Diseases & Conditions

 

Acne

Diseases & Conditions

 

What is acne?

Acne is a skin condition causing plugged pores and outbreaks of lesions commonly called pimples. It appears on the face, neck, back, chest, and shoulders. Although acne is not physically disabling, it can be a source of significant emotional distress causing low self-esteem, depression, and anxiety.1,2

Although many people experience acne during their adolescent years, it does not affect only teenagers. Indeed, acne prevalence is 70 to 87% in teenagers and persists into the 20s and 30s in around 64% and 43% of individuals, respectively.3

 What causes acne?

The glands that produce sebum (an oily substance) in the skin grow during adolescence and sebum production increases. These glands are found in abundance on the face, neck, back and chest where acne is most likely to occur. Sebum normally travels along the hair shafts and empties via the opening of the hair follicle on the surface of the skin. Sometimes, hair follicles become plugged with sebum and an excess of normal skin cells creating a pimple in the follicle. Bacteria called propionibacterium acne that normally lives on the skin can induce an inflammation causing the pimples to swollen. This can lead to the rupture of the follicle and the formation of a red pimple.

Factors believed to be related to acne formation include:4

  • Hormonal changes like the increase of androgens during puberty cause the glands that produce sebum to become enlarged and produce more sebum in hair follicles.
  • External factors such as cosmetic products especially oil-based can cause breakouts of acne
  • Diet: Some studies have found a weak association between some dietary products (milk and carbohydrate-rich foods) and an increased risk of acne. However, the role of diet in acne is still controversial.
  • Stress: It has been shown that during time of increased stress, students develop acne

Some misconceptions about acne formation include:

  • Poor hygiene does not cause acne
  • Excess sweating does not cause acne
  • Greasy food has little to no effect on acne
  • There is little evidence that chocolate can cause or exacerbate acne

 

What are the signs and symptoms of acne?

Signs and symptoms of acne depend on the severity of the condition and may include:5

  • Whiteheads: Pimples that form under the skin and are caused by blocked pores
  • Blackheads are open to the air, and are black due to the pigmentation of the inner lining of the hair follicle
  • Papules: Small red tender bumps
  • Pustules: Pustules are papules with white tip of pus
  • Nodules: Large painful lumps underneath the skin
  • Cysts: Painful lumps underneath the skin that are filled with pus. These are the most severe type of spot caused by acne

 

How is acne treated?

It is recommended to treat acne with a combination of medications for a minimum of two to three months before the patient can decide if the treatment is effective. Some of the medications are topical which can be applied to the skin.6

  • Topical medications: They are usually prescribed for people with mild signs of acne to be applied directly to the lesion. These topical medications include:
    • Retinoids: These vitamin A derivatives prevent the blocking of hair follicles
    • Antibiotics: Topical antibiotics kill the bacteria and reduce the redness of the skin
    • Dapsone: This is a gel that works best with retinoids
  • Oral medications: They are usually prescribed for people with moderate to severe signs of acne.
    • Antibiotics: Oral antibiotics work to slow the growth of acne-producing bacteria
    • Combined oral contraceptives: Low dose of certain contraceptive pills may help regulate acne in women who have flare-ups before menstruation
    • Anti-androgen agent: This work by blocking the effect of androgen hormones on the glands that produce sebum
    • Isotretinoin: This is a powerful drug with some side effects reserved for patients with severe acne who do not respond to other medications
  • Therapies: These therapies can be prescribed either alone or in combination with other medications
    • Light therapy: Light is applied to the skin in an attempt to improve symptoms of acne by targeting the bacteria that causes the inflammation
    • Chemical peel: This treatment consists of applying a chemical solution to the skin, which makes it peel off
    • Extraction of whiteheads and blackheads: Special tools are used by the dermatologist to remove whiteheads and blackheads
    • Steroid injection: Steroids are directly injected into inflamed nodular and cystic lesions to help reduce the size and pain
  • Treating acne scars
    • Soft tissue fillers: A filler such as collagen or fat is injected directly into acne scars to improve the skin’s appearance
    • Dermabrasion: This is a technique used to remove the upper layer of the in order to improve the appearance of the acne scar
    • Laser resurfacing: This is a technique using a laser to improve the appearance of the skin.

 

References:

  1. Klassen, Anne F., John N. Newton, and Eleanor Mallon. "Measuring quality of life in people referred for specialist care of acne: comparing generic and disease-specific measures." Journal of the American Academy of Dermatology 43.2 (2000): 229-233.
  2. Dalgard, Florence, et al. "Self-esteem and body satisfaction among late adolescents with acne: results from a population survey." Journal of the American Academy of Dermatology 59.5 (2008): 746-751.
  3. Bhate, K., and H. C. Williams. "Epidemiology of acne vulgaris." British Journal of Dermatology 168.3 (2013): 474-485.
  4. Patient information: Acne (Beyond the Basics) (Acne) http://www.uptodate.com/contents/acne-beyond-the-basics (Accessed December 18, 2015)
  5. Acne - Symptoms (Acne) http://www.nhs.uk/Conditions/Acne/Pages/Symptoms.aspx (Accessed December 18, 2015)
  6. Acne (Treatments and drugs) http://www.mayoclinic.org/diseases-conditions/acne/basics/treatment/con-20020580 (Accessed December 18, 2015)