Acne vulgaris is a very common skin problem where there are different skin lesions like scaly red areas on the skin, whiteheads and blackheads, popular pin head lesions, nodules or larger papules, pimples and finally scarring of the affected area. Most people simply think of it as pimples during the teen years but acne vulgaris is quite a complex skin condition. Acne usually affects those parts of the body that have a higher concentration of oil glands, like the face including the forehead, shoulders, upper arms, upper part of the chest and the back.
It usually occurs in adolescents and about 80% of the teenagers suffer with acne. However, sometimes acne may also occur later in life even during the thirties or forties. Other than scarring, acne may have a negative psychological impact on the affected person. Poor self esteem in the affected person and even severe depression with suicidal tendencies may be seen in some acne sufferers. Fortunately acne can be treated.
Other than face, acne is often found on the shoulders, upper part of chest and back. Sometimes it may even be seen as low down as the buttocks. Acne can present mainly in two forms: non-inflammatory and inflammatory
- Non-inflammatory lesions: Comedones commonly known as blackheads and whiteheads are non0inflammatory lesions of acne. Comedones appear when the openings of the skin glands are clogged with oil secretions, dead skin cells and bacteria. Those which are open at the skin surface are known as blackheads whereas comedones closed at the skin surface are known as whiteheads.
- Inflammatory lesions include papules, pustules, nodules and cysts.
– Papules (pimples) are small bumpy lesions indicating inflammation.
– Pustules are red painful papules filled with pus.
– Nodules are large solid bumpy lesions under the skin.
– Cysts are large nodules filled with pus located under the skin and commonly lead to scarring on the affected area.
Acne is well known to be caused by changes in hormone levels, but there are other factors that contribute to the entire condition. It is a combination of excessive oil production, accumulation of dead skin cells and bacteria on the skin. The reasons why it tends to occur in teens is a result of the rise in androgens (male sex hormones) seen during puberty. Both males and females experience a rise in androgens in the teen years, although males have it at higher levels than females.
Acne occurs whenever dead cells and excessive oil block the opening of the oil glands (sebaceous glands). The oil (sebum) produced by the glands is required for lubrication of skin and hair. Blockage of the openings of the gland leads to a soft plug forming that is prone to bacterial infections. With time there is inflammatory changes in the plug may develop into pus filled lesions pustules or cysts.
Certain factors are known to worsen acne. These are:
- Increased androgen levels in the body especially during puberty.
- Intake of certain drugs like steroids, lithium and hormone medication.
- Certain foods like dairy products and refined carbohydrates (controversial risk factor).
There is a widespread belief that chocolate and greasy foods may aggravate acne but there is no scientific evidence to support the belief. Again contrary to common belief, acne is not caused by dirty skin. While a good skin cleansing regime can help, excessive scrubbing of skin may worsen existing acne.
The goals of acne treatment are to reduce oil production, eradicate the bacterial infection, ease inflammation and increase skin cell turnover. Usually it takes 4 to 8 weeks before acne medications show any visible improvement. Sometimes the skin lesions may worsen during the initial days of using the drug.
Common acne treatments can be applied on the skin (topical) or taken as a tablet/capsule (oral/systemic medication). Locally applied drugs include benzoyl peroxide, salicylic acid, retinoic acid, adapalene and certain antibiotics like erythromycin or clindamycin. Oral medication that are commonly used for acne includes antibiotics and isotretinoin. Sometimes oral contraceptives are prescribed.
Good skin care is important as well. Regular gentle washing and avoiding touching the face or pinching the lesions are helpful and can minimize the chances of scar formation. Acne scarring can be treated with laser, light therapy, dermabrasion and chemical peeling.