Dermatologists say that cystic acne is common during puberty because all that hormones activity causes the glands to produce more sebum, hence clogging up pores and causing acne. Eventually, most people's bodies adapt to these higher levels of testosterone, etc (i think it's androgens that really cause the glands to go crazy) and stop producing so much sebum, but this isn't always the case as evidenced by adult acne.
Androgens (higher during puberty in both genders) cause increased sebum production. A bacterium (Propionibacterium acnes) which lives in the sebaceous glands of some people breaks down the sebum into fatty acids. The fatty acids irritate the walls of the sebaceous glands. The walls get inflamed and swell up, causing the opening to get blocked. The enclosed inflammation attracts white blood cells and other inflammatory mediators, which constitute pus.
The treatments for acne are five-fold:
1. Comedolytics (such as benzoyl peroxide) break down the acne.
2. Antibiotics (usually applied topically but can be taken orally) kill the Prionibacterium acnes.
3. Keratinoids change the way the skin grows, so as to make less comedones.
4. Antiinflammatories (such as steroids injected into the skin) reduce inflammation.
5. Antiandrogens (a last resort) cause less sebum to be produced.
Sebum is what clogs up the pores and causes cistic acne, not fat. Simply washing the face regularly can't prevent acne because the pores get clogged up deep beneath the skin where you're not going to be able to unclog it no matter what you use. Things like dirt and bacteria do not cause acne (sebum does), but they can exacerbate the problem. Believe me, if you've got bad acne, it doesn't matter how many times you wash your face.
The strongest evidence for why some people get acne and some don't is genetics. The overproduction of sebum in the sebaceous glands causes blockages in the pore which the immune system responds to (because bacteria can grow like wildfire in such conditions) and the inflammation results in Cystic Acne. The purpose for this overproduction is hormonal, yes, but genetically linked, and maybe stress linked.
Wash the skin
Avoid oily substances
Shampoo the hair daily
Don`t "pop" pimples
Exercise regularly
Don't stop the acne medicine
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