Acne or Acne Vulgaris is a medical condition affecting the skin when the hair follicles get plugged or blocked by dead skin cells and sebum (oil). Acne is commonly seen on the face, neck, back, shoulders and chest. Acne can be stubborn and can be distressing for the patient. The lesions of the acne heal slowly and even before complete resolution, new lesions start to appear. Severe acne can be very disturbing for the patient, as it can result in scarring. Treatment should be started as soon as possible in order to decrease the chances of permanent damage.
Acne or Acne Vulgaris isn't a life threatening or a serious condition. However, severe acne, which leaves behind scars, can be very damaging to a person's self esteem and self confidence. So, always seek treatment as soon as acne appears. Never touch or pick on your pimples, as this may aggravate your condition and leave behind scars.
Treatment comprises of topical and oral antibiotics, light and laser therapy etc.
Causes of Acne or Acne Vulgaris
Three Important Contributing Factors of Acne or Acne Vulgaris Are:
- Sebum (oil) overproduction.
- If the dead skin cells do not slough off properly and accumulate and block the hair follicles.
- Bacteria buildup.
Excessive sebum production and accumulation of dead skin cells clogs the hair follicles and this creates a bacteria friendly environment. This plug of sebum and dead cells leads to bulging of the follicle wall and results in a whitehead. If the plug is open at the surface, then it turns dark in color and is known as blackhead. When the clogged hair follicle becomes infected or inflamed then it results in pimples or acne or acne vulgaris.
Factors Which Can Cause Or Trigger Acne or Acne Vulgaris Are:
- Hormonal imbalances or disturbances during puberty, pregnancy and in any stage of life. Using oral contraceptives may also affect the sebum production and cause acne.
- Medicines which contain androgens, corticosteroids or lithium can trigger acne.
- Dietary products, such as carbohydrate-rich foods, oily and sugary foods, dairy foods etc. can trigger acne.
Risk Factors of Acne or Acne Vulgaris
- Teenagers, pregnant women and females around 2-6 days before periods are at a higher risk for developing acne due to the hormonal changes.
- Use of medications which have lithium, corticosteroids or androgens in them.
- Application of certain cosmetics or getting in contact with oily or greasy substances.
- Having a family history of acne increases your risk for developing it.
- Friction on the skin from helmets, cell phones, backpacks and tight collars.
- Stress can worsen acne.
Symptoms of Acne or Acne Vulgaris
- Acne commonly is seen on face, neck, chest, shoulders and back, as these areas have the maximum amount of functional oil glands.
- Acne can occur in the following forms:
Comedones which include whiteheads and blackheads. These develop when the hair follicle opening becomes clogged with sebum, dead cells and bacteria. Closed comedones are called whiteheads and they appear as skin-colored, slightly raised bumps. Open comedones at the skin surface are blackheads and they appear as dark dots on the skin.
- Papules are the small bumps which are slightly raised and these indicate infection/ inflammation in the hair follicles. Papules can be tender to touch and appear red in color.
- Pustules also known as pimples are red colored, tender bumps which have white pus at their apex.
- Nodules are lumps present under the skin's surface and they are large in size, solid and painful to touch. They occur as a result of accumulation of the secretions deep inside the hair follicles.
- Cysts are painful lumps, which are filled with pus and they are present beneath the surface of the skin. These boil-like infections can cause scars.
Treatment for Acne or Acne Vulgaris
The aim of treatment is to decrease the oil production, increase the turnover of the new skin cells, reducing inflammation and treating bacterial infection. Results can be seen in a month to two months; however, there may be some worsening of acne before improvement is seen.
Depending on the severity of acne, the dermatologist prescribes topical medication or oral medication or sometimes both.
Oral medications for acne are contraindicated in pregnancy.
- OTC topical ointments help in drying up the excess oil, killing the bacteria and triggering the shedding of the dead skin cells. These ointments are usually mild and have sulfur, benzoyl peroxide, salicylic acid, resorcinol as their main ingredient. They are beneficial if you have mild acne. Side effects of topical acne medications are dryness, skin irritation and flaking.
- Stronger prescription medicines, which are derived from vitamin A for severe acne are tretinoin, adapalene and tazarotene. They also work by increasing the turnover of new cells and preventing clogging of the hair follicles. Topical antibiotics are also used to destroy the surplus bacteria on the skin. Usually a combination of all these products is needed for treatment of acne.
- A short course of oral antibiotics is given for moderate to severe acne to fight bacteria and inflammation. Oral antibiotics are commonly used with topical medications for acne. Side effects of antibiotics are stomach upset, skin discoloration, dizziness, increased sensitivity to sun light and potentially decreased effectiveness of OCPs.
- Isotretinoin is a medicine used for severe and stubborn scarring cystic acne which have deep cysts and which are not improved by antibiotics. Isotretinoin is a potent drug is used for extremely severe acne. It is contraindicated during pregnancy, as it can cause serious birth defects in the baby. It cannot be used if you are planning to become pregnant as the drug remains in your system even after completion of treatment. Side effects include: Dryness of skin, eyes, lips, mouth, and nose; nosebleeds, itching, sun sensitivity, muscle aches, and poor vision at night. The medicine can also increase cholesterol, triglycerides and liver enzyme levels in the blood.
- Isotretinoin is thought to increase the risk of depression and suicide although this hasn't been proven conclusively.
- Oral contraceptives can improve acne in some women. Side effects of OCPs are headaches, nausea, breast tenderness and depression.
- Laser therapy and light therapy are the emerging treatment being done for treating acne. These therapies affect the more deep layers of skin without damaging the skin's surface. Laser treatment decreases oil or sebum production by damaging the sebaceous glands. Light therapy kills the acne causing bacteria. Other than this, both these therapies also enhance the texture of the skin and decrease the appearance of scars.
- Other cosmetic procedures such as microdermabrasion and chemical peels help with reducing the acne scarring along with reducing the appearance of sun damage and fine wrinkles. Other procedures for reducing the appearance of acne scars include: Soft tissue fillers, chemical peels, dermabrasion, microdermabrasion, laser, light and radiofrequency treatments and punch excision.
Lifestyle Changes and Home Remedies for Acne or Acne Vulgaris
- Keep your pimple prone areas clean with a mild and gentle cleanser. Avoid using harsh products, as they cause skin irritation. Frequent washing and scrubbing is also not recommended. If acne is present surrounding your hairline, then wash your hair regularly with a mild shampoo.
- OTC acne products with the active ingredient benzoyl peroxide or salicylic acid is effective.
- Avoid using greasy or oily cosmetics or hairstyling products. Always use products which are labeled as "non-comedogenic" or "water-based."
- Always shower after exercising or doing strenuous activities which produce sweat.
- Keep your hair and hands clean and see that they don't touch your face. Always keep your hands off your face. Never pick or scratch a pimple, as they cause scarring.
- Avoid wearing tight fitting clothes and hats.
- Avoid wearing heavy make up for long hours and always remove your make up before going to sleep.
- Some alternative or natural medicine also helps with the acne; however, always consult your doctor before using them. Alternative supplements include: Tea tree oil, Alpha hydroxy acids, azelaic acid, zinc supplements and brewer's yeast.