A) Internal:
1. Genetic
2. Hormonal
3. Stress (emotional)
4. Poor diet
5. Certain drugs (e.g. cortisone)

B) External:
1. Lack of personal hygiene'
2. Topical pressure or friction through restrictive clothing
3. Comedogenic creams and cosmetics

In most cases acne is the result of an internal malfunction manifesting as a symptom on the face, chest and back. This is often aggravated externally through improper management and the wrong kinds of products.

Appearance

1. Thick, coarse skin with extended follicular orifices
2. Oily, shiny surface
3. Blocked orifices and small white lumps under skin - open and closed comedones
4. Papules that are red and swollen
5. Pustules with white or yellow-tinged centers
6. Deep-seated painful lumps (nodules and/or cysts)

Touch

1. Rough
2. Swollen (inflamed)
3. Greasy