Acne (blemishes) – causes, treatment, and the most effective skincare routine for pimples
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Acne package
In this article, you will find 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 conditions. Yet, 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 lack of cleansing. The reality is far more complex.
If you are struggling with pimples, blackheads, clogged pores, or adult acne, it is important to understand what is actually happening in the skin. Only when you address 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, which produces sebum – the skin's natural oil.
Sebum protects the skin and prevents 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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Sebaceous filaments
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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.
Multiple pimples are acne.
Blackheads are acne.
Sebaceous filaments are acne.
The difference lies solely in 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 is disrupted.
Dead skin cells accumulate around the hair follicle, forming a plug.
This blockage is often the first step in the development of acne.
2. Increased sebum production
Hormones – especially DHT (dihydrotestosterone) – can stimulate the sebaceous glands to produce more sebum.
The more sebum accumulates in the pore, the greater the risk of breakouts.
3. Inflammation
Many believe that inflammation only occurs when a pimple turns red.
In reality, 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. Disturbed 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 bacteria 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 comedone.
A whitehead or sebum bump is called a closed comedone.
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 develops further, 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 blemished skin.
Who gets acne?
Almost all teenagers experience acne to a greater or lesser extent.
But acne is far from just a teenage problem.
Adult acne is becoming increasingly common, 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
Therefore, we often see adults with blemished skin around:
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the chin
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the jawline
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the neck
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cheeks
even though they never had problems as teenagers.
Why do common acne products often not work?
Many acne products only try to dry out the skin.
The problem is that acne is not solely caused by bacteria.
Modern research shows that acne arises from an interaction between hyperkeratinization, inflammation, sebum production, and the skin's microbiome.
If only one of these mechanisms is treated, temporary improvements are often achieved, after which breakouts return.
Raz Signature Acne Treatment
When I help people with acne, the goal is not just to remove visible pimples.
The goal is to treat the four mechanisms behind acne:
✔️ Hyperkeratinization (clogging)
✔️ Overproduction of sebum (sebum)
✔️ Inflammation
✔️ Disrupted 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 designed 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 dries 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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greasier skin
Powder to Mousse is 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 maintaining the skin's natural balance.
A healthy skin barrier is crucial for long-term acne control.
2. Mdh
If I had to highlight one product in the series that most acne clients don't expect the effect of, it's Mdh.
Many treatments try to fight bacteria.
Mdh instead works on some of the mechanisms that occur before the pimple appears.
Mdh helps, among other things, to:
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regulate sebum production
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reduce the tendency to blackheads
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reduce blockages
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improve the flow of sebum through the pores
The freer the sebum can move through the hair follicle, the lower the risk of pore blockage.
Therefore, Mdh is used both morning and evening.
3. Young Balancing Face Gel
One of the biggest misconceptions about acne is that oily skin doesn't need moisture.
The reality is the opposite.
Many people with acne have a skin barrier that is stressed, inflamed, and dehydrated.
Young Balancing Face Gel contains 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 is 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 people skip sunscreen.
This is a mistake.
When 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 scars
Permanent structural damage to the skin.
At the same time, both retinoids and chemical exfoliation make the skin more sensitive to UV radiation.
Therefore, daily sun protection is crucial.
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 blockages in people with acne-prone skin.
Therefore, I recommend a light sunscreen that effectively protects without leaving the skin feeling heavy, greasy or uncomfortable.
The best sunscreen is the one you actually want to use every day.
Evening routine
Thoroughly cleanse the skin for:
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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 the active ingredients.
Mdh is applied again in the evening.
This is because sebum production occurs around the clock.
Continuous regulation provides the best results over time.
Young is applied 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 crucial for tolerating the active ingredients in the treatment.
4. A-Retinoid
In my assessment, A-Retinoid is 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 renewal
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reduce blockages
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reduce 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 to normalise this process and thereby reduce the risk of new blockages occurring.
It is therefore not just a product against existing pimples.
It is a product that helps prevent new outbreaks.
Many people 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 scars
While many acne products attempt to treat pimples once they have already appeared, retinoids work at the stage where the blockage forms.
This means that A-Retinoid not only helps against existing pimples – it also helps prevent new outbreaks.
Therefore, retinoids are considered by many dermatologists to be one of the cornerstones of modern acne treatment.
Even the best daily skincare routine can have difficulty dissolving older blockages in the skin.
Therefore, I often use CP Chemical Peel as a supplement to the daily treatment.
CP works with several different types of acids simultaneously.
Salicylic Acid (BHA)
Salicylic acid is fat-soluble and can therefore work down into the hair follicle where acne occurs. It helps dissolve sebum, blackheads and blockages.
Lactic Acid (AHA)
Lactic acid exfoliates the skin surface and helps to improve skin texture while 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 scars
Start with 1-2 treatments weekly. If well tolerated, the frequency can be gradually increased.
Hormonal acne
Many women experience pimples around:
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the chin
-
the jawline
-
the neck
This type of acne is often called hormonal acne.
Although 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 scars, PIE and PIH
Many people believe that acne is gone once the pimple disappears.
However, for many, the challenge only begins then.
PIE (Post Inflammatory Erythema)
PIE refers to red marks left after inflammation.
PIH (Post Inflammatory Hyperpigmentation)
PIH refers to brown marks left after inflammation.
Both conditions can last for months if the skin is not properly protected.
Therefore, daily use of SPF 30 is one of the most important investments you can make for your skin.
Sun protection not only helps against sun damage. It also helps to reduce the risk of long-lasting red and brown marks after acne.
When will you see results?
We are all different.
Some people experience improvements after just 2-4 weeks.
Others need 8-12 weeks before they see the full results.
Retinoids, in particular, require patience.
Many stop treatment just before the results start to show.
The most important rule is therefore:
Consistency beats intensity.
You should not try to scrub your skin free of pimples.
You need to teach your skin to function correctly again.
Maintenance
Once the skin is under control, the routine can often be simplified.
Morning:
Evening:
CP Chemical Peel is then used as needed, typically 1-2 times a week.
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 scars in the long term.
For severe acne, cystic acne or extensive scarring, I always recommend seeking a doctor or dermatologist.
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REMEMBER
You can always book a skin analysis with me, and I'll be happy to help. You can read much more about my skin analysis and service on this link
Curious for more 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 bacteria alone are not the cause of acne.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884775/
5. Inflammation in Acne Vulgaris
Supports your section that 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.