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Acne, also known as acne vulgaris, is a common skin condition that causes spots to appear on the skin, usually on the face, neck, chest, and back where most people are affected by it at some point during their life. Acne lesions appear small and is hardly noticeable, have a small white or black head, or can appear red with a white or yellow center.
Acne begins when hair follicles; a small hole in the skin where the hair grows out of, become plugged with oil and dead skin cells. Close to the surface of the skin are sebaceous glands which are tiny glands that are attached to hair follicles. These sebaceous glands perform hair and skin lubrication, in order to stop them from drying out via producing sebum; an oily substance. When excess amounts of sebum are produced, acne occurs. Moreover, the excess sebum mixes with dead skin cells where both of them form a plug in the follicle.
A blackhead forms when a plugged hair follicle stays open causing the oil to turn brown when exposed to air and so it appears somewhat black. On the other hand, a whitehead forms when a plugged hair follicle closes up making the top of the bump looks whiter. When normal flora of the skin; harmless bacteria that live on the skin infects or contaminates the plugged follicles, it results in papules, pustules, nodules, and cysts.
A number of risk factors play a role in causing acne or triggering the worsening of symptoms such as hormonal changes, before the monthly period (in women) or during pregnancy, certain medications, stress, squeezing or picking at skin blemishes and hard scrubbing of the skin.
The symptoms of acne can range from mild to severe. Mild acne usually causes only whiteheads and blackheads whereas severe acne can produce hundreds of pimples that cover large areas of skin. Cystic lesions are pimples that are large, deep, painful and with a possibility of leaving scars. A complication of acne or when the spots are picked or squeezed is called acne scarring.
Examining the skin to assure the presence of acne, followed by a grading given for acne from one to four, where four is considered the most severe acne are necessary for acne diagnosis. Information about women’s menstruation cycles can help decide whether hormones play a role or not.
The grade and severity of acne determine the type of treatment. Medications of acne work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation, which help prevent scarring. In general, four to eight weeks is the time needed for acne to respond to treatment where some cases may even get worse and flare up before getting better. For acne to clear up completely, many months or years are required.
A build-up of sebum and dead cells on the skin surface may increase the risk of blocked follicles and allow bacteria to multiply, but acne is not infectious nor is it caused by poor hygiene. Adapting a good hygiene routine removes the factors causing acne such as dead skin cells and gets rid of contaminants that may provoke the growth of pimples, such as cleaning of the face.
An overall prognosis for acne in people ranks as good. Teen years form the tip of problematic acne but end up in recovery. Scarring occurs when severe acne is left untreated for a long time although scarring is treatable. Acne and associated scarring negatively impact a person's psychological state, worsen the mood, lower self-esteem and could leave the person involved with depression and suicidal thoughts.
According to the US National Institutes of Health (NIH), acne is the most common skin disease. Acne can occur at any age and in all races, including new born babies and people in their forties and fifties. An estimated 80%of all people between the ages of 11 and 30 have acne outbreaks at some point. Nevertheless, it is most common in teenagers and young adults.
Acne is a chronic skin disease that causes pimples to appear anywhere on the skin. They are formed when hair follicles become plugged with oil and dead skin cells which makes it a favorable place for bacteria to grow which can lead to an inflammatory response in the skin. Later on, the plug starts to break down causing a pimple to grow. Anyone can get acne, but it is common in teenagers and young adults. Acne can be small and is hardly noticeable, but can also cause scars.
1) Blackheads and whiteheads
Oil, dead skin cells and bacteria block the skin pores, causing small pimples to appear which are called blackheads or whiteheads. When a plugged follicle stays on the surface of the skin, the oil turns brown when exposed to air; it may seem somewhat black and is called a blackhead. A whitehead occurs when a plugged follicle closes up and stays under the skin surface making the top of the bump look whiter. Blackheads and whiteheads are easy to treat.
2) Papules and pustules
Sometimes the pores get so irritated that their walls break leading to the formation of bigger pimples that are called papules and pustules. Papules are small red, tender and hard bumps. A bunch of papules that are located near each other can make the texture of the skin feel like sandpaper. Pustules or also called pimples are like papules except for a yellowish pus that fills their tips. Papules and pustules are a little tougher to treat.
3) Nodules and cysts
When blocked pores get more irritated, they become larger, deeper in the skin and painful. Nodules appear hard in texture. However, cysts contain pus and are softer, coming to a similar look of boils. It is the most severe form of acne that occurs when oil and dead skin cells build up deep within hair follicles. Both nodules and cysts require a dermatologist intervention. After the disappearance of pimples, they might leave red or dark marks on the skin that will fade, but may take a few days, weeks, or months. Sometimes pimples end up as permanent scars. Scars can be bumps or dents in the skin. A dermatologist can help make some of those scars fade.
Four main factors cause acne:
1) Oil production
Normally, sebaceous glands secrete an oily substance called sebum to lubricate hair and skin. Sebum usually travels along the hair shafts and through the openings of the hair follicles onto the surface of the skin.
2) Dead skin cells
Normally, dead skin cells rise to the surface of the pore, and the body sheds the cells.
3) Clogged pores or hair follicles.
4) Bacteria.
When the body starts to make lots of sebum, the dead skin cells can stick together with sebum inside the pores instead of rising to the surface, which causes acne to appear, forming clogged pores. Sometimes, the bacteria that live on the human’s skin, p. acnes, can also get inside the clogged pore. Inside the pore, the bacteria have a favorable environment for multiplying very quickly, which causes the pore to become inflamed (red and swollen).
Everyone might have been exposed to acne once in their lifetime. Risk factors of acne can vary. However, the following conditions increase the likelihood of developing acne:
1) Age
Adolescence or puberty are when most people have acne, although acne can occur at any age. The sebaceous glands are particularly sensitive to hormones. Newborn babies can get acne.
2) Hormonal changes
Androgens are hormones that increase in production, in boys and girls, during teenage years causing the sebaceous glands to become enlarged and produce more sebum. Hormonal changes that are related to pregnancy and the use of oral contraceptives can affect sebum production. In addition, low amounts of androgens circulating in the blood of women can cause acne to worsen. Furthermore, hormones thicken the inner lining of the hair follicle, causing the blockage of the pores. Cleaning the skin does not help in removing this blockage.
3) Familial trait
Genes play a role in acne, which makes an individual with parents who have suffered from acne more likely to get acne. Genes define whether a person is more prone to develop acne and how severe the case can be. For example, when a case of acne cysts and nodules is present in the family, a person should see a dermatologist to check the possibility of getting acne. These types of acne often have a genetic predisposition.
4) Medication
Side effects of certain drugs like steroids, lithium can cause acne.
5) Greasy foods
Eating greasy food has little to no effect on acne.
6) Greasy makeup
Cosmetics do not necessarily worsen acne, especially when oil-free makeup is used, that does not clog the pores and when makeup is regularly removed.
7) Friction or pressure on your skin
This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
8) Stress
If someone already has acne, stress may make it worse.
9) The immune system
Some people are extra sensitive to the bacteria that get trapped in their hair follicles, which might cause an immune response.
10) Gender
Both boys and girls get acne. Nevertheless, it may be worse in boys because they have more skin oils.
11) Hormonal disorders
Women with hormonal disorders like polycystic ovary syndrome are more likely to get acne.
12) Diet
Studies indicate that certain dietary factors such as dairy products and carbohydrate-rich foods such as bread, bagels and chips may trigger acne.
13) Dirty skin
Dirt does not cause acne. However, it does help to gently remove oil, dead skin and other substances. Scrubbing the skin too hard or cleansing it with harsh soaps or chemicals irritates the skin and can make acne worse.
Acne is a chronic disease involving hair follicles. The sebaceous glands; tiny glands that are found near the surface of the skin attach to hair follicles, and produce an oil called sebum that keeps the skin from drying out. These glands are spread throughout every part of the skin except for the palms of the hands and soles of the feet, and are found most abundantly on the face and scalp.
Clogging the openings of hair follicles causes acne to occur due to dead skin cells, excess sebum production caused by an androgenic stimulation of the sebaceous glands and an increased proliferation of the bacteria, such as Propionibacterium acnes, which normally lives in the hair follicle.
An obstruction of the follicle leads to the formation of the micro-comedo; the precursor of all acne lesions. Once the follicle is plugged, its lower portion becomes stuffed and enlarged with sebaceous discharge and keratinocytes that are the outermost layer of the skin. When the pore opening remains closed, the lesion is called a closed comedo, or "whitehead". The closed comedo is 1-3 mm in diameter and is described as white or flesh-colored, and very slightly raised. An enlargement of the follicle enough to cause it to stretch the pore and expose the trapped matter to air, leads to oxidization, and the characteristic dark appearance of open comedo or "blackheads." Open comedo is described as flat or slightly raised, brown-to-black , and about 3-5 mm in diameter. Sometimes, it appears yellow because of melanin buildup.
Early acne involves a majority of open and closed comedones, and is considered a non inflammatory process. With the continuation of the dilation of the follicle, the follicular epithelium is discontinued, and irritants such as sebum, hair, and keratinocytes are released into the surrounding dermis. This leakage causes an inflammatory reaction and initiates the formation of the inflammatory lesion papules, pustules, and nodules. The follicular structure disruption causes the death of P. acnes . Releasing toxins into the dermis increases inflammation. Therefore, uncomplicated, inflammatory acne is a sterile process and is not a skin infection.
As the inflammation continues to worsen, larger papules and pustules are created. Acne papules are pink or red and 2-5 mm in diameter. Pustules contain pus; a grossly purulent material. Acne nodules are solid, raised inflammatory lesions that exceed 6-10 mm in diameter and are situated deeper in the dermis. The acne cyst is a large nodule that has a discharge and becomes problematic. Scars form as a result of damage to the surrounding dermis. Scars are seen as small deep punched out pits, atrophic macules, hypertrophic papules, or broad, sloping depressions.
Noticeable acne can range from mild to severe and can be red, inflamed, or painful. The signs and symptoms of acne include:
Small black or yellowish bumps that develop on the skin.
Their appearance is similar to blackheads, but may be firmer and will not empty when squeezed.
Small red bumps that may feel tender or sore.
Similar to papules, but with a white tip in the center and is caused by pus build-up.
Large hard lumps that build up under the surface of the skin and can be painful.
The most severe type of spot caused by acne; they are large pus-filled lumps that look similar to boils and carry the greatest risk of causing permanent scarring.
Sometimes people who have acne can encounter these problems:
These dark spots usually appear after acne has healed, which usually take months to years to disappear.
People who get acne cysts and nodules often see scars when the acne clears. Preventing these scars can be done by treating acne before cysts and nodules appear.
In addition to physical symptoms, acne may cause psychological symptoms in patients that may need co-treatment along with acne treatment. These symptoms include:
Many people with acne usually have low self-confidence. They become isolated from their friends, miss school and work, and their grades slide.
Not only do people with acne suffer from low self-esteem, they also can have depression.
To diagnose acne, a dermatologist will first examine the skin in the face, chest and back for different types of spots, such as blackheads or sore, red nodules. The type of lesions and their severity determine the grading of acne, and hence which therapies are given. Dermatologist uses four grades to measure the severity of acne:
This case is restricted to whiteheads and blackheads, with just a few papules and pustules.
It includes multiple papules and pustules that mostly appear on the face.
Papules and pustules are abundant in this case along with the occasional inflamed nodule, where the back and chest are also affected by acne.
Large numbers of large, painful pustules and nodules are present in this case.
Laboratory tests
Acne is clinically diagnosed Laboratory testing are recommended in the following situations:
The most common cause of hormonal imbalances in women is polycystic ovary syndrome (PCOS). A combination of ultrasound scans and blood tests are able to diagnose PCOS.
A skin lesion culture is performed, which is a laboratory test that scans and identifies the germs responsible, and in this case is used to rule out gram-negative folliculitis.
Treatment aims at healing existing lesions, stopping new lesions from forming, scarring prevention, and minimizing the psychological stress and embarrassment caused by this disease.
· Self-help techniques
These techniques prevent the case of acne from becoming worse by avoiding frequent face washing, using a mild cleanser or soap, limiting the use of make-up and not squeezing the pimples. When the problem is a few blackheads, whiteheads and spots, a successful treatment is possible with over-the-counter gels or creams or also called nonprescription.
Stronger topical or oral medications can be prescribed when over-the-counter products do not clear up acne, or when a person has a large number of papules and pustules. The drug recommended by the doctor depends on the type and severity of acne. Prescription medications that can be used to treat acne include:
These products include gels or creams that are used to unblock pores and kill bacteria. For an effective result, they should be applied to clean, dry skin about 15 minutes after washing but the result may require a few weeks to show. In addition, you may notice skin irritation at first, such as redness, dryness and peeling. To overcome these side effects, some steps recommended by the doctors are advised such as a gradually increased dose, washing off the medication after a short application or switching to another medication. Topical treatments include:
1) Benzoyl peroxide
2) Topical retinoids
3) Topical antibiotics
4) Azelaic acid gel or cream
5) Dapsone (Aczone)
1) Antibiotic tablets
They target bacteria and are usually used for moderate to severe acne cases, in combination with a gel or cream. In most cases, a class of antibiotics called tetracyclines such as minocycline and doxycycline is prescribed, with the exception of pregnant or breastfeeding cases. In such cases, erythromycin is the safer alternative. The usual time needed to notice the improvement of the antibiotics is about six weeks and depending on the person’s reaction to the treatment .
2) Isotretinoin
It is found in the form of capsules or tablets and is derived from vitamin A. It is more powerful than the retinoid gel or cream, but shares the same way of action of it.. When other treatments fail to work, isotretinoin is effective in treating severe cases of acne; it reduces the amount of sebum produced which leads to a normal level of production,, prevents follicles from becoming clogged, decreases the amount of bacteria on the skin and reduces redness and swelling in and around spots.
3) Anti-androgen agent
This drug may be prescribed for women and adolescent girls when oral antibiotics are not helping. It includes spironolactone which blocks the effects of androgen hormones on the sebaceous glands. .
4) Combined oral contraceptives
Combined progestin and estrogen oral contraceptives are used in treating acne in women and adolescent girls.
Several treatments for acne do not require medication. These therapies may be recommended either alone or in combination with medications that include:
A small, pen-shaped instrument that can be used to clean out blackheads and whiteheads but could cause scarring.
Repeated applications of a chemical solution to the face, such as salicylic acid, causing the skin to peel off withnew skin replacing it.
Chemical peels should not be combined with oral retinoids because together these treatments can significantly irritate the skin.
Light is applied to the skin, targeting the bacteria causing acne inflammation which can improve the symptoms of acne.. However, these treatments may have no effect and cannot be routinely recommended.
Injecting a steroid drug directly into nodular and cystic lesions which improves their appearance without the need for extraction.
Acne can leave scars which need treatment through the following treatments::
A less noticeable scars is achieved by injecting soft tissue fillers, such as collagen or fat, under the skin and into indented scars that fill out or stretch the skin. .
High-potency acid is applied to the skin in order to remove the top layer, causing the scars to be minimized.
Severe scarring is treated via this method. It involves blending acne scars into the surrounding skin by sanding the surface layer of skin with a rotating brush. .
The appearance of the skin is improved y this technique. This is a skin resurfacing procedure, which uses a laser to improve the appearance of the skin.
It involves using certain lasers pulsed light sources and radiofrequency devices.. These treatments heat the dermis and cause new skin to form, without injuring the epidermis. This treatment requires several treatments for acne scars to become less noticeable.
Punch excision is used; a minor procedure that involves the doctor cutting out individual acne scars and reconstruct the hole at the scar site with stitches or a skin graft.
The number of younger children who are getting acne is increasing, where most studies include 12 years of age or older. A pediatric dermatologist can be consulted when a child has acne. Drugs to avoid in children, appropriate doses, drug interactions, side effects and how treatment may affect a child’s growth and development are essential to know.
1) Talking therapies such as cognitive behavioral therapy (CBT).
2) Using a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs).
Acne scarring can sometimes develop as a complication of acne. Scarring is most common when nodules and cysts exist; the most serious types of acne that burst and damage nearby skin, but any type of acne spot can lead to scarring.,. Avoiding picking or squeezing spots will reduce scars occurrence. There are three main types of acne scars:
They are described as small, deep holes in the surface of the skin that are similar in appearance to skin that has been punctured with a sharp object.
Bands of scar tissue that form under the skin cause this type, giving the surface of the skin a rolling and uneven appearance.
They are round, oval depressions, or craters, in the skin.
Intense feelings of anxiety and stress accompany people with acne making them socially withdrawn, in some cases. This combination of factors can lead to those with acne to become depressed. Depression can be sosevere that people Have thoughts of committing suicide.
Mild acne can avoided or conrtolled with nonprescription products, good basic skin care and other self-care techniques. You can also use these acne-prevention tips:
1) Acne-prone areas should be washed only twice a day in order to remove excess oil and dead skin cells, keeping in mind that washing the skin multiple times can irritate the skin. A gentle cleanser should be used on affected areas. Furthermore, oil-free, water-based skin care products are recommended.
2) An over-the-counter acne cream or gel should be used to help dry excess oil bearin in mind the products choses contain benzoyl peroxide or salicylic acid as their active ingredient.
3) Choose oil-free cosmetics that will not clog pores.
4) Makeup should be removed before going to bed since Keeping makeup on while asleep can clog the pores. In addition, old makeup should be disposed of and regular cleaning of cosmetic brushes and applicators with soapy water is advised.
5) Wearing loose-fitting clothing is recommended especially that tightfitting clothing causes heat and moisture to get trapped which can irritate your skin. When possible, avoid tightfitting straps, backpacks, helmets, hats and sports equipment to prevent friction against your skin.
6) Strenuous activities demand showering afterwards to avoid breakouts caused by oil and sweat on the skin. .
7) Scarring the skin can be avoided by not touching or picking at the problem areas.
The overall prognosis for people with acne is good. Most of the time, acne goes away after the teenage years but can still be present in the middle age. Six to eight weeks is the time needed for the condition to respond to treatment but with possible flare ups from time to time.
The severity of the acne governs the emotional distress and the level of the scarred skin. Earlier treatment can lower therisk of a lasting physical and emotional damage.
Picking acne spots can cause a serious secondary bacterial infections; cellulitis that can spread deep into the skin .
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