Acne is a common chronic disorder affecting the hair follicle and sebaceous gland, in which there is expansion and blockage of the follicle and inflammation. There are several variants. It afflicts most people, to a varying degree, during the teen years, with 85% of 16 to 18 year olds affected. However, the disease is by no means restricted to this age group; adults in their 20’s or 30’s may have acne.
Causes of Acne
Acne is due to a combination of factors:
- Rising hormone levels during adolescence cause enlargement and overactivity of the oil glands in the skin. The canals that bring this oil to the surface become blocked with keratin (a protein that is part of the skin). When these oil glands are overactive and the canals are blocked, the bacteria that normally live on the skin and in the oil become trapped. They subsequently multiply, and cause inflammation and irritation.
- Cleansing and Cosmetics
- Unhealthy diet
- Familial tendency
- Endogenous and exogenous androgenic hormones
- Dead skin cells
- Acne bacteria
- Innate immune activation with inflammatory mediators
- Distension and occlusion of the hair follicles
- Flares of acne can be provoked by:
- Polycystic ovarian disease
- Drugs: Steroids, hormones, anticonvulsants, epidermal growth factor receptor inhibitors and others
- Application of occlusive cosmetics
- High environmental humidity
- Diet high in dairy products and high glycemic foods.
Acne is often confined to the face but it may involve the neck, chest, and back.
Acne is characterized by:
- Open and closed uninflamed comedones (blackheads and whiteheads)
- Inflamed papules and pustules
- In severe acne, nodules and pseudocysts
- Post-inflammatory erythematous or pigmented macules and scars
- Adverse social and psychological effects.
Acne Vulgaris
Acne vulgaris is the medical name for common acne, the presence of blackheads, whiteheads, and other types of pimples on the skin. The most common spots for breakouts are the face, chest, shoulders, and back. Although mild acne may improve with over-the-counter treatments, more severe forms should be treated by a dermatologist.
Comedones
A comedo or basic acne lesion, is a hair follicle that has become clogged with oil and dead skin cells. Comedones (the plural of comedo) can develop into bumps called whiteheads and blackheads. Products that may trigger comedones are called “comedogenic.” Makeup labeled “noncomedogenic” is less likely to clog pores and contribute to acne.
Blackheads
Blackheads are comedones that are open at the surface of the skin. They are filled with excess oil and dead skin cells. It’s not dirt that causes the comedone to turn black. The black hue results from the irregular reflection of light coming from clogged hair follicles. Blackheads can frequently be treated with over-the-counter medications.
Whiteheads
Comedones that stay closed at the surface of the skin are called whiteheads. This happens when oil and skin cells prevent a clogged hair follicle from opening. Many of the same over-the-counter medicines that treat blackheads are also effective against whiteheads.
Papules
Papules are comedones that become inflamed, forming small red or pink bumps on the skin. This type of pimple may be sensitive to the touch. Picking or squeezing can make the inflammation worse and may lead to scarring. A large number of papules may indicate moderate to severe acne.
Pustules
Pustules are another kind of inflamed pimple. They resemble a whitehead with a red ring around the bump. The bump is typically filled with white or yellow pus. Avoid picking or squeezing pustules. Picking can cause scars or dark spots to develop on the skin.
Nodules
Nodules are large, inflamed bumps that feel firm to the touch. They develop deep within the skin and are often painful. Nodules should be treated by a dermatologist since they can scar. Over-the-counter treatments may not be powerful enough to clear them up, but prescription drugs can be effective.
Cysts
Cysts are large, pus-filled lesions that look similar to boils. Like nodules, cysts can be painful and should be treated by a dermatologist since they also can scar. People who develop nodules and cysts are usually considered to have a more severe form of acne.
Acne Conglobata
Acne conglobata is one of the most severe forms of acne. It involves many inflamed nodules that are connected under the skin to other nodules. It can affect the neck, chest, arms, and buttocks. It often leaves scars. This type of acne is more common in men and is sometimes caused by taking steroids or testosterone. Timely treatment by a dermatologist is essential.
Acne Mechanica
Acne mechanica is caused by heat, friction, and pressure against the skin, often the result of wearing sports gear such as a helmet or baseball cap. It is sometimes called “sports-induced acne” because it occurs frequently in athletes. Preventive measures include wearing an absorbent material under sports equipment and showering immediately after activity.
Based on severity, acne is classified as mild, moderate, or severe.
- Mild acne: total lesion count <30
- Moderate acne: total lesion count 30–125
- Severe acne: total lesion count >125
Sometimes acne can cause scarring.
Scarring happens when the acne penetrates the top layer of your skin and damages deeper skin layers. Inflammation makes your acne pores swell and the pore walls start to breakdown, which causes skin damage. Scarring can be a source of anxiety, which is normal. Before treatment, your healthcare provider will determine what type of acne caused your scars. There are several treatment options available for acne scars.
Treatment
There are several ways to treat acne. Each type of treatment varies based on your age, the type of acne you have and the severity. A healthcare provider might recommend taking oral medications, using topical medications or using medicated therapies to treat your skin. The goal of acne treatment is to stop new pimples from forming and to heal the existing blemishes on your skin.
- Topical acne medications: You can rub these medications directly onto your skin as you would a lotion or a moisturizer. These could include products that contain one of the following ingredients:
- Benzoyl peroxide: This is available as an over-the-counter product (such as Clearasil, Stridex and Panoxyl) as a leave-on gel or wash. It targets surface bacteria, which often aggravates acne. Lower concentrations and wash formulations are less irritating to your skin.
- Salicylic acid: This is available over the counter for acne as a cleanser or lotion. It helps remove the top layer of damaged skin. Salicylic acid dissolves dead skin cells to prevent your hair follicles from clogging.
- Azelaic acid: This is a natural acid found in various grains such as barley, wheat and rye. It kills microorganisms on the skin and reduces swelling.
- Retinoids (vitamin A derivatives): Retinol, such as Retin-A, Tazorac and Differin, which is available without a prescription, breaks up blackheads and whiteheads and helps prevent clogged pores, the first signs of acne. Most people are candidates for retinoid therapy. These medications aren’t spot treatments and must be used on the entire area of skin affected by acne to prevent the formation of new pimples. You often need to use these for several months before noticing positive results.
- Antibiotics: Topical antibiotics like clindamycin and erythromycin control surface bacteria that aggravate and cause acne. Antibiotics are more effective when combined with benzoyl peroxide.
- Dapsone: Dapsone (Aczone) is a topical gel, which also has antibacterial properties. It treats inflamed acne.
Oral acne medications are pills that you take by mouth to clear your acne. Types of oral acne medications could include:
- Antibiotics: Antibiotics treat acne caused by bacteria. Common antibiotics for acne include tetracycline, minocycline and doxycycline. These are best for moderate to severe acne.
- Isotretinoin (Amnesteem, Claravis and Sotret): Isotretinoin is an oral retinoid. Isotretinoin shrinks the size of oil glands, which contributes to acne formation.
- Contraceptives: The use of certain contraceptives can sometimes help women and people AFAB who have acne. The U.S. Food and Drug Administration (FDA) approved several types of birth control pills for treating acne. These pills contain a combination of estrogen (the primary AFAB sex hormone) and progesterone (a natural form of steroid that helps regulate menstruation).
- Hormone therapy: Hormone therapy is helpful for some people with acne, especially if one experiences acne flare-ups during menstruation or irregular periods caused by excess androgen (a hormone). Hormone therapy consists of low-dose estrogen and progesterone (birth control pills) or a medication called spironolactone that blocks the effect of certain hormones at the level of your hair follicles and oil glands.
Acne therapies include:
- Steroids: Steroids can treat severe acne with injections into large nodules to reduce inflammation.
- Lasers: Lasers and light therapy treat acne scars. A laser delivers heat to the scarred collagen under your skin. This relies on your body’s wound-healing response to create new, healthy collagen, which encourages growth of new skin to replace it.
- Chemical peels: This treatment uses special chemicals to remove the top layer of old skin. After removal of the top layer of skin, new skin grows smoother and can lessen acne scars.
Acne can be treated and also can be prevented to some extent with proper care of skin. On average, it can take between one to two weeks for acne pimples to clear up on their own. With medicated treatment and a good skincare routine, one can speed up the body’s healing time to make acne go away faster.
You can reduce your risk of developing acne by:
- Washing your face daily with warm water and a facial cleanser.
- Using an oil-free moisturizer.
- Wearing “noncomedogenic” makeup products and removing makeup at the end of each day.
- Keeping your hands away from your face.
