Acne is a rash, usually on the face, due to blockage and inflammation of
glands in the skin. While not a life threatening condition, acne can be
upsetting and disfiguring. Severe, acne can lead to serious and permanent
scarring. While most people outgrow acne by their early 20s, some - especially women
- have acne into their 40s or 50s.
Cause of Acne
Acne is caused by the over-production of sebum, an oily substance secreted by
the sebaceous glands in the skin. Normally, the sebum drains into hair follicles
out through the follicle openings on the skin's surface, thereby keeping the
skin lubricated and supple. However, when the glands produce excess sebum, the
follicles become blocked. If the sebum remains clogged in the follicle openings,
it hardens and becomes dark, forming plugs called
blackheads. In some cases, follicles
are sealed by an excess of keratin, the tough, fibrous protein produced by the
skin cells. When this happens, the trapped sebum hardens into white lumps,
called whiteheads, under the surface
of the skin. In both types of blockage, bacteria multiply in the sebum, causing
inflammation of the surrounding issues.
Acne starting at puberty is thought to result from increased sensitivity
to androgens (male sex hormones), which are present in both boys and girls
and levels of which are raised during puberty. Androgens cause the sebaceous
glands to increase their output of sebum.
Rapid production of P. acnes
There may be a genetic factor since acne can run in families.
The use of anabolic steroids to improve performance in sports may also
raise androgen levels.
Other causes of acne vulgaris include hormonal disorders such as
Cushing's syndrome , which is due to an excess of corticosteroid hormones.
In girls, outbreaks may be affected by the hormonal fluctuations that
occur during the menstrual cycle.
The condition may also be exacerbated by the use of oil-based cosmetics.
Poor hygiene does not cause acne, although a build-up of oil and dead cells
on the skin surface may increase the risk of blocked follicles and allow
bacteria to multiply. There is no evidence that fatty foods, sweets, or
chocolate either cause or aggravate acne.
Occupational acne is usually caused by long-term contact between the skin and
oily clothes. The reasons for drug-induced acne are not know.
Types of acne
Acne lesions range in severity from comedones (blackheads and
whiteheads) to nodules and cysts. Here is a brief definition of acne
Comedo (plural comedones) - A comedo is a sebaceous follicle
plugged with sebum, dead cells from inside the sebaceous follicle,
tiny hairs, and sometimes bacteria. When a comedo is open, it is
commonly called a blackhead because the surface of the plug in the
follicle has a blackish appearance. A closed comedo is commonly
called a whitehead; its appearance is that of a skin-colored or
slightly inflamed "bump" in the skin.
- A papule is defined as a small (5 millimeters or less), solid
lesion slightly elevated above the surface of the skin.
- A dome-shaped, fragile lesion containing pus that typically
consists of a mixture of white blood cells, dead skin cells, and
bacteria. A pustule that forms over a sebaceous follicle usually has
a hair in the center.
- A macule is the temporary red spot left by a healed acne lesion.
It is flat, usually red or red-pink, with a well defined border. A
macule may persist for days to weeks before disappearing. When a
number of macules are present at one time they can contribute to the
"inflamed face" appearance of acne.
Nodule - Like a papule, a nodule is a solid, dome-shaped or
irregularly-shaped lesion. Unlike a papule, a nodule is
characterized by inflammation, extends into deeper layers of the
skin and may cause tissue destruction that results in scarring.
Cyst - A cyst is a sac-like lesion containing liquid or
semi-liquid material consisting of white blood cells, dead cells,
and bacteria. It is larger than a pustule, may be severely inflamed,
extends into deeper layers of the skin, may be very painful, and can
result in scarring.
Cysts and nodules often occur together in a severe form of acne
WHAT ARE THE SYMPTOMS?
Acne vulgaris occurs in areas in of skin that have a high density of
sebaceous glands. At puberty, the hair, face, and upper trunk normally become
greasy due to increased production of sebum. However, in people with acne,
oiliness is excessive. Acne tends to appear on the face, but other areas such as
the upper back, centre of the chest, shoulders, and neck are also commonly
affected. The disorder is usually more serve in winter and tends to improve in
summer with increased exposure to sunlight. Lesions that are caused by
occupational acne may appear on parts of the body that come into close contact
with oily clothes, such as thighs. All forms of acne may produce some or all of
the following types of lesion:
Small, firm white heads.
Red pimples, often with yellow pus-filled tips.
Painful, large, firm, red lumps.
Tender lumps beneath the skin without obvious heads (cysts).
All of the types of lesion listed above may develop at any one time, but the
severity of acne varies greatly from person to person. Deep-seated lesions may
leave scars after they have healed.
The key to getting rid of acne and preventing new ones from forming lies in
Resolution takes time.
What works for one person may not work for another.
A dermatologist's help may be required.
Acne does not clear overnight. On average, 6 to 8 weeks are needed to see
initial results. Once acne significantly improves or clears, continued treatment
is needed to keep acne from re-appearing. If acne does not improve in 6 to 8
weeks, treatment may need to be adjusted as not every acne treatment clears
every case of acne.
Besides, there is a range of treatment options to tackle the problem.
important to keep spot-prone areas clean,
so wash the affected area twice a day with an unperfumed cleanser. Antibacterial
face washes and soaps specifically for greasy skins are also available. However,
the skin needs a certain amount of oil to maintain its natural condition, so
avoid aggressive washing with strong soaps.
try to avoid the temptation to pick at spots: over-enthusiastic squeezing can
cause scarring. No home treatments for acne will work immediately. It can take
weeks, if not months, for significant effects to be noticeable.
that contain benzoyl peroxide dry out the skin and encourage it to shed the
surface layer of dead skin. Benzoyl peroxide also has an antibacterial action.
Together, these effects make it harder for pores to become blocked and for
infection to develop. Benzoyl peroxide can cause redness and peeling, especially
to start with. This tends to settle down within a few days.
Resorcinol, a popular ingredient in over-the-counter acne medications helps in
controling small acne lesions and is frequently combined with sulfur in
over-the-counter products. Sulfur has been used for more than 50 years in
combination with other agents, such as alcohol, salicylic acid and resorcinol
and is found in many over-the-counter acne medications. An ingredient, effective
in treating non-inflammatory acne lesions, is salicylic acid. It helps correct
the abnormal shedding of skin cells and unclog pores to resolve and prevent
lesions. Salicylic acid does not have any effect on sebum production or P.
Like benzoyl peroxide, salicylic acid must be used continuously. Once stopped,
pores clog and acne returns. Salicylic acid is found in many over-the-counter
acne products, including lotions, creams and pads. It may be irritating to the
There are a range of other treatment options that can either be rubbed onto the
skin (topical) or taken in tablet form (oral):
Azelaic acid, which is an alternative to benzoyl peroxide, which may cause less
Topical retinoids, which are medicines based on vitamin A, and are rubbed into
the skin once or twice a day. They work by encouraging the outer layer of skin
to flake off, and may cause irritation and skin peeling at the start of
treatment. Disadvantages of this treatment include them making the skin
hypersensitive to sunlight.
A topical antibiotic lotion applied to the skin can be used to control the
Propionobacterium acnes bacteria. Treatment needs to continue for at least six
months. Preparations that combine an antibiotic with other acne medication are
Oral antibiotics (tablets), taken daily for around 3 months, can be prescribed
acne. This acts to kill off the bacteria infecting the skin.
The success of this treatment can be limited because the strains of bacteria are
often resistant to the common antibiotics. It might take four to six months for
the benefits to be seen. Antibiotics do not prevent pores from becoming blocked
so treatment to prevent blackheads, such as benzoyl peroxide, is often also
prescribed at the same time. Some people find that it's a prolonged course of
antibiotics is a nuisance. This explains whey some people do not always complete
Hormone treatment. For women, a standard combined oral
oestrogen and a progestogen) can improve acne symptoms. But in
some women, it can also make symptoms worse. One particular type of Pill, called
Dianette, contains a medicine called cyproterone acetate which cuts the amount
of male hormone in circulation and be an effective treatment for acne.
Isotretinoin (Roaccutane) is a powerful medicine known as an oral retinoid -
which also exists
in topical form. It tends to be used in severe forms of acne
that have proved resistant to other treatments. It works by drying up oily
secretions. There are a number of side effects of this drug including
the skin, aches and pains and headaches. It can also damage an unborn baby if
taken by a pregnant woman. For safety reasons, isotretinoin is only prescribed
by hospital specialists.
There is no immediate cure for acne. However, scarring may be prevented if
treatment is started at an early stage. Individual acne cysts may be treated
with corticosteroid injections. If acne has already left noticeable scars, you
may wish to consult a cosmetic surgeon and discuss techniques such as
dermabrasion. In this procedure, the top layer of skin is removed under a
general anaesthetic. The raw areas then heal to leave a more even layer of skin.
ACNE MANAGEMENT & PREVENTION
Following these simple self-help measures may help clear up acne and prevent
Wash your skin twice a day with warm, but not hot, water and a mild cleanser. Do
not scrub your skin too vigorously.
Do not pick at pimples because this may make the condition worse and result in
Apply a benzoyl peroxide cream daily to the affected areas.
If you have occupational acne, keep work clothes clean to avoid prolonged
contact with oils.