If the follicle wall breaks under pressure and sebum leaks into nearby tissue, pustules or inflammatory acne can develop. If pustules become infected, matters are further complicated: The infection can penetrate deep into the skin and create cysts, which can rupture and leave temporary or permanent scars.

Various factors appear to make certain people prone to developing acne, it can be inherited, a stressful lifestyle, and the use of oral contraceptives. Taking oral contraceptives may trigger acne in some women but actually suppress it in others, depending on the type of pill taken. Anabolic steroids taken by some bodybuilders can also lead to severe outbreaks.

However common acne vulgaris usually occurs in adolescent years as this is when there are large increases in hormone production from the sex organs and the Adrenal Glands.

During puberty, both boys and girls produce high levels of androgens - male sex hormones that include testosterone. Androgens can increase production of sebum, the substance that lubricates the skin and helps it retain moisture. There is usually only enough sebum produced to keep the skin supple and healthy.

Acne can afflict anyone who is undergoing hormonal changes for whatever reason. The inflamed redness, pimples, blackheads, whiteheads and in extreme cases, cysts are the result.

Traditional Treatment

The most important treatment is to keep the skin clean which allows the pores to breathe. Do not squeeze or touch any infected or inflamed areas as acne can produce lifelong scars.

A clean face can only be of help if the hair is also washed and away from the face. The overactive sebaceous glands cause the hair to become oily and dandruff can develop which can aggravate acne problems.

The occasional pimple or two need no treatment. Over-the-counter cover-up creams and cosmetics, if used at all, should be water based and hypoallergenic. These creams usually contain anti-bacterial antiseptics to reduce skin bacteria and keratolytics which remove any plugs of sebum blocking the follicles. These products can be very helpful for many patients.

Always follow the instructions carefully. Mild degreasing products may also be beneficial.

If you use cosmetics ensure that only water-based products are the favoured choices.

If these simple procedures do not help the problem, it is sensible to consult a doctor who may prescribe certain treatments.

To treat mild acne, your doctor may recommend a topical over-the-counter medication containing benzoyl peroxide or prescribe the anti-acne drug tretinoin (retinoic acid), a vitamin A derivative. Before applying the medication, wash the affected area with a mild oil- and scent-free soap.

When pus-filled pimples are ready to break, applying a hot towel for a few minutes may encourage the process. Infected pimples should be opened only by a nurse or doctor using surgical instruments and following antiseptic practices. Squeezing pimples yourself may lead to further infection and the possibility of permanent scars.

Conventional medicine favours drug therapies that inhibit sebum and keratin production, limit bacterial growth, or encourage shedding of skin cells to unclog pores.

Because many therapies can have potent side effects, any patient with a skin problem should proceed with caution when trying a new treatment. People with severe, persistent cases need the care of a dermatologist. However, if this course of action is chosen antibiotics can be quite helpful.

Oral antibiotics are usually left to treat the more severe cases of acne. They are of a lower dose that would be prescribed for an infection. Some forms of bacteria inflame acne and this is where antibiotics can help by removing these and settling the problem.

For moderate to severe cases, a mainstay of treatment is tetracycline, an antibiotic that is usually taken orally, sometimes in combination with topically applied tretinoin. Other useful antibiotics are oral erythromycin and clindamycin.

Another development in acne treatment is the use of medication called isotretinoin which is taken from Vitamin A. However it should only be considered in extreme cases of acne where no other treatment has been of assistance and its use must be strictly supervised by a medical practitioner. It must not be used during pregnancy or if there is any likelihood that conception has taken place. At present this drug can only be prescribed by a dermatologist. Chemical peeling and laser therapy are also avenues that could be investigated.

Patients taking anti-acne drugs should be alert to possible side effects and interactions. The drugs tretinoin and benzoyl peroxide can leave skin reddened, dry, and sensitive to sunlight. Benzoyl peroxide may inhibit the healing effects of tretinoin, so never apply them at the same time. Taking antibiotics for more than a few weeks may leave women susceptible to yeast infections.

There are surgical procedures available to eliminate the scars from acne and your medical practitioner will be able to advise on this treatment.

Alternative/Natural Treatments

Some alternative therapies have proven to be very beneficial. In addition to these therapies it is advisable to keep the skin and hair clean as in the conventional treatments mentioned above.

• Use mild soaps designed for skin health every day

• Use a skin scrub based on oatmeal, calendula, tea tree oil (which is a natural anti-bacterial agent), thyme or cinnamon which gently removes the top layer of the skin and open the pores. Use 2-3 times per week.

• Avoid alcohol based skin toners

• Herbal treatments aid in reducing excess oil production, help the system cope with the overload of bacteria, helps reduce inflammation and aids in healing

• Expose your acne to some sunlight in moderation, but be careful to avoid overexposure.

• Diet is vitally important and fatty or oily foods should be reduced.

• Reduce stress by relaxing with a cup of tea made from lavender or chamomile.

• Chinese herbal medicine for acne seeks to rid the skin of dampness and heat, which are believed to be contributing factors.

• Many herbs are used to help heal the skin and soothe inflammation and itching. The herbs a trained naturopath or herbalist may consider are Echinacea, calendula, tea tree oil, and goldenseal.

Never use any herbal medicines on newborns without consulting your doctor.

Most doctors now believe that acne is not a food-related problem. Some alternative therapists, however, make a change in diet the basis of treatment. While experts in both camps concede that chocolate, fats, and other suspect foods don't cause acne, debate continues over whether they can aggravate the condition. Most Health Professionals agree that fatty or oily foods should be avoided and to eat plenty of fresh fruit and vegetables.

It is also important to drink plenty of filtered water throughout the day. Try to combine fresh food with vitamin supplements such as Vitamin A, B complex, Vitamin C and the minerals Zinc and potassium. Also useful are Lecithin, Echinacea, Garlic and Evening Primrose Oil. Always check the required doses.

• If you notice your condition worsening and the infection becomes severe with the formation of larger boils, cysts or abscesses

• If the surrounding tissue is bruised and damages as a result of squeezing the blackheads.

• If your acne doesn't respond in two to three months to over-the-counter remedies; you may need medical treatment.