Acne (Acne vulgaris), is a common human disease. It is commonly found among adolescents. It affects more than 96% of teenagers undergoing hormonal changes and often the adults.
What is Acne?
Acne is characterized by areas of skin with multiple non inflammatory follicular papules (Circumscribed common elevation of skin with no sign of fluid) or comedones and also by inflammatory papules, pustules (small elevations of skin that contains cloudy and purulent material that consists of necrotic inflammatory cells) and nodules in its most severe forms.
Acne appears when greasy secretions from the skin’s sebaceous glands plug the tiny openings for hair follicles (plugged pores). If the openings are large, the clogs transforms into blackheads which are small, flat spots with centers darkened by exposure to air. If the openings remain small, the clogs take the form of whiteheads characterized by small, closed, flesh-colored bumps. Both types of plugged pores can turn into swollen, tender inflammations or pimples or deeper lumps or nodules. Cysts associated with severe cases of acne (cystic acne) are nothing but firm swellings below the skin’s surface. This becomes inflamed and sometimes also infected.
Although acne is considered a curse of adolescence, about 20% of all cases occur in adults. Acne normally starts during puberty between the ages of 10 and 13 and proves to be worse in people with oily skin. Teenage acne generally lasts for five to 10 years, normally disappearing during the early 20s. Acne occurs in both sexes, although teenage boys tend to have the most severe cases. Women are more likely than men to have mild to moderate forms of acne into their 30s and beyond.
Acne spots are most common on the face, but they can also be seen on the neck, chest, back, shoulders, scalp, and upper arms.
Acne isn’t caused by a harmful diet, poor hygiene, or an uncontrolled sex drive but heredity and hormones are actually behind the most forms of acne. To state the truth, swearing off chocolate or scrubbing your face 10 times a day won’t change your tendency to this unsightly, sometimes painful, and often embarrassing skin problem.
Acne may be of three types: mild (few, occasional pimples), moderate (inflammatory papules), or severe (nodules and cysts). So treatment depends on the severity of the condition.
No one factor is responsible for acne. The cause of acne is yet to understand properly. Though stress can make acne severe, it clearly does not cause it.
Acne happens when oil (sebaceous) glands emerges around puberty stimulated by the secretion of male hormones from the adrenal glands of both boys and girls. During puberty, both boys and girls produce high levels of androgens, the male sex hormones that consist of testosterone. Testosterone instructs the body to make more sebum, a waxy substance that retains skin moisture. Oil is a natural substance to lubricate and protect the skin, and under certain circumstances, cells close to the surface, block the pores of sebaceous glands and produce oil underneath.
This oil from sebaceous glands stimulates bacteria, living in everyone’s skin but generally cause no problems, to increase in number and cause surrounding tissues to become inflamed. . Excess sebum clogs the openings to hair follicles; especially those on the face, neck, chest, and back. Now bacteria grow in these clogged follicles causing blackheads or whiteheads on the skin’s surface. This is called non-inflammatory acne. Sometimes the follicle wall breaks under the pressure of this growth. Under these circumstances, sebum leaks into nearby tissues and gives birth to a pustule. This is known as inflammatory acne which can create cysts. Ruptured cysts can even leave temporary or permanent scars.
If the inflammation happens right near the surface, you get a pustule; if it’s deeper, a papule (pimple) appears; deeper still and it’s a case of cyst. If the oil breaks through to the surface, it causes “whitehead.” If the oil becomes oxidized (that is, acted on by oxygen in the air), the oil color changes from white to black, resulting in a “blackhead.”
Some factors that don’t usually cause acne, at least by themselves are:
Heredity: Apart from very severe acne, most people do not suffer from the problem exactly as their parents did. Almost everyone comes across acne at some point in their life.
Food: Although parents constantly tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food which they believe can cause acne or aggravate it, in reality they don’t cause acne or make it worse but yes, these foods are not good for overall health.
Dirt: Some individuals posses more “oily” skin than others. But let you know that sweat does not cause acne; therefore, there is no point to have a bath instantly after exercise fearing that sweat will clog pores. On the other hand, you must remember that excessive washing can dry and cause irritation to the skin.
Stress: Some people become so depressed due to their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct part in causing acne.
Hormones: Some oral contraceptive pills may help relieve acne, unless a woman suffer from abnormal menstrual periods and excessive hair growth, it’s unlikely that hormones play much of a role in causing acne.
Cosmetics: Most of the cosmetics and skin care products are not pore-clogging (“comedogenic”). At present many brands are available in market but those which are labeled as “water-based” or “oil-free” are generally a better choice.
In occasional patients, contributing factors may be:
Pressure: In some patients, pressure from helmets, chinstraps, collars, and the like can increase acne.
Drugs: Some medications may cause or aggravate acne, especially those that contain iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids that bodybuilders or athletes take). Most cases of acne, however, are not related to drugs.
Occupations: In some jobs, exposure to industrial products such as cutting oils may produce acne.
Types of acne:
Acne neonatorum and acne infantum occasionally affect newborns and infants, generally boys. A pimply rash appears on the face but usually comes round within weeks with no long-term effect.
People who spent their teen years almost pimple free may develop persistent adult-onset acne as they age. In spite of the normal raise in androgen levels during puberty, some doctors believe that acne depend less on androgen levels than on how a person’s skin responds to an increase in production of sebum.
The bacteria Propionibacterium acnes and Staphylococcus epidermidis occur naturally in healthy hair follicles. But if too many of these bacteria gather in plugged follicles, they may secrete enzymes that break down sebum and cause inflammation. Some people are simply more susceptible than others to this reaction. Sebum levels that might cause a pimple or two in one person may result in widespread outbreaks or even severe cystic acne in another person.
Dermatologists classify acne into four types or grades. Acne grade is determined only by a visual inspection of your skin.
|GRADE I||Mildest||Minor pimples; blackheads and milia may occur but with no sign of inflammation.||Commonly found in early adolescence||Nose and/or forehead.|
|Grade II||Moderate||Blackheads and milia come out in greater numbers.||Teenagers||Nose, forehead and other areas of skin; may also affect the chest, shoulder and back (especially in men).|
|Grade III||Severe||Amount of inflammation is very high; skin becomes completely reddened and inflamed.||Teenagers and adults||Neck, chest, shoulder, upper back and face.|
|GRADE IV||Most Severe (Cystic Acne)||Very painful in nature. The skin displays numerous papules, pustules and nodules along with cysts. Most of the cystic acne sufferers develop scarring.||Adult||Spreads beyond the face and affect entire back, chest, shoulders and upper arms.|
Common pimple needs no treatment. Water based Over-the-counter cover-up creams and cosmetics are preferable. Though outbreaks of acne cannot be eliminated completely, conventional treatment can at least provide relief.
The best treatments reduce sebum production, control bacterial growth, or encourage shedding of skin cells to unclog pores. As many therapies can have serious side effects, patients with acne should continue with caution when trying a new treatment. People with severe, persistent cases of acne need to consult a dermatologist.
Prescription Treatments for Acne
Antibiotics: Antibiotics may be applied on the surface of the skin (topical) or taken orally (systemic). Antibiotics clear the skin of acne-causing bacteria and reduce inflammation. These days there are several topical products available in creams, gels, pads, and lotions. While topical antibiotics are limited in their ability to enter the skin and clear more deep-seated acne, systemic antibiotics circulate throughout the body and enter into sebaceous glands thus causing more side effects than topicals, but they can be used for more severe kinds of acne. Generally, topical antibiotics aren’t suggested alone as an acne treatment because they can heighten the risk for antibiotic resistance in skin bacteria. However, using benzoyl peroxide with a topical antibiotic may decrease the chances to developing antibiotic resistance. Oral antibiotics such as Azelex, Finacea, and Finevin, Erythromycin, Clindamycin, Klaron etc. for acne, should not be used during pregnancy. Some antibiotics may reduce the impact of oral contraceptives, risking a pregnancy during treatment.
Retinoids or vitamin A derivatives: These drugs are available in the form of topical or oral drugs. Topical retinoids heal moderate-to-severe acne by normalizing the way the skin grows and sheds. They can be used combined with other acne products, such as benzoyl peroxide, and oral antibiotics. Topical retinoids don’t have the severe side effects of oral retinoids; still they aren’t prescribed for pregnant women. Side effects of topical retinoids are- redness, dryness, and itchy skin. Topical retinoids include:
For severe cystic acne, isotretinoin (Claravis, Sotret, and Amnesteem) proves to be the most effective therapy and the only medication that intervenes in all of the causes of acne. It can often even heal severe acne that hasn’t responded to other treatments. However, the product can have serious side effects. It can also cause severe birth defects and must not be taken by a pregnant woman or who is not using contraception. But it can’t be taken by a woman who is breastfeeding. Its use has been related with an increased risk of severe depression and suicide.
Oral contraceptives: Oral contraceptives are female hormones that minimize the effect of male hormones (such as testosterone) on acne. But their use is limited to female patients. Oral contraceptives containing estrogen (such Estrostep and Ortho Tri-Cyclen 28) are also effective. The maximum benefit of oral contraceptives on acne is visible in three to four months. The side effects include:
A common treatment option is to inject triamcinolone (which is a type of corticosteroid), directly into the cysts. This treatment may turn some patients’ skin temporarily darkened around the lesion.
Some adults may have scars or pitted skin from cysts or deep pimples that were scratched or severely inflamed. Two relatively aggressive surgical procedures can recover the skin’s appearance. These are: dermabrasion, in which a dermatologist essentially sandpapers skin, and chemical peeling. Both procedures eliminate the scarred surface and expose clear skin layers. Before adapting such treatment it is essential to discuss the procedures, necessary precautions, and likely results with at least two dermatologists. Dermatologists also seldom use glycolic acid and other chemical peels to loosen blackheads and reduce pimples. Mark that Microdermabrasion has little effect on acne itself.
Non Prescription Treatment
Benzoyl peroxide: For mild acne, you may go for, or your doctor may recommend, treatment with a nonprescription medicine containing benzoyl peroxide. It’s believed that this compound destroys the bacteria related to acne. It usually takes at least 4 weeks to work and it must be used persistently to keep acne at bay until you outgrow getting acne. This happens because it does not influence sebum production or the way the skin follicle cells are shed, so when you stop using it, the acne reappears. It is available in a wide range of products: creams, lotions, washes, and gels. Benzoyl peroxide can lead to dry skin and can bleach fabrics, so be careful when applying it. Put on an old t-shirt to bed if you are applying it to your back or chest overnight.
Salicylic acid: Salicylic acid helps to correct the unusual shedding of cells. In case of milder acne, salicylic acid helps unclog pores to resolve and avoid lesions. It does not have any effect on sebum production and does not destroy bacteria. It must be used continuously, just like benzoyl peroxide, since its effects come to an end when you stop using it. Consequently, pores clog up again and the acne comes back. Salicylic acid is found in many acne products, including lotions, creams, and pads.
Sulfur: Along with other substances including alcohol, salicylic acid, and resorcinol, sulfur is an ingredient of many over-the-counter acne medications. It generally isn’t used by itself because of its distasteful odor. It’s still not clear how sulfur works.
Resorcinol: Apart from sulfur, resorcinol is a component of many of the most popular over-the-counter acne products.
Alcohol and acetone: Alcohol is a mild anti-bacterial agent and acetone can eradicate oils from the surface of the skin. These substances are used in some over-the-counter acne medicines. These agents have mild or no effect on acne.
Herbal, organic, and “natural” medications: There are many herbal, organic, and natural products applied to treat or prevent acne. The effectiveness of these agents is yet to prove and they are unlikely to have much help.
Natural Therapy: Though the result is not proved some raw natural products may cure the problem of acne.
Peppermint is preferable to spearmint as a medicinal herb. It contains menthol. Meant Leaves contains menthol which works as a natural analgesic and anti-inflammatory. Though a strong reaction is improbable, stop using it if it irritates your skin.
The gel of the aloe Vera plant has a cooling, soothing effect on acne sores. It is also known as a natural antibiotic. Aloe Vera gel is good for acne for two main reasons- it immediately soothes the skin and is a mild anti-inflammatory. Secondly, aloe Vera is a natural antibiotic – it cleans the skin and limit bacteria.
The oatmeal cleanses your pores as it absorbs oil and exfoliates the skin.
Honey eases application and works as a skin toner.
Lemon juice is considered a natural astringent and mild antibacterial agent.
Rose petals, from which rose water is made, also contain antibacterial properties. It is also a good skin toner and helps to alleviate the rather harsh, acidic quality of straight lemon juice. Be careful of exposing your skin to direct sunlight if you have applied lemon juice on your skin. Though a strong reaction is unlikely, stop continuing this treatment if it irritates your skin.
Cosmetic Procedures: Skin Care for Acne-Prone Skin
Acne may appear in your teen years, when age and hormones meet to cause those awful breakouts. Or, you may have acne breakouts in your adult years also.
Many people find acne troublesome or embarrassing. To reduce acne and its damage to your skin, follow these guidelines:
Cleanse your face gently with soap and water no more than two or three times a day can. It can remove the excess oils and help the “oily skin” from getting acne. However, this does not clear up acne that is already there. Remember harsh scrubbing can injure the skin and cause other skin related problems.
Choose a cleanser which is especially formulated for acne. These products often contain salicylic acid or benzoyl peroxide, which help clear acne sores.
Clean your face gently, as trauma to the acne breakouts may deteriorate the acne or may also cause scarring. When cleansing your face, use your hands, as any terrycloth or other scrubbing material may cause acne sores to rip apart.
If you feel the need to use a moisturizer, use only light, non-comedogenic moisturizers, which do not worsen acne. There are also oil-free moisturizers on the market containing anti-bacterial agents for acne-prone skin. This type of product may be the finest option.
If you are a woman, go for an oil-free foundation. Avoid heavy makeup or other cosmetic products that block pores and may cause a flare-up of acne.