Itchy Acne: Types, Causes, Treatments and More

• Itchiness is a very common symptom of acne due to several reasons including skin inflammation, irritation and dryness
• Cystic acne is most closely associated with itchiness due to the severe infection that forms deep within skin tissue 
• Fungal and bacterial infections can mimic acne symptoms and cause itchiness
• Over-the-counter and prescription-strength treatments can alleviate symptoms as can several home remedies

Acne is a chronic skin condition that can take many forms. It can present with mild symptoms of  whiteheads and blackheads or inflamed papules, pustules and cysts. Itchy acne is a very common characteristic of inflammatory lesions—especially cystic acne—due to the severity of the infection. Itchiness also occurs due to the effects of certain medications and the healing process. 

Types of Acne That Cause Itching

Pruritus, or itchy skin, is understood to be a very common and significant symptom of all forms of inflammatory acne and is aggravated by heat, sweat and stress.

One study examining itching and acne found that 50% of participants reported itching along with acne lesions; 31.5% used medical treatment to calm this sensation.

When looking at the progression of acne lesions, inflammatory acne first begins with the development of papules. There are small red bumps that are pus-free.

However, colonization of Cutibacterium acnes triggers the release of white blood cells in order to fight the growing infection; it is this response that causes pus-filled lesions to form and provoke sensations of tenderness and itchiness.

Some degree of itching is therefore expected, due to the prominent role of C. acnes. 

Cystic acne

Cystic acne is a severe form of acne and is characterized by large, soft lumps that form deep within tissue. These lesions consist of sebum, dead skin cells, debris, bacteria and pus. 

They are visible as large boils on the skin’s surface. 

This form of acne can develop as a result of papules and pustules which degrade, worsen and cause bacteria to multiply and break through the cell walls. The infection then spreads beneath the skin, forming cysts. 

This is a severe form of acne that can cause extensive tissue damage, and it is this level of  inflammation that causes irritation, itchiness and pain. In one study, researchers determined that pruritus in inflamed skin is perceived as being more intense and painful than noninflamed skin.

Fungal acne

Fungal acne (which is actually a misnomer) is also linked to itchiness.  

The proper name is Pityrosporum folliculitis, or Malassezia folliculitis and is a skin condition that is caused by the overgrowth of Malassezia which is a yeast-like fungus that infects hair follicles.

Lesions develop in the form of small, uniform, itchy papules and pustules which typically present on the face, chest, back, upper arms and less frequently, on the face.  

This skin condition can be mistaken for acne because of the similarity in the appearance of lesions and that they develop in proximity to areas with greater numbers of sebaceous glands – hence the fungal acne name. 

However Pityrosporum folliculitis differs from acne in that comedones are not present and the itchiness is much more severe.  

This skin condition primarily affects adults who have a chronic disease such as diabetes, and in those who are immunosuppressed, such as people with AIDS. 

Other Causes of Itchy Acne 

In addition to inflammation as a cause of itchiness in acne, there are several other reasons why acne can be itchy.

Healing

Whether it’s a cut, scrape, wound, skin infection or inflamed acne lesion, as part of the body’s defense system against infection and perceived threats, it releases proinflammatory cytokines to the area during the healing process. These cytokines act on sensory nerve endings which leads to transmission of the itch signal to the central nervous system.

As part of the healing process, the body also releases histamines through injured tissue mast cells which causes the surrounding blood vessels to dilate and boost blood flow.

This enables healing chemicals to enter the area to repair and remodel skin. The action also causes the sensory nerves to become hypersensitive and itchy.

Side effect of acne treatments

Many topical acne treatments target the excess oiliness that prompts acne development. As such, they can have a drying effect on skin and cause redness, irritation, peeling and itchiness. 

These are symptoms of an altered skin barrier function.

Benzoyl peroxide is an established and well-supported treatment for acne but it has been shown to damage the protective outer layer of skin by increasing transepidermal water loss (TEWL). This leads to excessively dry, itchy skin.

Other topical acne treatments that can disturb the equilibrium of the skin barrier and cause irritation and itchiness are salicylic acid and retinoids.

Allergic reaction to topical treatments

Some people experience mild side effects such as itching, swelling or a burning due to their acne treatment. 

Severe reactions are extremely rare and include difficulty breathing, swelling in the throat, face, lips or tongue, and hives. Seek immediate medical attention if you experience any of these symptoms.

Treatments for Itchy Acne

Skin barrier damage, dry skin and itch are closely linked, therefore in order to successfully treat itchy acne, it is important to address all three concerns. This involves antihistamines in tandem with topical acne medications and emollients to moisturize and heal the skin.

Oral antihistamines

Oral antihistamines can effectively respond to the body’s release of histamines during the healing process by blocking their effects. This serves to reduce redness and inflammation to calm skin and inhibit histamine-induced itchiness.

Antihistamines are typically prescribed for chronic and seasonal allergies. While they are not indicated for pruritus, they are frequently used for this purpose. Newer, second-generation antihistamines have non-drowsy formulas to allow you to function normally. 

Topical treatments

Several effective over-the-counter (OTC) cleansers, creams and gels and ointments are available to reduce lesion count, alleviate inflammation and kill acne-causing bacteria. These effects will combine to relieve itchiness.

• Benzoyl peroxide has long been a staple in acne management; it can kill C. acnes, reduce inflammation, exfoliate blocked pores and clear away excess oils

• Retinol is a derivative of vitamin A and can effectively improve skin by two mechanisms of action: exfoliating debris, grime, oils and dead skin from the outermost layer of skin and by penetrating the skin to stimulate collagen and elastin production

• Salicylic acid and azelaic acid are both effective against acne and can be used together for greater benefits. The former is an effective exfoliant and can slough off dead skin cells, clear pores of debris and excess oil; the latter has antimicrobial and anti-inflammatory effects to kill bacteria, calm inflammation and heal lesions

In addition to the above topical agents, itchiness can be relieved by including an effective moisturizer in your anti-acne regimen. Not only do they counteract the drying effects of acne medications, they go a long way to repair skin and improve the skin’s natural barrier function by protecting against external irritants. 

Look for moisturizers that contain one or several ingredients including occlusive agents, emollients, humectants and lipids. These soften, smooth, moisturize and protect skin to subdue itchy skin.

Prescription medications 

If OTC solutions are not achieving satisfactory results, prescription acne medications are another option for treatment-resistant cases and for moderate-to-severe acne.

As well, combination treatments have been shown to be more effective in treating acne than one sole treatment. Topical retinoids, benzoyl peroxide or both agents are routinely combined with oral antibiotics for greater efficacy and to reduce the risk of antibiotic resistance. 

Antibiotics are a first-line therapy for moderate-to-severe acne and are prescribed for a set period of time. These include tetracycline, erythromycin, minocycline and doxycycline which work to kill bacteria.

Azithromycin is another oral antibiotic that is typically prescribed for bacterial infections such as bronchitis or pneumonia. However, one comparative study showed that 85.7% of those taking azithromycin had a greater than 80% reduction in their inflammatory acne lesions versus an average of 77.1% for all the other agents. 

This makes it a viable option for those unable to take standard oral antibiotics or as another potential therapy for difficult-to-treat cases.

Oral isotretinoin is the most effective treatment for severe and stubborn acne because it can shrink sebaceous glands to limit oil production, speed up skin cell turnover, reduce levels of acne-causing bacteria and calm inflammation. 

You will be closely monitored while on this medication as it does have several potentially serious side effects.

Antifungal treatments

Mild cases of Pityrosporum folliculitis can be successfully treated at home by using an OTC topical antifungal ointment or cream, or selenium sulfide lotion, another antifungal medication. Treating the fungus will eliminate the itch.

For moderate-to-severe cases, you’ll need a prescription-strength topical or oral antifungal agent such as fluconazole or ketoconazole. Both have been shown to be effective in resolving symptoms, however the topical may require a longer course of treatment. Recurrence is common, so maintenance therapy is usually called for.

Home Remedies to Relieve Itchy Acne 

Home remedies can quickly ease itchy acne and can support the effects of OTC and prescribed medications.

Aloe vera

Aloe vera gel boasts a number of important skin-healing properties: it’s an antifungal, antiseptic, antibacterial, antioxidant and an anti-inflammatory. 

This gel can moisturize and protect skin, regulate sebum production, promote cell generation, and accelerate wound healing. It can tamp down the redness, itching, swelling and pain of inflammatory acne lesions. 

You can take the gel directly from the plant or purchase an aloe vera gel product marked as 100% pure to avoid any skin irritating additives.

Avoid scratching

There is a complex interplay between many itch mediators and signaling pathways within the itch-scratch cycle: itch causes the scratch reflex, scratching causes inflammation which triggers more itching and scratching.

While it may be difficult to resist the impulse, scratching will only worsen symptoms and lengthen the healing process.  

Cold compress

Cooling the skin to suppress itching is a long-established remedy. You can apply ice, cold compresses or gel packs to skin for 5–10 minutes to temporarily alleviate itch and any discomfort caused by inflamed lesions. (Always wrap ice in a thin, clean cloth first to avoid damaging skin.)

Similar Skin Conditions That Cause Itching

Several skin conditions can mimic acne as well as cause itching. 

Folliculitis

Bacterial folliculitis is caused by an overgrowth of bacteria within hair follicles (usually Staphylococcus aureus) which causes the development of  itchy, pus-filled bumps.

Bacterial folliculitis is relatively common and can result due to the following:

• Physical contact with an infected person
• Contact with personal items such as razors, towels or clothing of an infected person
• Obesity; skin folds can create a breeding ground for bacteria
• Wearing tight-fitting clothing especially during hot and humid conditions

Treatment involves prescription-strength topical and oral antibiotics such as clindamycin or  medications as well as antibacterial and antiseptic agents which combine to inhibit or kill bacteria and for keratolytic effects to break down the outer layers of the skin which decreases the raised bumps. 

Eczema 

Eczema is an inflammatory skin condition that is characterized by itchy, dry inflamed skin. It tends to be hereditary and is associated with several other conditions including allergies and asthma.

Eczema presents with red, scaly patches of skin and can cause intense itching, stinging and discomfort. While there is no cure, management of symptoms includes regular use of emollients to moisturize skin and topical corticosteroids to relieve itching, swelling and inflammation. 

Perioral dermatitis

Perioral dermatitis presents with small inflamed papules and pustules around the mouth, sometimes spreading to the nose, eyes and forehead. These lesions can discharge a clear fluid  and cause mild itching and burning. The cause of this condition is not yet known. 

Antimicrobial agents such as metronidazole, erythromycin and pimecrolimus are prescribed as well as topical corticosteroids; oral antibiotics such as tetracycline and oral and topical metronidazole.

Takeaway

Itchiness is a very common symptom of inflammatory acne, due to the inflammation itself, skin dryness and irritation, and as part of the healing process. Cystic acne is most likely to cause itching due to its severity; fungal and bacterial infections can mimic acne symptoms and also cause itching.

There are many effective OTC and prescription-strength treatments that work topically and systemically to heal acne lesions, thereby alleviating symptoms. These include antihistamines, benzoyl peroxide and antibiotics.

Several home remedies can work in conjunction with these therapies to target inflammation and reduce uncomfortable sensations. Including a quality moisturizer can provide many benefits, including easing dryness and itchiness, and repairing and protecting the skin.

Fungal infections can be successfully treated with either topical antifungal agents for mild cases; oral agents for moderate-to-severe cases.

Regardless of the cause, it’s essential to resist the urge to scratch, as this can worsen itchiness and discourage healing.