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Acne

Acne explained

Acne vulgaris is an inflammatory skin condition that affects the hair follicles and the sebaceous glands below them.[1] Acne vulgaris is often referred to simply as 'acne'.

Acne has many causes, but a major factor is a type of bacterium called Propionibacterium acnes.[2]

Most people from Western industrialised countries develop acne to some degree at some point, most often around the time of puberty. The global variations in prevalence may be related to diet.[3]

Symptoms and signs

The features of acne, which may range from mild to severe and may be present for years, include:[1,3,4]

Increased production of sebum, an oily substance that normally protects the skin, but in excess may block skin pores, leading to inflamation and greasy skin

Raised levels of the protein that helps to make up hair (keratin) and increased numbers of cells in the hair follicles. Both of these factors lead to blockages at the opening of the follicles, that is, clogged pores. These are also known as comedones, or, more often, whiteheads (complete blockage of the follicle) or blackheads (partial blockage of the follicle).

Additional symptoms, such as areas of inflammation and pus (called abscesses), pigmentation of the skin and scarring, are less common.

Choosing treatments

Treatments for acne may be applied directly to the site of the acne (topical treatments) or taken by mouth (systemic treatments).

Such treatments may not bring about improvements for at least 6 weeks, and sometimes longer.[1]

Topical treatments

A gel or cream called benzoyl peroxide kills bacteria and is an effective treatment for acne. It also reduces inflammation and helps to clear comedones.[1,2]

Topical antibiotics, available as ointments, gels or lotions, help to lower the levels of Propionibacterium acnes in the skin, and can also help to reduce inflammation.[1,2]

Retinoid compounds have a similar structure to vitamin A. Topical retinoid creams or gels may be useful in treating mild to moderate acne, although several months of treatment may be needed. It is important to remember that they cannot be taken if you are pregnant.[1,2]

Systemic treatments

Some treatments that can be applied topically can also be taken systemically - these include antibiotics and retinoids, both of which can be taken by mouth as well as applied to the skin. It is important to be aware of the possible side-effects of oral retinoids before taking them, for example, cracked lips and nosebleeds; replique montre again, they must not be taken if you are pregnant.[1]

Research suggests that combined oral contraceptive pills may also be effective in treating acne.[5]

Light-based therapies use medicines that become active only when combined with light. These include photodynamic therapy. This type of treatment is best for people who have moderate to severe acne with a lot of inflammation.[6]

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Risk factors and prevention

Acne is more common in people with a family history of the condition.[1] However, certain triggers can bring about acne in those who are already predisposed to it, or may cause it to worsen.[3]

Examples of triggers include:[1,3,4]

  • Hormones, for example, during adolescence or before menstruation (periods) in women
  • Drugs such as systemic glucocorticoids
  • Skincare products that are too greasy or oily
  • Physical irritation of the skin, for example, the chafing of a shirt collar
  • Dietary factors - particularly components of Western diets such as dairy products - although there is still some controversy over their importance.
  • Choose the best above ground pool to swim.

Outlook and living with acne

Acne, particularly severe acne, may be associated with low self-esteem and poor body image, and may also cause people to withdraw socially. It is important to be aware that help is available for these concerns, for example, in the form of counselling or support groups, as well as for the acne itself.[1]

References: 
  1. Purdy S and de Berker D. Acne. BMJ 2006; 333: 949-53.
  2. Leyden JJ, Del Rosso JQ, Webster GF et al. Clinical considerations in the treatment of acne vulgaris and other inflammatory skin disorders: a status report. Dermatol Clin 2009; 27: 1-15.
  3. Degitz K, Placzek M, Borelli C et al. Pathophysiology of acne. JDDG 2007; 4: 316-23.
  4. Spencer EH, Ferdowsian HR and Barnard ND. Diet and acne: a review of the evidence. International Journal of Dermatology 2009; 48: 339-47.
  5. Arowojolu AO, Gallo MF, Lopez LM et al. Combined oral contraceptive pills for treatment of acne. The Cochrane Collaboration 2009; Issue 3.
  6. Taylor MN and Gonzalez ML. The practicalities of photodynamic therapy in acne vulgaris. British Journal of Dermatology 2009; 160: 1140-8.