Causes of Acne and Treatment Options: What You Need to Know

There are many factors that can contribute to acne, but broadly speaking, the causes can be grouped into three main categories:

1. Excess sebum (oil) production

2. Clogged follicle openings due to dead skin cells (keratin) → sebum cannot be expelled

3. Proliferation of acne-causing bacteria (P. acnes)

In most cases, acne results from a combination of these factors, so addressing each cause individually tends to lead to better treatment outcomes.

So, how do we treat each one?

1. Excess Sebum Production

Treatment aimed at regulating sebum production is needed. One of the first options worth considering is PDT.

PDT (Photodynamic Therapy) involves applying a photosensitizing agent to the face. After a set period of time, light is directed onto the skin, causing the agent to react and generate reactive oxygen species within the target cells, ultimately destroying them.

In simple terms: a light-sensitive substance is applied to the skin and then activated by light, which destroys the sebaceous glands and kills acne-causing bacteria.

For cases where PDT does not provide adequate control, or where inflammatory acne is prominent, Agnes RF (Agnes Laser) may be considered. This procedure uses Kobayashi insulated needles — designed specifically to target sebaceous glands — to selectively destroy the oil glands in acne-prone areas one by one. By precisely targeting and eliminating the affected sebaceous glands, this treatment offers the advantage of preventing acne from recurring in those specific areas. Agnes RF is a newer approach to acne treatment that offers targeted control of problematic sebaceous glands. It is considered effective for inflammatory acne, severe acne, and frequently recurring acne.

In addition to PDT and Agnes RF, oral isotretinoin (known by brand names such as Roaccutane or Isotinon) is another option for regulating sebum production. When prescribed and monitored by a physician, it can be used alongside other treatments for meaningful results. However, as this medication carries a number of potential side effects and contraindications, a thorough evaluation and detailed explanation from your doctor are essential before starting.

2. Clogged Follicle Openings Due to Dead Skin Cells → Impaired Sebum Expulsion

The skin naturally renews itself approximately every 28 days through a process called cell turnover, during which dead skin cells (keratin) are shed. If dead skin cells fail to shed properly or accumulate too thickly for any reason, they can block the follicle openings and prevent sebum from being expelled normally. This environment is conducive to acne formation. In such cases, procedures that remove dead skin cells can be a straightforward way to treat and help prevent acne.

Exfoliation treatments such as scalings, oxygen peels, and Aladdin peels can be used for this purpose. An oxygen peel combines skin scaling with a vitamin C infusion to enhance brightening effects, and has the advantage of requiring virtually no downtime. The Aladdin peel is one of the procedures our clinic particularly favors — it can produce noticeable results even after a single session and has a low side-effect profile, making it well-suited as a starting treatment for acne. Minor redness may occur for one to two days afterward, and some itching and flaking of the skin may be experienced for about a week.

3. Proliferation of Acne-Causing Bacteria (P. acnes)

Overgrowth of P. acnes bacteria is also a key driver of acne development and inflammation. This can be managed through PDT treatments or oral medication. The antibiotic most commonly used for this purpose is minocycline (brand name: Minocin). Because minocycline has direct anti-inflammatory effects, it tends to work well when used in combination with other acne treatments.