Reviewed by DR. D. DATTA.
Ex. Emergency Medical Officer.
Acne is also called Acne vulgaris. It is a very common skin problem. There are sebaceous glands in the skin. Each sebaceous gland produces sebum (oil) which comes out from the skin through a pore. This oil keeps the skin lubricated and soft. When this pore is blocked by dead skin cells or dust this oil cannot come out of the skin and produces acne. Face is the most common site of acne. Acne may also occur in the chest, shoulders and back.
Complications of acne
It may cause anxiety, depression and may reduce confidence. Abnormal healing of acne may lead to scar formation. There may be temporary or permanent hyperpigmentation at the site.
Risk factors for acne
1 Puberty and pregnancy- Teenagers and young adults suffer more from acne due to hormonal changes. Increased androgen level during puberty increases sebum production.
Hormonal changes during pregnancy also cause acne.
2 Family history of acne- Acne is more common in people who have a positive family history of acne.
3 Stress and poor sleep may worsen acne.
4 PCOS (polycystic ovarian syndrome) increases acne.
5 High oil containing beauty products may contain substances that clog the pores and cause acne.
6 Certain medicines- Medicines such as corticosteroid, lithium, isoniazid, testosterone may cause acne.
7 Diet- High glycemic diets and dairy diets may cause acne.
8 Pollution, hot humid climate, sun exposure, and dust in the air can cause acne.
9 Friction or tight pressure of helmet, hat, tight collar etc. can cause acne.
10 Squeezing pimples.
Acne usually tends to go away after the age of 30 years, but in some persons this problem continues even after 30 years. Males are more commonly affected during adolescence and females are more commonly affected during post adolescence periodÂ
Types of acne
Blackheads (open comedones)– when the pores are filled with dead skin cells and dust, but it remains open. Melanin of dead skin cells becomes oxidized and black or dark brown color is produced. Most common sites are nose, chin, shoulders and back. They are also non inflammatory.
Whiteheads (closed comedones)– when the pores are not open, they produce white or flesh- colored tiny bumps. These are not inflammatory and don’t cause any pain. Most common sites are forehead, chin and cheeks.
Papules– tender red or pink bumps. These are inflammatory.
Pustules– white or yellow colored with a red ring at the base. Pustules are inflammatory and contain pus. Scrubbing or self-extraction may cause scarring of skin.
Nodules– hard and tender and deeply situated in the skin. These are inflammatory and red colored. Self-extraction may cause skin scarring.
Prevention of acne
Washing skin once or twice daily with mild warm water and gentle cleanser.
Avoid skin care products that contain alcohol.
Avoid irritating the acne by Squeezing it.
Treatment of acne
Several weeks or a few months treatment is necessary.
Treatment regimen depends upon age, whether the patient is pregnant or not, severity and type of acne.
1 Medicines for topical use-
Topical retinoids- such as tretinoin and adapalene remove dead skin cells and prevent clogging of pores. They are available as lotion, cream or gel. These medicines are applied at night. These are not applied at the same time with benzoyl peroxide.
Side effects of these medicines are dryness and redness of the skin. These medicines increase the sensitivity of skin when exposed to sunlight.
These medicines are not used during pregnancy as they may be harmful to the fetus. A six-week course is usually necessary.
Benzoyl peroxide- It has antibacterial properties that kill bacteria on the skin. It has a bleaching effect. Avoid contact with hair and clothes.
Side effects may be dry skin, itching sensation and redness of skin. It is used for mild acne and takes at least four weeks to start working.
Topical antibiotics- Topical antibiotics kill the bacteria that grow in skin and acne, reducing redness and swelling. Topical antibiotics such as clindamycin or erythromycin in combination with benzoyl peroxide are applied in the morning. These are applied for six to eight weeks to prevent antibiotic resistance.
Azelaic acid- It is available as cream or gel. It has antibacterial properties and kills bacteria on the skin surface. It also removes dead skin. It is used when patients cannot tolerate benzoyl peroxide or retinoids. It is applied twice daily. Azelaic acid does not cause skin sensitive to sunlight.
Side effects may be burning and itching sensation and redness of the skin.
Salicylic acid- It removes the dead cells and opens the pores and prevents clogging.
Dapsone- It is available in gel form applied twice daily. It has antibacterial properties and is used in inflammatory acne.
2 Oral antibiotics – Tetracyclines such as doxycycline or minocycline are used to treat acne. Tetracyclines are contraindicated in pregnancy and breast-feeding women.
Tetracyclines can cause the skin to be sensitive to sunlight and it decreases effectiveness of oral contraceptives. So alternate birth control measures must be taken when using these medicines.
Erythromycin or Azithromycin is used when tetracyclines are contraindicated.
3 Combined oral contraceptive pills are effective in women with acne. These pills contain estrogen and progesterone. Several months of treatment is necessary to see its effects. Common side effects of these medicines are spotting, headache and migraine, nausea, weight gain, breast tenderness.
Cardiovascular problems, breast and cervical cancer, deep vein thrombosis and stroke may also occur.
4 Antiandrogen drug (spironolactone) blocks the effects of androgen and decreases the size of oil producing glands.
5 Oral isotretinoin- It is used in case of severe acne. It is an oral retinoid, shrinks the size of oil glands. It has several side effects including inflammatory bowel disease and birth defects. These drugs must be used under guidance of a doctor.
6 Other treatment
Laser therapy- may improve the condition.
Light therapy- tried with different success rates.
Chemical peel- a chemical solution is applied on the skin to peel off dead skin and replace it with new skin.
