Acne

Definition

Acne, also known as pimple or blackhead, is a very common skin disease that occurs due to obstruction of the pilosebaceous follicles. This obstruction can be caused by excess sebum produced by sebaceous glands and also by the presence of dead cells. Accumulation causes inflammation of the skin and this environment can encourage the appearance and growth of bacteria, especially Propioniumbacterium acnes. Acne lesions heal slowly.

Sebum
Sebum, an oily product, has the main function of lubricating the hair, hair and skin. Excessive sebum production and accumulation of dead cells in the hair follicles can clog the follicles. The formation of these blockages favors the swelling of the follicle walls, which can acquire a white color. They can also open and acquire a black color, these are blackheads. In case of inflammation, the follicles may also become red.

Forms of acne
According to its severity, acne can be classified into:

– Grade I acne: presence of open or closed comedones with few signs of inflammation.

– Grade II acne: presence of inflamed open and/or closed comedones filled with pus (superficial papulo-pustular acne).

– Grade III acne: presence of open and/or closed comedones with pus and inflammatory nodules (deep papulo-pustular acne).

– Grade IV acne: presence of nodules and cysts and also called acne conglobata.

See the figure below the levels of acne:

Source: Acne vulgaris, Denise Steiner

Epidemiology

Acne appears more commonly among young people and adolescents, starting at puberty. Research shows that acne affects 70-95% of teenagers aged 13-18, 8% of youth aged 25-34 and 3% of adults aged 35-44. According to the Ministry of Health, 20% of people between 15 and 25 years old do not have the disease. About 40% of young people have severe acne, requiring medical treatment.

Although acne is more common during adolescence, more and more adults after age 30 get pimples due to a variety of factors, both genetic and environmental (see Causes ). Data indicate that acne has a greater tendency to develop in men, however, in women it seems to be more resistant. By age 40, there are lesions in 1% of men and 5% of women.

It is estimated that, in general, acne disappears spontaneously by the age of 20.

Causes

Acne occurs when the pilosebaceous follicles become clogged by excess sebum production and the presence of dead skin cells. Once obstructed, the follicles can remain closed, forming pimples, or open, forming carnations with black dots in the center. Inflamed follicles become red and bulge, usually with pus (white dots) in the center. See below how acne forms:

– Juvenile acne is caused by hormonal imbalances: at puberty, sebaceous secretion, which depends on androgens (male sex hormones, in particular testosterone) and estrogens (female sex hormones), increases significantly and influences the condition of the skin. It is still not known exactly which factors cause increased production of sebum in the skin. Some of the causes that seem to be related, depending on the type of acne, are:

– It is also important to know that acne (juvenile or not) has a strong hereditary incidence (influence of genes). For example, if the parents had acne, the child will have a 60% chance of having it too.

 In other types of acne, and sometimes even in juvenile acne, different causes can originate it. We emphasize the importance of a bacteria: Propioniumbacterium acnes or stress, which can also favor acne, due to an increase in sebum production.

Washing your skin with exfoliating soaps or chemicals can irritate your skin and increase sebum production, making acne worse. A simple, gentle wash is preferred over abrasive products.

– Food (chocolate…) can favor the appearance of acne.

Studies have shown that in adults particularly, consumption of milk and dairy products such as cheese and butter can aggravate acne.

In addition, cereals rich in sugar and also bread (especially white), chips and chocolate also have a negative effect on acne. It is estimated that chocolate favors the emergence of acne, it is precisely because of its high concentration of sugar. This sometimes increases insulin levels, which can trigger acne breakouts.

– Taking certain medications, such as corticosteroids, hormones (androgens), lithium or vitamin B12 .

It is possible that an excess of vitamin B12 favors acne. A June 2015 study conducted by the University of California Los Angeles (UCLA) in the United States associated vitamin B12 with the appearance of acne. The study was published in the June 24, 2015 issue of the scientific journal Science Translational Medicine, coordinated by dermatologist Dr. Noah Craft.
According to the results of the study, vitamin B12 causes the bacteria normally found on the skin to start producing chemical agents that cause acne breakouts. The bacteria in question, found both in people with and without acne, is Propionibacterium acnes. The difference is that in people with acne, this bacterium has a differentiated metabolism. The researchers found 109 genes that are more active in the bacteria of people with acne and 27 less active genes.
The researchers gave vitamin B12 supplements to 10 acne-free subjects, and one of them developed acne 1 week later. This study provides a possible explanation for a fact that scientists already knew but didn’t understand why, that vitamin B12 causes acne. Read more

Groups of risk

The main risk groups for acne are:

– Adolescents and young people entering puberty, due to intense hormonal variations that occur at this time.

– Women before menstruation, also due to fluctuations in female hormone levels.

– Men in general, due to genetic factors and hormones such as testosterone.

– Pregnant women.

– Patients using cortisone and certain medications.

Some risk factors may also be associated with the disease:

– Using very oily cosmetics on the skin can clog the pores, causing inflammation and acne.

– Use of abrasive products, which can lead to an increase in sebum production by the sebaceous glands.

– Exposure of the skin to products that cause friction, such as helmets, necklaces, phones, etc.

– Excessive exposure of the skin to the sun can aggravate some acne conditions.

Symptoms

The most common form is juvenile acne, which affects around 80% of teenagers. It is characterized, most of the time, by open comedones (blackheads with black dots in the center) or closed (small reddish or whitish pimples), present on the skin. You may know that open pores are black because of surface oxidation of sebum lipids.

In case of acne, the skin can become oily, but this is not the rule for all types of acne.

Other forms taken by acne are:

– Papules: are small reddish swollen lesions present in the hair follicles. They can be red and tender.

– Pustules: are red, soft lesions with the presence of pus.

– Nodules: present as large, solid, painful lesions under the surface of the skin. The nodules are formed by the accumulation of secretions at the bottom of the hair follicles. Nodules can affect teenagers with severe acne (acne grade IV), for example in the form of acne called acne conglobata. These nodules can generate scars.

– Cysts: are very painful lesions, with nodules below the surface of the skin. Cysts can cause scarring of the skin. They are full of pus.

Body Parts Affected by Acne – Where is Acne Located?
Pimples are usually located on the face, back, chest, neck, shoulders or décolletage. These areas have a high concentration of sebaceous glands.

Diagnosis

The diagnosis of acne is made by simple physical examination. The doctor may use loupes or magnifying glasses to check the extent and depth of the acne. The patient’s history is also important and the doctor may question whether there are resistant cases of acne in the family, exposure to oily or abrasive products, severe exposure to the sun, etc.

In the diagnosis of acne, it is important to check the severity of the lesions and their resistance to drugs. The doctor will evaluate the potential of the lesions to form scars and will indicate the appropriate treatment to cure them. This is normally done based on the number of acnes present and how severe they are (from I-IV).

Acne is easy to diagnose and is difficult to confuse with other skin diseases such as impetigo or boils.

Complications

Usually acne does not cause other health complications. However, in the most serious cases, injuries can leave sequelae such as scars in the affected regions. These scars are usually difficult to remove and require very severe treatments, such as surgical and laser peels.

Psychologically speaking, acne can cause reduced self-esteem, especially in young people and teenagers, who feel less accepted in society. A study published in the Journal of Investigative Dermatology conducted in Oslo revealed that teenage girls with severe acne are twice as likely to think about committing suicide and boys three times more than their friends who do not suffer from this problem. In addition to suicidal ideation, these young people, the study revealed, have social relationship problems, not having friends, boyfriends or even performing poorly at school.

Treatments

Attention: for all acne treatments it is important to be patient, as the results will only appear after a few weeks.

In superficial acne or non-severe acne, a topical treatment is sufficient, as well as good hygiene, to limit acne bacteria (in the morning and at night, wash well the areas where acne could be present and use a mild soap for the skin sensitive). Over-the-counter products include cosmetics or medications that contain sulfur, salicylic acid, lactic acid, resorcinol, and benzoyl peroxide.

We can therefore see that hygiene care is very important, as well as cleaning the skin with a mild soap, twice a day, or products that remove dead cells, to be used once or twice a week (Normaderm® Vichy® Gel).

Benzoyl peroxide- based medications are effective in treating benign to moderate acne vulgaris. This product has a proven anti-acne effect, thanks to a reduction in the formation of comedones and the production of sebum. It also helps prevent the growth of acne bacteria.

Note: medicines based on benzoyl peroxide contain, as the name implies, a peroxidized derivative, which discolors hair and, above all, fabrics (towels, clothes, bed sheets, etc.), so be careful when applying the product , in order to avoid these occurrences and unnecessary clothing expenses! When purchasing a medicine based on benzoyl peroxide, read the leaflet and ask your doctor for advice.

Salicylic acid is often used topically against acne.

Another product can be used to treat acne: this is motretinide cream (which will take at least 6 to 8 weeks of treatment to take effect), a product that is particularly effective against comedones.

In case of more pronounced acne and when the dermatologist sees fit, he may also prescribe topical antibiotics such as clindamycin . In this case, it is important not to self-medicate and consult a doctor, dermatologist or general practitioner who will be able to prescribe the appropriate medicine.

Other topical acne products are the retinoid derivatives of vitamin A, such as tretinoin, adapalene, and tazoretene. They work because they increase cell renewal and prevent the follicles from clogging. Antibiotics other than clindamycin are also indicated, such as erythromycin. The combination of clindamycin and benzoyl peroxide is superior to using either product individually.

In severe acne (characterized, for example, by fever and pain, including in the joints close to the skin lesions), medical consultation is highly recommended. The dermatologist may prescribe, for example, antibiotics to be taken orally (not topically), from the tetracycline family ( doxycycline , minocycline ,…) or topical antibiotics, derivatives of vitamin A, in ointment or orally ( isotretinoin ).

Caution: isotretinoin-based medicines can cause serious malformations in pregnant women and cause dry lips and eyes. This medicine should therefore only be used in case of severe acne or resistance to other treatments.

Isotretinoin has an effectiveness of 80%, if a complete treatment is followed, according to the Rutgers Robert Wood Johnson Medical School in the United States that published a press release in April 2019 .

Other treatments include laser exposure and phototherapy. This type of therapy helps reduce oil production by the sebaceous glands and also kills the bacteria that cause inflammation. Also, it helps with skin texture and reduces scar marks.

For the treatment of scars left by acne, several approaches are indicated, such as peeling, dermabrasion or surgical sanding of the skin, microdermabrasion, laser therapy, plastic surgery of the skin, etc.

Special: women and acne

In some women, taking birth control pills can have a positive effect on acne (leading to healing). However, the pill can also have the opposite effect, so talk to your doctor for more information and to find the best treatment. Contraceptives based on norgestimate, chlormadinone, among others, have a beneficial effect on the improvement of acne.

We also emphasize that in some women, acne can be caused by an excessive production of male hormones. Taking a pill based on the antiandrogen, cyproterone acetate, may decrease acne in some women. This class of pills is indicated above all to treat acne and to combine with a means of contraception.
The oral drug spironolactone, a hypotensive agent, is particularly effective in adult women suffering from acne, as revealed by a study published in February 2019 in the scientific journal Dermatologic Clinics (DOI: 10.1016 / j. det.2018.12.001).

Ask your doctor for advice on more information about prescription contraceptives.

natural treatment

The medicinal plants mentioned below have shown efficiency in the treatment of acne. In our opinion they function more as a complementary measure than as a main treatment. As the main therapy, favor classic treatments (medicines).

– Burdock ( burdock root ), to be taken in the form of capsules or infusion.

– Tea tree , to be taken preferably in the form of essential oil, cream, ointment,…

– Argan oil , to be applied in cream.

– Evening primrose oil ( donkey grass ), to be taken preferably in capsule form.

– Watercress can be used to combat acne. Soak a cotton pad in watercress juice and apply it to the skin several times a day.

– Plantain can be used against pimples and blackheads. In 1/2 liter of water, put 4 tablespoons of the plant leaf and boil for 15 minutes over low heat. Coe in a cloth and squeeze very well. Add 1/2 cup of white vinegar to the juice and make compresses on the parts affected by blackheads and pimples.

– The vulnerary helps soften acne scars. Place 1 tablespoon of flower in 300 mL of hot water for 5 minutes and strain. Stir in 1 tbsp of sterile clay powder and 1 tbsp of yogurt. Apply to face and let it act for 20 minutes. Wash off with lukewarm water and repeat the application twice a week.

– Lavender : Lavender essential oil should be applied directly to acne.

– Coconut oil can be applied in a thin layer in cases of acne, especially after applying a cream or chemical, for example, based on salicylic acid, which tends to dry the skin. Coconut oil (which contains vitamin E) and lauric acid have antibacterial and anti-inflammatory properties.

Tips

Here are some tips on how to deal with and treat acne:

– For many teenagers and even adults, the psychological consequences of acne are very serious. We now know that acne can be a very serious psychological condition, especially in adolescence, when individuals seek to please and discover their personality. This is why treating acne from the beginning is highly recommended in order to avoid associated psychological disorders. Ask your doctor for advice and help.

– In humid environments or with a lot of smoke (clubs, bars, concerts, etc.), the bacteria responsible for acne develop more quickly on the skin. The same is true when playing sports (here moisture occurs due to perspiration). Therefore, it is advisable to wash your face well (with a mild soap) after these situations, in order to prevent the proliferation of acne bacteria.

– You should wash your face with a suitable soap (ask your pharmacist). The soap should be mild and suitable for acne-prone skin.

– It is important not to touch your face with your hands or objects (eg mobile phone). One should keep the face as clean as possible. You can also take a shower right after exercising.

– As a home remedy to treat or prevent acne, infusions based on echinacea, milk thistle or peppermint can be effective. However, this plant therapy is still unproven. Burdock , which is also a plant, would also have a positive effect on acne, it must be taken in capsules.

– Sun exposure temporarily improves acne, due to an anti-inflammatory effect and drying of the skin, however acne can reappear and even more severe than at the beginning. This is because the pimples that are trapped under the skin can reappear even more vigorously (what we call the “reappearance” effect). Especially during summer or winter (for a surfer or skier, for example), the skin can become much less acneic, but in autumn or spring, acne can reappear, often with greater intensity. Talk to your dermatologist, doctor or pharmacist, who will certainly prescribe you a sunscreen with a higher factor and try to find the most suitable solution.

– No study has really proven the harmful effect of tobacco on acne, however we know that it causes skin aging, teeth yellowing, etc…

– Food can trigger acne. Studies have shown that consumption of milk and dairy products such as cheese and butter, particularly in adults, can aggravate acne.
Cereals rich in sugar and chocolate also have a negative effect on acne.
The influence of diet on acne seems to come from the impact of certain foods on the microbiota (intestinal flora). It is assumed that a diet rich in sugar favors acne due to the disturbance in the microbiota. The exact links between the microbiota and the skin are not yet known, according to Justin Sonnenburg professor of microbiology at Stanford University in California, who spoke about this in an article in the New York Times .in August 2018. To eat low in sugar, it is advisable to consume whole foods and limit saturated fats. Taking probiotics can help fight acne, but studies are still inconclusive. However, a 2016 study showed that ingesting Lactobacillus rhamnosus SP1 bacteria was associated with a decrease in acne in adults.

– According to a Scottish survey, published at the end of 2013 in the journal Marine Drugs, seaweed and salmon consumers can benefit in the fight against acne. In fact, researchers have observed that the omega-3 fatty acids EPA and omega-6 DGLA found in these marine foods have anti-inflammatory action and have proven their effectiveness against the bacteria that often cause acne, Propionibacterium acnes (or Acnies propiones). The authors of this study claim that it is possible to eat seaweed and salmon, but also apply these fatty acids directly to the skin. Scientists are working on researching new products based on these fatty acids.

There are many myths and truths about acne and its treatment. Below is a table with some clarifications:

DoubtReply
Chocolate, soft drinks and fatty foods make acne worseTruth There are data that prove that chocolates or fatty foods make acne worse.
Squeezing acne helps to eliminate itMyth. This practice is contraindicated, because in addition to not completely eliminating acne, it can leave marks and scars.
Washing your face often helps control acneMyth. Excessive washing can lead the skin to produce more sebum and make acne worse. The ideal is 2-3 times a day.
acne is contagious 

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Myth. Although it is an infectious disease, it is not communicable.
birth control improves acneTruth. Some medications help to improve the acne condition, as they help to balance the woman’s hormone levels.
Physical exercises improve acneTruth. Physical exercises improve circulation, oxygenate the organs and help eliminate toxins. Wash your face thoroughly after exercising.
Toothpaste helps with acneMyth. Although toothpaste dehydrates the lesions, the fluoride present in these products can irritate the application site and make the condition worse.
Zinc improves acneTruth. This mineral has been shown to be effective in fighting acne. Talk to your doctor to know the indicated amounts.
Women with menstruation problems may have more acneTruth. Many women have hormonal imbalances that can trigger acne. Patients with polycystic ovary syndrome may also have more acne.
Stress and anxiety make acne worseTruth. These conditions can increase acne in individuals.
Acne scars have no cureMyth. Nowadays there are several aesthetic treatments that help in the improvement of scars.
I give B complex vitamins to cause acneTruth. In addition to these compounds, others that can cause acne are lithium, isoniazid, and corticosteroids.
Too Much Makeup Makes Acne WorseTruth. Makeup can clog pores and encourage acne breakouts.
The weather can influence acneTruth. In summer, due to excessive sweating and the use of oily sunscreens, acne can get worse.

– Glycolic acid, a natural acid found in sugar cane, applied to the skin helps remove dead skin cells and unclog pores.

– Zinc may have a beneficial effect on acne, reducing inflammation and stimulating healing.

Prevention

Some tips are useful to prevent the appearance of acne:

– Always maintain hygienic habits with your skin. Prefer mild deep cleaning soaps to abrasive and exfoliating products. Soaps with triclosan and salicylic acid are a good choice.

– Control stress . Increased nervousness can trigger factors that increase the skin’s production of oil.

– Avoid using too much makeup and oily creams, as this can clog pores and aggravate acne.

– Beware of excessive exposure to the sun, which can worsen acne frames.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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