What Is Acne?
Acne is a disorder of the pilosebaceous unit, pilo meaning hair, and sebaceous meaning oil-producing gland. These pilosebaceous glands are densely distributed over the face, neck, back, shoulder, and arms. It also has a genetic component, meaning the appearance or severity of acne depends on the genes from parents.
When the hair follicles and the sebaceous glands under the skin get clogged with dead cells or oil, it can lead to acne. The sebaceous glands, which secretes an oily substance called sebum, can cause pimples and cysts when they get blocked. The pimples can be seen on the face, forehead, shoulders, neck, upper back, and chest. Acne can lead to blackheads, whiteheads, papules, pustules, and acne cysts or nodules.
How Does One Develop Acne?
The sebaceous gland produces oil expelled out through the duct that opens on the skin surface. As long as this duct is intact, oil flows freely onto the skin. If there is any blockage in the duct, the oil cannot come out, and it starts irritating the surrounding skin and causes comedone (black and whiteheads).
Our skin has a harmless commensal bacteria called Propionibacterium acnes (P. acnes). This bacteria acts on the oil collected inside and causes inflammation leading to red bumps, pustules, cysts, or nodules as it progresses. Acne, if not treated on time, will leave scars.
Hormones have a strong effect on acne. Increased androgen hormone can cause thickening of the duct wall, leading to its blockage causing comedones (black and whiteheads). PCOD/ PCOS (polycystic ovarian disease/ syndrome) is the most frequent hormonal disease that causes acne in teenagers and adult women.
Environmental/ External/ Emotional Factors:
Psychological stress can lead to acne. A hot and humid climate, causing increased sweat, can clog the pores. Application of oil, oil-based cosmetics, or steroid creams is another cause of acne.
What Are the Grades of Acne?
The most common factor determining the treatment regimen is the grade of acne and type of acne lesions.
Grade I – Blackheads and whiteheads (comedonal).
Grade II – Predominantly red bumps (papules), few pustules, and few comedones.
Grade III – Lots of pustules and a few red bumps.
Grade IV – Cysts and nodules (bigger bumps and cysts).
What Are the Treatment Options Available for Acne?
Treatment for acne ranges from simple creams to LASER (light amplification by stimulated emission of radiation).
1. Topical Medications:
Clindamycin 1 % topical gel/ lotion for inflammatory acne lesions like red bumps and pustules.
Retinoids: Follow all the instructions from your dermatologist regarding using this group of medicine.
Tretinoin (0.025 %, 0.05 %, 0.1 %).
Adapalene (0.1 %, 0.3 %).
Isotretinoin (0.05 %).
Tazarotene (0.05 %, 0.1 %) for comedonal acne. As these cause peeling of the superficial layer of skin, you need to be very cautious while using them.
Benzoyl peroxide (2.5 %, 3.75 %, 5 %, 7.5 %, 10 %) - for comedones and inflammatory acne.
Dapsone (5 %, 7.5 %) topical gel for inflammatory acne.
2. Comedone Extraction - Manual.
3. Oral Medications: (Dose depends on the patient's body weight).
Isotretinoin (5 mg to 40 mg).
Doxycycline (100 mg) and Minocycline (50 mg to 135 mg).
Azithromycin (250 to 500 mg).
Hormonal treatment - Oral contraceptive pills (Estrogen/ Progesterone), antiandrogen pills.
4. Intralesional Injection of Triamcinolone - for cystic acne.
5. Cosmetic Treatment:
What Are the Specific Skin Care Tips for Acne-Prone Persons?
1. Face Wash:
Wash your face with mild cleansers if your face is dry, or use Benzoyl peroxide face wash if your face is oily. Wash your face three times a day to remove excess oil and dust which accumulates over time. Using a washcloth, mesh sponge, or anything else can irritate the skin; therefore, use your fingertips to apply a gentle, non-abrasive cleanser. Wash the face even after sweating, especially when wearing a hat or helmet. As this can worsen acne, wash your skin as soon as possible after sweating.
Use a good sunscreen with SPF 50. Apply to the whole face 30 minutes before you step out, irrespective of the presence of sunlight. UV rays will always be there during day hours (even if cloudy). Apply every four hours for maximum benefits. This is because sunscreen can protect your skin from UV rays for four hours. Hence you need to repeat every four hours. Always use non-comedogenic sunscreen.
3. Do Not Pick or Squeeze Your Acne: It will leave dark pigmentation and scars, which are even more difficult to treat.
4. Regular Physical Exercise: Exercise is very much essential to keep hormones in check. Exercising for at least 40 minutes a day, six days a week.
5. No Oil Massage: Avoid oil massage to the scalp. It will aggravate dandruff. And, if there is oil flow onto the facial skin, it can clog the pores leading to comedones.
6. Vitamin A and Water:
Eat fruits and vegetables that contain a high amount of vitamin A such as papaya, mango, muskmelon, pumpkin, carrot, and beetroot. These have beta carotene in them, a good antioxidant that is very helpful for healthy skin. Drink two to three liters of water per day. This keeps the skin hydrated.
Always use water-based cosmetics, which have the "non-comedogenic" label.
8. Stress Management:
Stress (mental as well as physical) causes acne breakouts. Meditation is beneficial for controlling mental stress.
9. Waxing the Hair on Face:
Waxing can irritate hair follicles and can aggravate pimples. However, threading to remove unwanted hairs over the face is fine. Threading has no effect on acne.
10. Use of Steroid Creams:
Steroid causes very bad acne. It makes the skin very thin and sensitive. Avoid over-the-counter (OTC) steroid creams like Betnovate (Betamethasone) and Panderm (Terbinafine, Clobetasol, Ofloxacin, and Ornidazole).
How to Prevent Acne?
To prevent acne, follow these steps:
Rinse with lukewarm water.
Wash your face twice a day and after sweating.
Be gentle with your skin by using your fingertips.
Do not use a washcloth, mesh sponge or anything else that can irritate the skin.
Avoid harsh scrubbing.
Stay out of the sun and tanning beds.
Do not use astringents, toners, and exfoliants that may irritate your skin.
Leave your skin to heal naturally. Do not pick or pop your acne on your own. If necessary, use only safe extraction methods with a qualified dermatologist.
Use non-comedogenic and alcohol-free products.
Check your hair care ingredients.
Shampoo regularly if you have oily hair.
Keep your hands off your face because it can cause flare-ups.
When Should You Consult a Dermatologist?
Consult a dermatologist if you have the following issues:
Acne that leaves scars or darkens your skin.
When acne makes you feel shy or embarrassed.
No products or remedies have helped with curing acne.
Acne is an inflammatory condition of hair follicles and the sebaceous glands. Avoiding substances that make acne worse and early acne treatment can reduce or prevent acne scars.