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ACNE

Overview

Acne is one of the most common skin conditions that affect millions of people worldwide. The age group most affected by this skin condition is teenagers, although it may occur at any age due to various causes. The medical term for this condition is known as acne vulgaris. In the majority of cases, it appears on the skin of the face, but it can also occur on the shoulders, chest, and back. On a commercial scale, multiple products are available that claim to treat acne, although they may or may not be effective in getting rid of this condition. It is best to consult a dermatologist in case of a long-standing acne issue rather than employing other options.

Causes

The exact cause of acne is yet to be determined, but it has been established that one major factor behind acne is the blockage of skin pores by the hair, dead cells, or sebum. Research has shown a strong hereditary factor linked with acne, which means that if you have a family history of acne, you may develop it too. Hormonal changes can flare up the occurrence of acne. This is why it is noticed among teenagers after puberty. Menstruation, pregnancy, stress, or anxiety are other factors that cause irregular hormonal levels, which may cause acne. Intake of a diet high in carbohydrates may also be a causative factor. In some cases, acne is caused by Propionibacterium acnes (P. acnes), a bacteria that triggers an inflammatory response in the skin's pores. Excessive use of skin products, makeup, or other cosmetic items may clog your pores and cause acne. Exposure to skin allergens or chemical irritants may also be considered as contributing factors.

Risk Factors And Epidemiology

Risk factors of acne are linked with its causes. Previous family history of acne is a potent risk factor. Changes in hormonal levels during puberty increase the risk of developing acne in males and females. Similarly, females may develop acne during the menstrual cycle or pregnancy. Diseases that cause irregular hormonal levels such as polycystic ovary syndrome (PCOS) etc. can also increase the risk of acne. Excessive use of greasy or oily products is another risk factor.
Acne can occur at any age, but usually, it appears after puberty among teenagers. It is more prevalent among females than males, which may be linked to changing levels of hormones during menstruation and pregnancy. It disappears in several cases by adulthood but may persist for many years in certain individuals.

Signs And Symptoms

Signs and symptoms of acne vary depending on its severity and other factors. Commonly it appears as whiteheads, blackheads, papules, nodules, pustules, or cysts. These eruptions are seen on the forehead and face region but can also be found in other body parts rich in sebaceous glands. They may be accompanied by redness, irritation, or itching. Some severe forms of acne may leave behind scars when they heal. Since acne can affect a person's self-esteem, the affected individual may develop social anxiety or depression.

Diagnosis

A dermatologist makes a diagnosis of acne based on presenting symptoms and history. Your dermatologist will require a detailed history, including the prevalence of acne in the family, dietary habits, hormonal changes, stress or anxiety levels, and menstrual cycle/pregnancy-related symptoms. This is followed by a clinical evaluation of the affected skin regions to gauge the severity of this condition. There are a few diagnostic criteria available, although the majority of the cases are diagnosed by history and symptoms alone. Your doctor may ask to get a few tests done if he suspects any other underlying skin or systemic condition.

Differential Diagnosis

Acne should be differentiated from other skin conditions with similar symptoms. These conditions include:

  • Impetigo
  • Chickenpox
  • Measles
  • Herpes zoster infection
  • Insect bite rashes
  • Monkeypox
  • Allergic reaction
  • Heat rash
  • Erythema multiform
  • Lupus

Treatment

The treatment of acne is decided based on its severity. A mild form of acne may not require any topical medication and can be lessened by properly cleansing the skin and maintaining good hygiene. Few dietary changes may also be suggested by your dermatologist if required. Oil-based or greasy products should be limited until the acne has lessened or disappeared. Some doctors may also recommend hormonal therapy for patients with an irregular level of hormones or underlying conditions like polycystic ovary syndrome (PCOS). The medications are to be taken only after a prescription by a doctor. Dermatologists also suggest not washing your face more than twice or thrice a day with soap or facewash. Excessive washing can cause dryness which may cause further skin problems. Other chemical and laser therapies are only considered for very severe cases of acne.

Medication

Topical antibiotics such as clindamycin or erythromycin are prescribed along with topical benzoyl peroxide in mild to moderate cases of acne. Topical retinoids such as retinol, retinaldehyde etc., also aid in reducing acne-related inflammation and improving the condition of preexisting skin cells. Birth control pills that contain estrogen or progestin are only recommended in particular cases. Other medications include salicylic acid, azelaic acid, nicotinamide, etc.

Prognosis

The prognosis of acne is good in the majority of cases. It disappears when a person reaches adulthood, but it may persist for a longer time in some individuals. It can be managed well with proper skincare and the use of topical or oral medications if necessary.

Prevention

Acne prevention is difficult, especially during teenage and other hormonal changes associated with puberty, menstruation, pregnancy, stress, or anxiety. But it can be managed by maintaining hygiene, washing your face with a gentle cleanser, moisturizing your skin, using non-comedogenic (oil-free) products, and avoiding the use of products that cause skin irritation. It is best to look out for skin and cosmetic products ingredients before their use. Including more fresh fruits and vegetables in your diet and drinking adequate water may also help in improving your skin condition.

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