Acne - Causes and Treatment
Acne can be a distressing condition, not only limited to teenagers. Fortunately there are helpful treatments and management methods available.
Acne occurs when sebaceous (oil-secreting) glands in the skin and along hair shafts become clogged, inflamed and infected, which may lead to the formation of pimples. In severe cases, large pimples form firm swellings deep under the skin. They become inflamed and may develop into painful lumps, causing scarring.
Development of acne involves four factors
- Increased oil production,stimulated by androgenic (male sex) hormones. During adolescence, hormones stimulate hair growth andsecretion by the sebaceous glands. The male sex hormone testosterone, which is present in both genders, is mainly responsible, but the female sex hormone progesterone also contributes to acne in women.Other factors that raise hormone levels (e.g. pregnancy, stress, menstruation, certain medicines) can aggravate acne.
- Obstruction of the hair follicle opening.
- Bacterial infection. Some kinds of bacteria occur naturally in hair follicles, but if these multiply excessively they secrete enzymes that break down sebum, promoting inflammation.
- Rupture (breakage of the follicle leading to inflammation).
Stages of acne severity
Blackheads and whiteheads form in the clogged pores. Blackheads are small spots with black centres. Whiteheads are similar, but are closed and don't have dark centres.Non-inflammatory acne is characterised by the presence of blackheads and whiteheads, and often also skin greasiness.
Blackheads and whiteheads may develop into pimples or pustules (inflammatory acne).
If pustules become infected, the infection may penetrate deeper and form cysts (cystic acne), which may rupture.
Someone with inflammatory acne may have:
- Small red bumps
- Red swellings or bumps visibly filled with pus (pimples/pustules)
- Large, inflamed, red, firm fluid-filled lumps (nodules) under the skin
- Large, inflamed, red, soft bumps (cysts) under the skin, up to 2.5cm across
- Healing of inflammatory lesions may cause scarring and dark spots.
Someone with acne may have non-inflammatory lesions,or a combination of non-inflammatory and inflammatory lesions with or without scars and brown spots.Acne lesions most commonly involve the face, neck, shoulders, back and chest.
Acne may cause embarrassment, frustration and anger, and sufferers may withdraw socially.
Who gets acne?
Acne is most prevalent in adolescence and early adulthood; teenage boys tend to get more severe acne than girls do.
In most people who develop acne, it persists 6-10 years until they “outgrow” it. However, some people develop acne for the first time as adults, and some have it throughout their lives. Five percent of women over40, and one percent of men may still be troubled by acne.
Occasionally, babies are born with acne because of exposure to maternal hormones.
Genes and oily skin type may predispose a person to acne.
See a doctor if:
- You have inflammatory acne
- Non-inflammatory acne worsens or doesn’t respond to home treatment within 2-3 months.
- Your acne leads to emotional distress.
- You develop scars or marks after a lesion has healed.
- Pimples become large and hard or fluid-filled.
- You notice other symptoms e.g. hair growth on the chin (in females),menstrual irregularity, head-hair loss, excess body-hair growth,bone and muscle pain, or other signs of androgen overproduction.
- You suspect new medication (e.g. cortisone,)cosmetics or other topical preparations are aggravating your acne.
Several treatments are available, but not all areappropriate for everyone. It’s important follow up with your doctor so that, together, you can determine the right treatment. Treatment usually starts showing results after 6-8 weeks, and needs to be continued for several months.
Over-the-counter topical medications for acne often contain benzoyl peroxide, alpha-hydroxy acids or salicylic acid. These medications should be water-based and hypoallergenic.
Use Cetaphil lotion as a cleanser.
For non-inflammatory acne, treatment of choice is tretinoin (Retin A, retinoic acid), adapalene (Differin) or benzoyl peroxide 5% (Panoxyl). Both Retin A and Panoxyl may cause redness, burning and scaling, and sensitivity to sunlight. When this occurs, use every second evening until the skin settles.Other drugs that can be used include salicylic acid, tazaroteneand topical antibiotics.
For mild inflammatory acne a topical antibiotic (such as Eryderm) may be applied.
For moderate inflammatory acne, an oral antibiotic e.g. tetracycline, is the treatment of choice. Minocycline is preferred by most dermatologists. Alternative oral antibiotics include erythromycin, clindamycin and sulphonamides. Topical treatment should be continued to combat inflammation.
For severe inflammatory acne,isotretinoin (Roaccutane) may be prescribed.
Anti-androgenic oral contraceptives may be useful in some women with inflammatory acne.
Triamcinolone, a type of corticosteroid, may be injected directly into cysts.
Dermatologists can surgically remove acne scars, throughdermabrasion, chemical peeling or laser resurfacing. These techniques remove scarred skin, exposing underlying, unblemished skin layers.
Controlled exposure to ultraviolet light, prescribed by a dermatologist, may help control acne in some cases.
Home treatment and prevention
- Wash your face with gentle soap twice daily –more often may irritate and dry your skin. Avoid hot water.
- Don’t use facial scrubs, soaps astringents and masks unless recommended by your doctor.
- Don’t squeeze, pick, scratch or rub your skin.
- Avoid stress – if necessary, seek counselling and follow a stress management programme. Stress doesn’t cause acne, but may aggravate it.
- Avoid greasy/oily cosmetics.
- There is no scientific proof that certain foods affect acne. An exception is iodised table salt, which may aggravate the condition.
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