Acne : Types, causes and treatment

What is acne

Acne is a prevalent skin condition resulting from the clogging of hair follicles beneath the skin. Sebum, an oil that prevents skin dryness, and dead skin cells combine to block pores, leading to the development of lesions commonly known as pimples or zits. While facial outbreaks are common, acne can also affect the back, chest, and shoulders.

This inflammatory skin disorder involves sebaceous glands connected to hair follicles containing fine hair. In healthy skin, sebaceous glands produce sebum, which exits through pores onto the skin surface. Keratinocytes, a type of skin cell, line the follicle. In acne, a combination of hair, sebum, and keratinocytes causes blockage within the pore, preventing normal shedding of skin cells and inhibiting sebum from reaching the skin surface. This mixture creates an environment for bacteria to thrive, leading to inflammation characterized by swelling, redness, heat, and pain. When the follicle wall breaks down, it releases bacteria, skin cells, and sebum, resulting in lesions or pimples.

While acne typically resolves by one's thirties, some individuals in their forties and fifties may continue to experience this skin issue.

Who get acne

Acne can affect individuals of all races and ages, but it is predominantly common in teenagers and young adults. During adolescence, acne is more prevalent in males. However, it can persist into adulthood, with a higher incidence in women.

Types of acne

Acne manifests in various lesion types, including:

1. Whiteheads:

 Plugged follicles beneath the skin, forming white bumps.

2. Blackheads:

Follicles that reach the skin surface, appearing black due to air discoloration of sebum, not dirt.

3. Papules:

 Inflamed lesions, presenting as small, pink, and tender bumps.

4. Pustules or pimples:

Papules with white or yellow pus-filled tops, often red at the base.

5. Nodules:

Large, painful solid lesions deep within the skin.

6. Severe nodular acne (or cystic acne): 

Deep, painful, pus-filled lesions requiring attention.

Causes of acne

Acne development is attributed to one or more of the following factors:

1. Excessive oil production in pores.

2. Accumulation of dead skin cells in pores.

3. Proliferation of bacteria in pores.

Risk factors for acne include:

Hormones:

Increased androgens, male sex hormones, during puberty enlarge sebaceous glands and boost sebum production. Hormonal changes in pregnancy can also trigger acne.

Family history:

There's a potential genetic predisposition, with a higher likelihood if parents had acne.

Medications:

Certain drugs, including hormone-containing medications, corticosteroids, and lithium, can contribute to acne.

Age:

Although acne can affect individuals of all ages, it is more common in teenagers.

Factors that do not cause acne but may exacerbate it include:

 Diet:

While some studies suggest a potential link between certain foods and acne, research is ongoing.

 Stress:

While not a direct cause, stress may worsen acne.

 Pressure from sports gear, tight clothing, or backpacks:

External pressure on the skin can exacerbate acne.

Environmental irritants:

Factors like pollution and high humidity may worsen acne.

Squeezing or picking at blemishes:

 This can aggravate existing acne.

Aggressive skin scrubbing:

Scrubbing the skin too hard can worsen acne symptoms.

Diagnosis of Acne

To diagnose acne, healthcare providers typically:

1. Inquire about Family History:

Obtain information about family history, with a focus on menstrual cycles for girls or women.

2. Assess Symptoms:

Gather details about the duration and specific symptoms of acne.

3. Review Medications:

Ask about current or recent medications, as certain drugs can be associated with acne.

4. Skin Examination:

 Conduct a thorough examination of the skin to identify the type of acne lesion present.

5. Lab Work:

In some cases, order laboratory tests to rule out other medical conditions or disorders that could be contributing to acne.

Treatment of acne

The treatment goals for acne aim to heal existing lesions, prevent new ones, and minimize scarring. Medications address various factors contributing to acne, such as abnormal cell clumping, elevated sebum levels, bacteria, and inflammation. Your doctor may recommend over-the-counter or prescription medications for oral or topical use. You may also like 10 Effective Acne Solutions  to get a confident look.

Topical Medications:

1. Benzoyl Peroxide:

Available over-the-counter, it kills bacteria and may reduce sebum production.

2. Antibiotics:

Often used in conjunction with other topical to combat bacterial growth.

3. Retinoids:

Derived from vitamin A, they treat lesions, reduce inflammation, prevent acne formation, and aid in scarring.

4. Salicylic Acid:

Breaks down blackheads and whiteheads, reducing cell shedding in hair follicles.

5. Sulfur:

 Assists in breaking down blackheads and whiteheads.

Topical medications come in various forms, including gels, lotions, creams, soaps, and pads. Some individuals may experience side effects like skin irritation, burning, or redness. It's crucial to discuss any side effects with your doctor.

In some cases, doctors may prescribe oral medications for acne treatment, including:

1. Antibiotics:

Slowing or halting bacterial growth and reducing inflammation, often recommended for moderate to severe acne, including severe nodular or cystic acne.

2. Isotretinoin:

 An oral retinoid that circulates in the bloodstream, treating acne and facilitating the opening of pores. This enables other medications, like antibiotics, to reach the follicles. Similar to topical retinoids, oral isotretinoin can prevent acne formation and aid in scar reduction.

3. Hormone Therapy:

Primarily used in women, it helps counteract the effects of androgens on the sebaceous gland.

4. Corticosteroids:

 Lowering inflammation, corticosteroids are used in severe acne cases, including severe nodular acne.

For individuals with severe acne or unresponsive acne scarring, additional treatments may be recommended, such as:

1. Laser and Light Therapies:

Ongoing research is exploring the optimal types and doses of light for effective acne treatment.

2. Corticosteroid Injections:

Direct injection into affected skin areas.

3. Superficial Chemical Peels: 

Recommended and applied by a doctor to the affected area.

4. Acne Scar Filling:

Utilizing substances to enhance the appearance of acne scars.

5. Microneedling:

 Treatment with tiny needles to promote healing.

6. Surgical Procedures:

Interventions to address and repair scarring.

For individuals with significant scarring, especially in people of color, skin discoloration may occur after acne heals. Doctors can suggest treatment approaches to fade existing dark spots, emphasizing the importance of using sunscreen outdoors for treating and preventing dark spots.

Health care providers who can diagnose and treat acne include:

1. Dermatologists:

Specializing in skin, hair, and nail conditions.

2. Primary Health Care Providers:

 This includes family doctors, internists, or pediatricians.

Tips for Living With Acne:

1. Gentle Cleansing:

 Use a mild cleanser in the morning, evening, and after intense exercise. Avoid strong soaps, astringents, or rough scrub pads. Rinse with lukewarm water.

2. Hair Care:

Regularly shampoo your hair, especially if it tends to be oily.

3. Avoid Touching Lesions:

Refrain from rubbing or touching skin lesions to prevent scarring or dark blotches.

4. Careful Shaving:

 Use a sharp blade, soften hair with soap and water before applying shaving cream, and shave gently to reduce the risk of nicking blemishes.

5. Sun Protection:

Use sunscreen to prevent sunburn, especially as some acne medications can increase sun sensitivity.

6. Cosmetic Choice:

Opt for oil-free cosmetics and hair care products labeled non comedogenic to avoid clogging pores. However, be aware that some individuals may still experience worsened acne with these products.

7. Emotional Well-being:

Acne can impact self-esteem. If you experience feelings of embarrassment, shyness, or anxiety, consider discussing them with your doctor.