Skin & Fragrance Blog by Thom Watson

Acne, Spots and Blemishes Explained

Why do spots happen?

Spots occur mainly because of a bacteria called Propionibacterium acnes or P. acnes bacteria. P. acnes live naturally on the surface of everyone’s skin and helps us by stopping harmful bacteria getting into our pores and entering our bodies.

When exposed to the air, the level of P. acnes are kept down to an optimal level, however, when air is cut off this spot causing bacteria thrives.

The diagram below illustrates how a spot begins but the process is pretty straight forward and simple:

  1. Skin cells build up in the hair follicle
  2. This accumulation traps P. acnes bacteria inside, cutting off oxygen and allowing it to proliferate.
  3. The proliferation of the P. acnes bacteria triggers our body’s response to an infection and our immune system responds
  4. Swelling is caused as the body fights to encapsulate the infection
  5. The body then tries to slowly push the encapsulated infection up through the skin, resulting in a white head.
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Difference between spots and acne

‘Acne’ is often used as a pejorative term to describe any spot or outbreak of spots. Spots can occur at any time and are usually isolated to one or two in a particular area.

However, acne as a skin disease, called acne vulgaris, presents itself as a more widspread outbreak through a mixture of spots (whiteheads), papules, pustules, nodules and cysts.

Whilst we all get spots from time to time, symptoms of acne vulgaris include, but are not limited to: widespread areas of infection; bleeding, pain or discomfort and often a notable redness and inflammation. Acne vulgaris is categorised as:

  • mild – mostly whiteheads and blackheads, with a few papules and pustules 
  • moderate – more widespread whiteheads and blackheads, with many papules and pustules
  • severe – lots of large, painful papules, pustules, nodules or cysts; there may also be some scarring

Therefore, whilst an isolated spot or mild outbreak can be treated easily by topical skincare, acne vulgaris often requires medical intervention through drug therapy and/or prescription topical treatments.

How do I treat acne or blemish prone skin?

The environment for spots is created by dead skin cells blocking the pores and trapping the bacteria. Therefore, to both treat and prevent spots, it’s about gently opening up those pores by removing dead skin cells.

At the same time, the outbreak should be calmed and treated like any other infection; gently and with soothing, anti inflammatory ingredients.


Use a gentle, ideally non-foaming face wash to dislodge surface dirt and grime accumulated through the day or during sleep.

Using gel face-washes that lather up can slightly dry out the surface of the skin, and those dry skin cells can be the culprits that cause the blockage.

Therefore, look for a face wash that come in a pump-foam bottle, where the foaming is created by the bottle itself, or a creamier acne targeting wash – Face Theory Clarifying Cleanser C2 is a good example of this texture and is specifically designed for acne.


Exfoliation helps remove those blockage causing surface dead skin cells. Only if an outbreak is not currently active, using an exfoliator with buffing particles, also known as manual exfoliation, will remove these dead cells effectively and quickly.

Dermalogica Daily Microfoliant is a good example of this type of exfoliator; use it daily by mixing a quarter of a teaspoon in the hand with water, then apply to the face avoiding the eyes.

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If an outbreak is active, manual exfoliation should not be used. Imagine a cut on a leg, or scab on an arm, and then rubbing it with sand. This would be painful, break the scabbing, cause irritation and inflammation and potentially spread any infection underneath the skin.

This is exactly what happens when a manual exfoliator is used on a spot or existing outbreak. Instead chemical exfoliators such as glycolic acid (an AHA), salicylic acid (a BHA) and/or lactic acid (another AHA) should be used.

These chemical exfoliators/acids, also known as keratolytic/desmolytic agent, gently softening dead cells and breaking down the bonds between them. Examples of effective chemical exfoliators include:

The products above are free from alcohol. Many spot, acne and blemish targeting chemical exfoliators use alcohol as a base. This can dry out the surface layers of the skin leading to further blockages. It is recommended to avoid alcohol based products where possible.

Hydrate and Moisturise

Skin that is prone to outbreaks of spots can often be oil, or at least in those areas. Whilst there is an increase in oil, this is often linked to a deficiency of water.

Oil protects our skin but it’s water that our cells need to stay plump and fresh; when there isn’t enough water, skin cells die more quickly and don’t shed from the surface of our skin evenly, collapsing into pores and creating blockages.

Therefore, water-based hydration is very important in helping calm and prevent a blemish outbreak.

These are often gel or gel-cream texture based. However, water-based/gel moisturisers that are widely available in supermarkets and drug stores/pharmacies are often alcohol based.

Although alcohol may temporarily reduce surface oil and create a matte effect, it does not address the problem and creates longer term dryness.

Look for ingredients such as Hyaluronic Acid, glycerin, urea and honey. These are called humectants and help to trap water in the skin. Hyaluronic Acid in particular binds water to collagen and effectively retains moisture in the skin; over the last few years, it has become a widely used ingredient in many skincare products.

Good examples of moisturisers for acne and spot prone skin or skin that is currently experiencing an outbreak is:

Spot Treatments

If blemishes occur as a one off or isolated outbreak, a spot-on treatment can be effective in alleviating the infection.

Spot-on treatments are usually very concentrated gels or creams that are designed to be applied as a small drop on the affected area every few hours. Active ingredients can include but are not limited to benzyl peroxide, salicylic acid and zinc.

Spot-on treatments are not designed to be used everyday. If a spot-on treatment is being used every day, consider changing the skincare routine to be more inline with the recommendations above as the spot-on treatment may be simply addressing the symptom and not the case.

Good examples of acne, spot and blemish spot-on treatments are:

Another reasonably recent innovation to spot-on blemish treatments is the use of hydrocolloid dressings, such as the COSRX Acne Pimple Master Patches.

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Hydrocolloid dressings work by creating and maintain a moist environment that supports wound healing. Hydrocolloids can help to promote angiogenesis, increase the number of dermal fibroblasts, stimulate the production of granulation tissue, and increase the amount of collagen synthesised (source: Wounds UK). Hydrocolloid dressings have been clinically shown to improve healing of spots, blemishes and acne.

Can acne, spots and blemishes occur on the body?

Whilst most often on the face, acne, spots and blemishes can indeed occur elsewhere on the body. Acne occurs in men more often that it does women and this is certainly true for instances on the body. The back, chest and buttocks are particularly prone to acne outbreaks. This can be exacerbated in transgender patients undergoing masculinisation hormone treatment and also men who are taking anabolic steroids or other performance enhancing drugs.

For those experiencing acne, spots and blemishes on the bum/buttocks, click here for a very in-depth treatment guide.

Is Salicylic Acid (Beta Hydroxy Acid) a keratolytic agent?

Salicylic acid has historically been known as a keratolytic agent. A keratolytic agent softens the keratin cells and intercellular keratin filaments, making them easier to dislodge through physical movement of hand, gentle cloth or cotton pad.

However, as of 2015, Salicylic Acid has been re-classified as a desmolytic agent, breaking down the desmogleins; in theory this doesn’t need as much agitating and the application of gels and creams containing the ingredient should work actively whilst on the skin.

Desmosome 2
diagram of a desmosone (source)

Special skincare considerations for acne vulgaris

Acne vulgaris can be a very difficult skin condition to treat. It can be painful, irritated, dry, prone to cracking and unsightly. Treatment often involves a mixture of antibiotics, isotretinoin (branded as Accutane or Roaccutane), non-prescription topical skincare and laser/light therapy.

Over-treatment of acne is very common, particularly in regards to skincare. Being such a visual skin disorder that is most often present on the face, leads many to throw as many skincare solutions as they can at it in the hope that more is better. Getting acne skincare and treatment wrong can be far worse than doing nothing at all.

Skincare treatments for acne

Treatment for acne vulgaris is similar to the treatment of skin that is prone to milder blemish outbreaks. The main differences are increasing the number of calming ingredients; being more careful to avoid irritants and ensuring that none of your skincare interferes with any topical prescription products.

Skincare considerations for isotretinoin treatment (Accutane, Roaccutane)

Sun Protection for Isotretinoin

Sun protection is an absolute must for anyone using Isotretinoin treatments. Isotretinoin treatments make skin far more sensitive to sunlight and increases the risk of burning and further sun-exposure related conditions.

Look for broad spectrum (UVA and UVB) sunscreens that are ideally physical rather than chemical (using minerals rather than potentially irritating chemicals) and that are oil-free. The CeraVe Hydrating Mineral Sunscreen SPF 50 Face Lotion ticks all these requirements and is available relatively inexpensively.

Symptoms of Dyness with Isotretinoin

Isotretinoin can also lead to extreme skin dryness and whilst using oil-free or reduced oil hydration for blemish prone skin is important anyway, it’s especially important with this treatment. Isotretinoin does reduce oil production so even something that does contain a little non-comodogenic oil may be beneficial.

In this case, non-comedogenic balms are often recommended including La Roche-Posay Cicaplast Baume B5 Soothing Repairing Balm (see Reddit comment below); Eucerin Aquaphor Soothing Skin Balm as recommended by dermatologist Yunyoung Claire Chang and finally Avene Cicalfate+ Restorative Protective Cream rich in copper sulphate and zinc sulphate which both sooth the skin and aid healing.