Acne, also known as acne vulgaris, is a common skin disorder characterized by red pimples or zits affecting the face, back, chest and shoulders. Teenage boys are more commonly affected than girls but it can occur at any age in both genders.
It is a non contagious inflammatory disorder involving hormones, inflammation and oil glands at the base of hair follicles. It is characterized by eruptions of varying intensity that may or may not cause scarring.
Types of Acne
The types of acne based upon its clinical signs are:
- Blackheads– They are blackish spots seen on the surface of the skin. They occur when skin debris and oil combine and block the follicle. It is visible open.
- Whiteheads- Also known as comedones they are usually invisible and closed
- Papules: Also known as pimples they are small pinkish swellings or bumps that appear on the skin
- Pustules: They are small pus-filled bumps found on skin with a pink base and pus-filled top. They may later develop into Nodules and Cysts.
- Nodules: They are painful large bumps found in the deeper layers of the skin
- Cysts: They are large, painful, fluid-filled eruptions, which usually leave a scar.
Acne breakout because of the blocked pores. There are numerous tiny pores on the face associated with hair follicles. The sebaceous glands open into the hair follicles. The sebum produced by sebaceous glands and the dead skin cells (keratin) clog inside the follicles and is not brought to the surface of the skin. The clogging of pores results in acne. The bacteria Propionibacterium acnes multiply inside these pores, and it results in inflammation that leads to rupture of follicles.
Factors that Worsen Acne
- Teenagers are prone for acne. During puberty, there is a surge of androgens. The androgens stimulate the oil producing glands or sebaceous glands to produce more sebum resulting in an increased outbreak of acne.
- Hormonal problems- When the male hormone levels are high in females it causes acne. It can also occur in association with the menstrual cycle in females. Polycystic Ovarian Syndrome is a syndrome in women associated with hirsutism, hormonal imbalances, and acne.
- Psychologically stressful states
- Genetic factors
- Environmental conditions such as high humidity
- Cosmetics that are oily in nature, medications such as steroids, antiepileptics, lithium)
- Pressure from helmets, tight collars, headbands, etc
Diet and Acne
Studies conducted in the past have confirmed the association of acne and diet. Recently it has been found that food with high glycemic index can aggravate and even trigger acne. Such food intake increases the blood sugar rapidly which causes the release of insulin in large levels. Insulin in turn stimulates the oil producing glands of the face resulting in increased sebum production and clogging. Milk and dairy products also aggravate acne. Processed milk and milk products are much more harmful. Studies have confirmed fewer outbreaks of acne among communities and regions consuming food with low glycemic index.
Treatment Depends Upon Severity of Acne
Acne occurs in different severities. The grades of acne according to the severity are:
- Grade1 (Mild): There are only a few blackheads and whiteheads
- Grade2 (Moderate): Blackheads, Whiteheads, multiple pustules and nodules limited to the facial area.
- Grade 3 (Moderately Severe): Numerous papules and occasional nodules on the face and back.
- Grade 4 (Severe): Painful multiple outbreaks of papules, pustules and nodules on the face, back, and chest.
Aim of treatment is to:
- Control its occurrence
- Reduce inflammation
- Prevent severe form of nodular or cyst formation.
- Avoid Hyer-pigmentation
- Avoid scarring
- Clear the skin by reducing the visibility of the scars
Acne treatments are categorized as:
- Topical treatment- for local application
- Oral medication –for internal use
Treatment of Mild to Moderate Acne
Nonprescription or over the counter solutions are usually initiated for mild acne treatment. OTC options such as creams, lotions and soaps containing topical medications are generally used to control acne and clear the affected skin. these lotions and soaps when used on a regular basis for 4-8 weeks are effective in controlling acne, overnight results should not be expected.
It is the most commonly used topical medication for acne available as a cream or gel. Benzoyl peroxide helps in reducing the oil produced by the sebaceous glands. It also kills the bacteria in the follicles. It has a bleaching effect and, therefore, adequate protection from the sun is required when applied. It is usually applied on the cleansed surface twice daily. It reduces and clears the skin of whiteheads and blackheads.
Benzoyl Peroxide also has excellent anti-inflammatory and antiseptic property. Being an excellent peeling agent, it renews the skin by increasing its turnover rate. It usually takes six weeks for the acne to reduce with topical benzoyl peroxide.
Salicylic acid is an antiseptic that has excellent anti-inflammatory property. It helps in removing whiteheads and blackheads and also decreases the oil release from the sebaceous glands. Salicylic acid accelerates the turnover of cells and increases the growth of new cells. It thus prevents the clogging of pores and reduces the swelling.
Sulfur has been in use in skin treatments of various diseases for many years. It oxidizes to sulfurous acid which acts as a reducing and antibacterial agent.
These are topical lotions or creams that are derivatives of Vitamin A. Tretinoin, adapalene and tazarotene are commonly used retinoids. These are applied once daily at night time. It helps in skin exfoliation, and it is an excellent peeling agent. It renews the skin and avoids clogging of hair follicles with skin debris. It is essential to protect from harmful sun rays while using it, and it is advised to be avoided in pregnant patients as it may cause birth defects.
It is used as an alternative to benzoyl peroxide. It kills the bacteria in the follicles and strengthens the cells lining the hair follicles reducing the oil expulsion. Azelaic acid also helps in removing skin debris and worn out cells. It is applied once or twice daily depending upon the skin, and it does not make the skin sensitive to the sun.
Other topical medications used for removing whiteheads and blackheads are Resorcinol and Dapsone. The topical medications are available as gels, creams, lotions and pads. Initially it may cause a slight burning sensation and redness, which does not persist. It may take about six weeks for them to be effective.