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.
Treatment of Severe Acne
When the acne do not subside with topical treatment or when the acne is severe in nature, it is recommended to consult a dermatologist. The dermatologists after examination and taking a detailed medical history prescribe drugs. They might prescribe the topical solutions mentioned above in combination with oral medications to treat acne.
Topical or oral antibiotics are prescribed. The antibiotics commonly prescribed are Tetracyclines and Erythromycin. Antibiotics reduce the bacterial load thereby reducing the inflammatory process. The antibiotics kill the Propionibacterium acnes that reside on the skin. Topical antimicrobials prescribed by dermatologists are sodium sulfacetamide, erythromycin, and clindamycin.
It takes about six weeks for the acne to reduce, and the prescribed antibiotic course may extend to a period of 6 months depending on the severity. The dermatologists may taper the doses as the condition improves to prevent antibiotic resistance. It is found to be effective when Benzoyl Peroxide is combined with antibiotics, I also effectively reduces the acne and reduces the chance of developing antibiotic resistance. Tetracyclines are contraindicated in pregnant women, for whom Erythromycin that is safe in pregnancy can be prescribed.
Contraceptive Pills in Combination:
A combination of contraceptive pills such as progesterone and estrogen is given to women, even when they are not active sexually. These combination pills can reduce severe acne in women that occur during periods or in association with hormonal imbalances like Polycystic Ovarian Syndrome. It helps to reduce the excessive acne eruption but may make acne worse. The therapy may extend to one year.
Anti-androgens are also effective in women. They are prescribed when the oral antibiotics are not successful in reducing acne. It helps to reduce the effect of androgenic hormones over the glands, thereby reducing the excessive sebum production.
Isotretinoin is prescribed only as the last line of treatment when all others are ineffective. It prevents acne by reducing the sebum production, by preventing clogging of follicles and reducing the bacterial production. It also has anti-inflammatory properties thereby reducing the swelling. It is one of the most effective drugs for acne treatment, but because of the potential side-effects it is prescribed strictly and last by the dermatologist.
People under this treatment are recommended to take the Food and Drug Administration safety monitoring program. It can cause inflammation of lips, eyes, eyelids, nostrils and elevated sugar levels. It can cause blood to appear in the urine. Rarely it may cause liver and kidney disease. It can cause birth defects, therefore, contraindicated in pregnant women and women of childbearing age.
Steroid injection is very effective for severe acne-cyst treatment. The corticosteroid when injected into the cyst, will reduce the inflammation, and enhances the healing process. It heals with less scarring.
Drainage and Extraction:
This procedure is used for removing whiteheads, blackheads and large acne cysts with a pencil-shaped instrument. This procedure helps ease pain and is commonly used to clean out blackheads and whiteheads when the cysts do not respond to topical or oral medication. It is not a desirable way of treating acne as it causes scarring.
This therapy is one in which light is used to reduce acne. It can be done in a doctor’s office, or it can be done by self with a handheld device. This therapy requires further research, and it is not yet emerged as a fool-proof method for acne reduction.
This therapy involves treating the skin with an antiseptic or chemical solution. The skin is peeled, and new cells come to the surface. It is very effective when it is combined with other acne treatment for blackheads and pustules. It is contraindicated to consume oral retinoids together with chemical peeling as it causes skin sensitivity and skin damage.
Alternative Medicine for Acne
Medical treatments, other than standard medical practices are known as alternative medicine. These forms of alternative medicine therapies are reported to be effective, but further studies of their long-term safety and efficacy are to be conducted. Some of them found to be important in acne prevention are the application of lotions containing zinc and green tea extract. Tea tree extract in the form of gels is also found to be very effective.
Citrus fruit extracts contain alpha hydroxyl acid. This natural acid is also found to reduce acne by preventing clogging of pores. A similar effect is exerted by azelaic acid extracted from whole grains. Aloe vera also reduces acne problems when combined with retinoids.
15 Must Do Lifestyle Measures for Acne Prevention
- The face should be kept clean by washing the face two times a day using warm water. Mild soaps and cleansers should only be used. Soaps with anti-acne formulations are also used for a long term to yield better results. Harsh scrubs and soaps should be avoided. People use strong soaps to remove dirt, but dirt causing acne is only a myth.
- It is must to the skin after every wash. Different moisturizers are available for different skin types. For dry skin, a cream based moisturizer should be used and for oily skin gel based moisturizer is recommended.
- Use products that are non-greasy and oil free. Do not use harsh scrubs, cleansing granules, astringents, cosmetics, sunscreens and foundations. These may irritate the skin causing more scarring and inflammation. Do not allow your face to dry up excessively, at the same time the face should not be oily too.
- Use a sunscreen that is non-comedogenic to protect from the harmful rays of the sun. Certain medications make the skin sensitive to sun and UV rays can worsen the acne. Therefore it is recommended to use a good quality oil free sunscreen lotion.
- Make sure that the hair is always clean, oil and dandruff free. All these may irritate the skin worsening acne problem.
- Avoid touching, squeezing and pricking the acne. It causes scarring and skin blemishes.
- It is also recommended to wash and change the pillow covers regularly or weekly to keep the face free of acne. The pillow covers come in contact with the oil and dirt of face, which might worsen the acne problem
- Care should be taken to remove cosmetics and makeup before going to bed. A mild cleanser should be used to remove them. If not properly cleansed, the pores get clogged.
- Dietary care it is essential to keep the body well hydrated. It is slightly controversial as to whether water flushes out the toxins or not, but it is a good practice to drink enough water to keep it hydrated
- A balanced diet is essential to maintain a healthy skin. The diet should include fruits, vegetables, nuts, wheat, whole grains, etc. Vitamin A is essential to have a healthy skin. It helps in increasing the skin turnover. Broccoli, spinach, and salmon fish have plenty of Vitamin A that is included in the diet. Evidence suggests that people who have acne problem are deficient in zinc. Therefore the deficiency in zinc can be replenished from the diet. It is also essential to have omega 3 fatty acids in the diet. It also helps in maintaining a good skin turnover. Foods that have high glycemic index should be refrained. Chocolates, milk, dairy products, fast foods, etc. can worsen the acne problem.
- Stress, sleeplessness, and anxious states can trigger acne. Regular exercise and stress-relieving activities should be made a part of the lifestyle. Good sleep and good exercise are therefore required to relax troubled and stressful minds.
- Evidence suggests that alcoholics and smokers have greater outbursts of acne than those who do not indulge in such activities. Cigarettes and alcohol need to be abstained from, if there is an acne problem.
- Boy often use Anabolic steroids for bodybuilding they can make acne worse. Avoid them at all costs
- Once initial acne improves, it is required to continue using topical medications to prevent future acne related problems.
Other than the therapies indicated above, it is also essential to meet the psychological needs of the people affected with acne. People especially the teenagers are affected most by low self-esteem and anxiety. They are into depression because of dark spots, scars, and pimples, that they prefer to stay away from crowds. Such people should be counselled, and their needs should be met.
Acne condition can be treated well by following self-care measures and by consultation of physicians/dermatologists. Regular visits to the dermatologists, maintenance treatment and practicing preventive methods on a long-term basis are essential measures to stop flare ups and ensure an acne free skin.