Acne is a skin disease. It’s not a “temporary skin condition”. Although many of us suffer from acne tos ome extent during puberty, in some cases, acne can occur at an adult age. Genetic predisposition plays an important role.

According tot he American dermatologist Nicolas Perricone, 7 stages of acne can be distinguished.

  • “Retention hyperkeratosis”. In a healthy skin, dead skin cells on the inside of our pores, are shed in a natural and continuous manner. In this first stage of acne, this no longer happens in a normal way. Dead skin cells and sebum (the natural grease our skin produces) cling together. As a result of this, pores get clogged and can eventually enlarge.
  • Bacteria start to grow inside the pore and its follicle (this is the hairshaft).Acne bacteria grow “anaerobically”, meaning they like places without oxygen.Skin condition deteriorates and the first lesions start to appear. Acne is a fact.
  • Comedones & blackheads start to appear.
  • Red, inflamed spots, the acne spreads.
  • Worsening of the condition: more spots, more redness.
  • Formation of cysts: this stage + 7 is called “acne conglobata” and is the worst case scenario. Large areas of heavily inflamed, large pimples.

In the first stages of acne (stage 1 to 4), good skincare can do a lot. It’s very important for young people to start taking care of their skin in an early stage. For stages 6 & 7, dermatologists’ treatments are a necessity.Treatment with antibiotics or Roaccutane/Accutane might be the only solution left.

Antibiotics kill the acne bacteria, but have the disandvantage of creating resistant strains. Roaccutane (Accutane in the US) is a very potent form of Vitamin A (iso-tretinoin) and clears up severe acne in a couple of months.

I personally suffered from acne from my 14th until my 23th. It was severe, and I tried everything I could to get rid of it. It took me years to go to a dermatologist. I wish I had done so before. Roaccutane was the ultimate solution for me. It helped, thank god it did. But it left my skin dry and parchy. Years of diligent skin care gave me back a “normal” skin. Nowadays, however,  I still suffer from acne scars and hyperpigmentation due to the many inflamations I had.

The worst thing you can do is “self-medicate”! Please don’t try to “dry out” your acne with desinfection alcohol, like I did.Don’t use soap or drying face washes either. It will only make matters worse, believe me.

What you can do, in order to improve your skin condition :

  • Use a mild, non-foaming cleanser twice a day. “Non-foaming” is important, because your sebeceous glands are already “overexcited”. Calm them down by using a very mild cleanser. Cleansing oil or milk is perfect. The body Shop makes a great cleansing oil with Chamomile and Clarins has a cleansing milk designed for oilier skin types. Cerave Cleansing Cream is rather a gel, so if you prefer a gel, this one will suit you. Clinique Facial Soap Extra Mild isn’t a soap, but a gelly milk and is great too.
  • If you use a toner (which I recommend), make it a hydrating one. Toners with glycerin, propanediol and hyaluronic acid are all very good. Not too much alcohol please ! Clarins, Exuviance, Lancôme and many Koreans (Leegeehaam, Klairs, Missha) are fab.
  • Use a AHA/BHA product. Fruit acids are GREAT for acne & oily skin. BHA’s can even penetrate inside your pores to help “clean them out”. Salicylic acid is great, glycolic, citric & lactic will be very helpful too. Use your product in the form of a gel, lotion or (very light) cream. Specialists in this section are brands like Paula’s Choice and Exuviance. Neostrata is available by dermatologists’ prescription (NL/BE).
  • Eventually use a product with Retinol (Vitamin A).Retinol is known to “improve” the pore lining, thus making your skin more healthy. It will also have a preventative effect on scarring and hyperpigmentation. Neostrata, Indeed Labs, Nazan Tastan and Mad Hippie all make excellent Retinol products.
  • Use a spot-on treatment on inflamed areas.On the pimples itself, that is. Do NOT use them all over your face !
  • Make-up is ok. Don’t let yourself be influenced by people saying it will “suffocate” your skin !Modern make-up does NOT do that. The only thing I would advice you is not to choose a stick or compact cream foundation as these are often based on heavier oils and waxes.

And don’t be as stupid as I was trying to “pop” spots. You can only do that when there is a BIG WHTE head on top of the pimple. And press gently, with CLEAN fingers. Don’t continue to press if it doesn’t “pop”. Just wait another day. (I know this isn’t easy, I’ve been there).

Last but not least : seek professional advise if your acne condition gets worse.


According to Dr. Nicolas Perricone, dermatologist, there are 7 different stages of acne that can be distinguished. Stage one being the beginning, stage 7 being the worst state of acne.

  • Retention Hyperkeratosis. In a healthy skin, dead skin cells are shedded in a natural, ongoing manner. This also goes for the skin cells INSIDE the pores. In the case of retention hyperkeratosis, the dead skin cells inside the pores do not exfoliate in that natural manner and cling together with the sebum (natural skin oils). As a result of this, pores get clogged. The condition is triggered by several factors, one of them being genetics. In order to normalise this process, vitamin A derivatives like Tretinoin or Retinol can be applied to the skin. Retinol normalises the way skin cells behave inside our pores. Salicylic and glycolic acid can help prevent new pores from getting clogged, as these ingredients will further help exfoliation (elimination of dead skin cells).
  • Bacterial accumulation and multiplication inside the follicle. The acne bacteria, Propionibacterium acnes, starts multiplying inside the clogged pores. Infection is around the corner. Antibiotics are used (as well orally as topically) by dermatologists, but there is a risk of developping resistant strains. Benzoyl peroxide kills the acne bacteria by releasing oxygen into the skin. This also means that free radicals are being formed, leading to possible cell damage and premature ageing. Benzoyl peroxide can also be very harsh to the skin and is not tolerated very well by sensitive skin types. Light Therapy with a wavelength of 410-420 Nanometer is very effective. Combined with the stage 1 treatments good results can be achieved.
  • Microcomedones/comedones formation. Meaning whiteheads and blackheads. Treatment should now be focused on anti-bacterial and light therapy.

4/5  Papule and pustule formation.Also called “stage 2 acne” by dermatologists. These are the well-known red, irritated and inflamed pustules that are so typical for people with acne. Treatment as in stage 3.

6/7 Nodules and cyst formation. This is a severe form of acne. Not every patient/acne sufferer gets to this stage. I did myself, unfortunately, mainly due to bad treatment in those days. Treatment now consists of Roaccutane (Isotretinoïn) orally. A course of about 3 to 4 months is generally effective at clearing the acne. Roaccutane has some serious side effects, like :

  • Bad vision at night
  • Hair loss (at high dosages)
  • Dryness of lips, nose, eyes
  • Increased triglyceride levels (this has to do with liver functions)
  • Severe birth defects in pregnant women

I personally did a course of 3 months of this medicine. It saved my skin and got me back on my feet after years of being depressed because of my severe acne. I only suffered dryness and had some increased triglycerides levels by the end of the course. This gets back to normal once you stop taking the medicine.I an soooo happy I did this !

What I also discovered during this stage, is how important GOOD, NON-AGRESSIVE skin care can be. It makes the whole difference, during and after the acne.



  • Start the day with a GENTLE, non-drying cleanser. Avoid foams if you can. A cream or milk will be just as affective, believe me ! Céravé Hydrating Cleanser, Mad Hippie Cream Cleanser, Klapp Bèta-Glucan Cleansing Milk, Clinique Take the Day Off are excellent.
  • Use a SPOT treatment ON your pimples. Try a solution with BHA/Salicylic acid. It will help reduce inflammation and “dry out” your spots (no, I know, you can’t litterally dry them out, but some of you NEED to hear it this way J)
  • Use an oil-controlling/mattifying product if you need to. A light moisturizer can be great too. Look for anti-inflammatory ingredients like Centella, Green Tea and Chamomile. Silver is great too.
  • Use suscreen (oil free) SPF 30 at least or a make-up with SPF. Avoid stick/compact make-up, as these often have waxes which could clog your pores.


  • Doublecleanse (see my articles about cleansing). Your first cleans eremoves make up and SPF. The second one cleanses your skin.
  • Spot treatment
  • Use a Retinoid:vitamin A derivative like Retinol. Many brands have good retinols and they all have different percentages. If you want a stronger one choose Paula’s Choice or Neostrata. If you want to start milder look for Klapp Micro Retinol Soft Cream or Mad Hippie serum.
  • Moisturize:with a light moisturizer. Hyaluronic acid based product are great. A gel like l’Occitanes Aqua Réotier or Leegeehaam Serum is wonderfull at this stage.


  • Mineral oil
  • Cinnamon oil
  • Cocoa butter
  • Coconut oil
  • Isopropyl myristate & palmitate
  • Lanolin
  • Myristyl myristate
  • Propylene glycol (some persons, not all)
  • Sodiul lauryl & laureth sulphate.

Remeber that not everyone has the same reaction to cosmetic ingredients and some of the above mentionned will be perfectly ok for some.

Be consistent in what you do and seek for medical/dermatological advise if your acne doesn’t get better or gets worse.