Acne

What is acne?

Acne, commonly known as pimples, is an inflammatory skin condition primarily affecting the sebaceous glands. It typically appears on the face but can also manifest on the arms, back, and chest.

How Does One Get Acne?

Acne development involves four main factors:

1. Excess Sebum Production: Post-puberty, hormones stimulate the skin’s oil glands to produce more sebum.
2. Clogged Pores: Dead skin cells, bacteria, and sebum can block the pilosebaceous follicles, resulting in blackheads (open comedones) or whiteheads (closed comedones), depending on whether the plug stays below the skin’s surface.
3. Bacterial Involvement: The bacterium Propionibacterium acnes (P. acnes) causes inflammation in the pilosebaceous units and initiates comedone formation.
4. Inflammation: This leads to the formation of large, solid bumps, pustules, and cysts filled with fluid.

What aggravates acne?

Several factors can worsen acne:

1. Genetic Factors: A person’s susceptibility to acne and its severity can be influenced by their genetic makeup. Severe acne often runs in families.
2. Hormonal Changes: Hormonal fluctuations, particularly before menstruation, can aggravate acne.
3. Cosmetics and Skin Products: Oil-based cosmetics and certain skin treatments like facials and bleaching can trigger acne outbreaks.
4. Polycystic Ovarian Syndrome (PCOS): This condition, characterized by multiple ovarian cysts, can lead to acne, irregular menstrual cycles, weight gain, and hair loss on the scalp.
5. Medications: Certain drugs, such as steroids, anti-tubercular medications (isoniazid), and anti-epileptics (phenobarbitone), can cause acne-like eruptions.
6. Topical Steroids: Misuse of topical steroid creams, often marketed as fairness creams, can cause acne.
7. Diet: While acne is not caused by specific foods, high-glycaemic foods (like pastries and sweets) and dairy products (such as cheese, paneer, butter, and ghee) can worsen the condition. Whey protein, commonly used in bodybuilding, can also exacerbate acne.
8. Stress: Both emotional and physical stress can aggravate acne.
9. Dandruff: There is a common association between dandruff and acne.

How Does Acne Appear?

Acne typically begins at puberty, affecting teenagers and young adults, though it can occur at any age. It often subsides by the mid-twenties but can persist or start afresh in adulthood, particularly in women. Acne lesions, which can be found on the face, arms, chest, back, and buttocks, include comedones (blackheads and whiteheads), red raised lesions, pus-filled lesions, and painful swellings. Dermatologists grade acne as mild, moderate, or severe based on the predominant type of lesions.

Why Should Acne Be Treated?

Acne can be effectively treated at any stage. Early consultation with a dermatologist can prevent post-acne scarring.

How Should One Care for Acne-Prone Skin?

1. Wash the face 3-4 times daily with soap-free cleansers and water.
2. Cleanse the scalp 2-3 times weekly to prevent dandruff.
3. Avoid greasy cosmetics; opt for non-comedogenic products.
4. Refrain from squeezing or picking at pimples to prevent scarring.

What Are the Treatment Options for Acne?

Treatments include topical medications (applied to the skin) and systemic medications (taken internally):

1. Topical Treatments: These include benzoyl peroxide, retinoids, azelaic acid, and antibiotic creams (like clindamycin). These treatments may initially cause irritation or dryness.
2. Systemic Treatments: These include antibiotics (azithromycin, doxycycline, minocycline, and tetracyclines), retinoids (isotretinoin), and hormonal therapy (oral contraceptive pills, anti-androgens). Most patients may require a combination of therapies.
3. Other Treatments: Chemical peels, laser therapy, and other technologies may be used for more effective treatment.

How Should Scars and Blemishes Be Treated?

Preventing scars through early and proper treatment is ideal. For existing marks, chemical peels (such as glycolic acid and salicylic acid peels) can be beneficial. Dermatologists may also use treatments like microdermabrasion, derma rollers, fractional lasers, and subcision for scars. Keloidal scars might need intralesional injections or cryotherapy.

Can Acne Recur?

Acne can clear up completely, but it can also recur. Factors that may trigger a recurrence include hormonal changes, the use of certain cosmetics, emotional stress, application of topical steroids, certain systemic medications, and dietary influences.

Why Should We Treat Acne?

While acne may eventually resolve or subside, it might not clear up on its own and can result in pus-filled lesions and large swellings that can leave permanent, disfiguring scars if untreated. Acne can also lead to poor self-image, depression, and anxiety. Therapy recommendations and counselling from a dermatologist can help alleviate both the physical and psychological effects of acne.