Acne vulgaris, commonly known as acne, is a chronic inflammatory skin condition that occurs when hair follicles become clogged with oil (sebum) and dead skin cells. It leads to various types of lesions, including blackheads, whiteheads, pimples, cysts, and nodules, primarily on the face, neck, chest, back, and shoulders.
Causes:
Acne develops due to a combination of several factors:
- Excess Sebum Production: Overactive sebaceous glands produce too much oil, which can clog pores.
- Dead Skin Cell Accumulation: Skin cells shed too quickly and stick together, blocking hair follicles.
- Bacteria: Propionibacterium acnes (now Cutibacterium acnes), a common skin bacterium, can multiply rapidly in clogged follicles, leading to inflammation and pus.
- Inflammation: The body’s immune response to the bacteria and clogged follicles causes redness and swelling.
- Hormonal Changes: Androgens (male hormones present in both sexes) increase during puberty, stimulating sebaceous glands. Hormonal fluctuations during menstruation, pregnancy, or due to conditions like PCOS can also trigger acne.
- Genetics: A family history of acne increases an individual’s likelihood of developing it.
- Diet: While research is ongoing, some studies suggest a link between high-glycemic index foods (e.g., sugary drinks, white bread) and dairy products with acne severity in some individuals.
- Stress: Stress itself doesn’t cause acne, but it can worsen existing acne by affecting hormones.
- Medications: Certain drugs, such as corticosteroids, testosterone, lithium, and some anti-tuberculosis drugs, can cause acne as a side effect.
- Friction or Pressure: Mechanical irritation from helmets, tight clothing, or prolonged pressure can trigger “acne mechanica.”
Symptoms:
Acne lesions can vary in type and severity:
- Comedones:
- Whiteheads (closed comedones): Small, flesh-colored or whitish bumps that are closed at the surface.
- Blackheads (open comedones): Small, dark or black spots that are open at the surface; the dark color is due to oxidation, not dirt.
- Inflammatory Lesions:
- Papules: Small, red, tender bumps.
- Pustules: Red, tender bumps with a white or yellowish center of pus.
- Nodules: Large, solid, painful lumps beneath the surface of the skin.
- Cysts: Large, painful, pus-filled lesions deep under the skin, which can cause scarring.
- Other symptoms:
- Redness and inflammation around lesions.
- Pain or tenderness in affected areas.
- Post-inflammatory hyperpigmentation (dark spots after lesions heal).
- Scarring (pitted or raised scars).
Diagnosis:
Acne is typically diagnosed by a dermatologist or general practitioner based on a visual examination of the skin. There are no specific laboratory tests required for diagnosis.
- Medical history: The doctor will ask about your symptoms, their onset, family history of acne, and any potential triggers (e.g., diet, medications, stress).
- Physical examination: The doctor will examine the affected areas of your skin to identify the types of lesions present and assess their severity.
- Ruling out other conditions: In some cases, the doctor may ask questions or perform tests to rule out other skin conditions that might resemble acne, such as rosacea, folliculitis, or perioral dermatitis.
Treatment:
Treatment for acne aims to reduce oil production, clear clogged pores, kill bacteria, and reduce inflammation. The approach depends on the severity of the acne.
- Topical Medications (applied to the skin):
- Retinoids (e.g., tretinoin, adapalene, tazarotene): Unclog pores and prevent new breakouts.
- Benzoyl peroxide: Kills bacteria and helps shed dead skin cells.
- Antibiotics (e.g., clindamycin, erythromycin): Reduce bacteria and inflammation.
- Salicylic acid: Helps exfoliate the skin and unclog pores.
- Azelaic acid: Reduces inflammation and kills bacteria.
- Oral Medications (for moderate to severe acne):
- Antibiotics (e.g., doxycycline, minocycline): Reduce bacteria and inflammation. Used for a limited time to avoid resistance.
- Isotretinoin (Accutane): A powerful retinoid used for severe, nodular, or cystic acne that hasn’t responded to other treatments. Requires strict monitoring due to potential side effects.
- Hormonal therapies (for women, e.g., oral contraceptives, spironolactone): Help regulate hormones that contribute to acne.
- Procedures (performed by a dermatologist):
- Chemical peels: Improve skin texture and reduce comedones.
- Microdermabrasion: Exfoliates the skin.
- Laser and light therapies: Reduce bacteria, inflammation, and improve scarring.
- Corticosteroid injections: Directly into large cysts or nodules to reduce inflammation quickly.
- Drainage and extraction: Manual removal of blackheads, whiteheads, or cysts.
- Lifestyle and Home Care:
- Wash affected areas gently twice daily with a mild cleanser.
- Avoid harsh scrubbing or picking at lesions.
- Use non-comedogenic (non-pore-clogging) skin care products and makeup.
- Shampoo hair regularly, especially if oily.
- Avoid touching your face.
- Manage stress.
Acne treatment often requires patience, as it can take several weeks or months to see significant improvement. A combination of treatments is often most effective, and ongoing maintenance therapy may be needed to prevent recurrence.
