modern acne treatment.
Even the best daily skincare routine can struggle to dissolve older blockages in the skin.
That is why I often use CP Chemical Peel as a supplement to daily treatment.
CP works with several different types of acid simultaneously.
Salicylic Acid (BHA)
Salicylic acid is oil-soluble and can therefore work down in the hair follicle, where acne originates. It helps to dissolve sebum, blackheads, and blockages.
Lactic Acid (AHA)
Lactic acid exfoliates the skin surface and helps improve skin texture while also binding moisture.
Gluconolactone (PHA)
PHA provides a gentler exfoliation and is also known for its moisture-binding properties.
Succinic Acid
Succinic Acid is particularly interesting for acne because it both helps with impurities and has an anti-inflammatory effect around the hair follicle.
Niacinamide
Niacinamide helps to reduce redness, strengthen the skin barrier, and support a more even skin tone.
The combination makes CP particularly interesting for:
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blackheads
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clogged pores
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adult acne
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hormonal acne
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uneven skin texture
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acne scarring
Start with 1-2 treatments per week. If well tolerated, the frequency can be gradually increased.
Hormonal acne
Many women experience pimples around the:
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chin
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jawline
-
neck
This type of acne is often called hormonal acne.
Even though hormones play a role, the breakouts are still caused by the same mechanisms:
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increased sebum production
-
hyperkeratinization
-
inflammation
-
microbiome disturbances
Therefore, the treatment principles are largely the same.
Acne scarring, PIE and PIH
Many believe that acne is gone when the pimple disappears.
But for many, the challenge only begins afterwards.
PIE (Post-Inflammatory Erythema)
PIE is red marks after inflammation.
PIH (Post-Inflammatory Hyperpigmentation)
PIH is brown marks after inflammation.
Both conditions can last for months if the skin is not protected correctly.
Therefore, daily use of SPF 30 is one of the most important investments you can make for your skin.
Sun protection does not only help against sun damage. It also helps to reduce the risk of long-term red and brown marks after acne.
When do you see results?
We are all different.
Some experience improvements as early as 2-4 weeks.
Others need to use it for 8-12 weeks before they see the full results.
Retinoids, in particular, require patience.
Many stop the treatment just before the results begin to show.
The most important rule is therefore:
Consistency beats intensity.
You should not try to scrub your skin free of pimples.
You must teach the skin to function correctly again.
Maintenance
Once the skin is under control, the routine can often be simplified.
Morning:
Evening:
CP Chemical Peel is used thereafter as needed, typically 1-2 times weekly.
The goal is not to use as many products as possible.
The goal is to keep the skin stable, reduce the risk of new breakouts, and prevent acne scarring in the long term.
For severe acne, cystic acne, or extensive scarring, I always recommend that you consult a doctor or dermatologist.
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REMEMBER
You can always book a skin analysis with me, and I will be happy to help. You can read much more about my skin analysis and service on this link
Curious for knowledge?
If you want to read more or see where I get my knowledge from, here are some articles that I think are good.
1. Acne Vulgaris
The most cited review article on acne pathogenesis and treatment.
2. Pathogenesis of Acne Vulgaris
Reviews the four central mechanisms:
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Hyperkeratinization
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Sebum production
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Inflammation
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Cutibacterium acnes
3. Acne Pathogenesis and Treatment
Modern overview of causes and treatment options.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445894/
4. The Role of Cutibacterium acnes in Acne
Very interesting article on why the bacterium is not the sole cause of acne.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884775/
5. Inflammation in Acne Vulgaris
Supports your section on how inflammation starts before the visible pimple.
6. The Skin Microbiome and Acne
Perfect for your section on the microbiome.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678709/
7. Retinoids in Acne Treatment
One of the best overviews of retinoids.
8. Salicylic Acid as a Peeling Agent
Good documentation for BHA and blackheads.
9. Post-Inflammatory Hyperpigmentation
Perfect for your section on PIH.
10. Post-Inflammatory Erythema and Acne Scarring
Explains red marks, scarring, and subsequent skin changes.