Acne is thought to affect teenagers, but in fact it can continue into adulthood or even appear for the first time then. That acne “passes” with age is, in fact, a dermatological myth. The situation becomes even more complicated, as there is no one type of acne and by extension, no one cure. Every skin is unique and a treatment suitable for one person may be deemed unsuitable for another.

Acne – What is it?

Acne Vulgaris is a disease characterized by inflammation of the sebaceous glands. It is located on the parts of the body where the sebaceous glands are most numerous (face, chest, back). The sebaceous glands are located around the hair follicles in the skin and produce sebum, which is normally secreted on the surface of the skin through the hair follicle.

Acne occurs when the normal passage of sebum to the surface is blocked and sebum accumulates in the gland. The build-up eventually breaks the wall of the hair follicle and forms a sebaceous cyst under the skin.

Acne lesions can be inflammatory or non-inflammatory. Non-inflammatory lesions include the lentigines (open – black spots, closed – white spots). Inflammatory lesions can be papules (small reddish pimples), pustules (pustules with pus), nodules and cysts. The latter two are usually responsible for the scars that form on the surface of the skin.

Types of acne:

The most common types of acne, as mentioned above, are whiteheads, blackheads, papules, pustules, nodules and cysts. These types then form the two major categories into which acne is divided: phagosomal (white and blackheads) and inflammatory (papules, pustules, nodules, cysts). Both types have common causes: bacteria, sebum overproduction, hormonal changes, clogged pores.

Acne treatment:

There are too many formulations on the market that target acne. However, when they are not used correctly or when consumer products are used that are not recommended by a dermatologist, the condition can worsen.

Topical treatments:

Moderate to severe inflammatory acne requires the prescription of topical treatments, such as:
• Retinoids: Adapalene, isotretinoin, tretinoin. Retinoids are derivatives of vitamin A and there are many studies that demonstrate their effectiveness in acne treatments.
• Antibiotics: clindamycin, erythromycin
• Azelaic acid: Found in cleansers and creams. It has antibacterial and anti-inflammatory properties.
• Benzene peroxide: Found in gels and lotions in concentrations of 2.5% to 10%. Research has shown that it is more effective than salicylic acid, however it can cause dryness and irritation. It helps to clog pores and reduce spots.
• Corticosteroids: The use of topical corticosteroids may be used for severe cases of inflammatory acne, but should be part of a short-term treatment.
• Hydrogen peroxide
• Niacinamide: A concentrated form of vitamin B3, which helps reduce oiliness and inflammation, soothing the skin. It also helps the epidermal barrier, reduces redness and balances sebum production levels.
• Salicylic acid: Helps to clog pores and treat stigmata. It is milder than other ingredients, such as benzoyl peroxide. It is found in concentrations of 0.005%-5%.
• Sulfur: Sulphur treatments are not as widespread because of the particular smell of sulphur. – Glycolic acid: Contributes to exfoliation, which in turn contributes to skin renewal.

Per os treatments, i.e. oral treatments

Oral antibiotics may be given in cases of inflammatory acne. The most common ones are: macrolides, erythromycin, clindamycin, azithromycin, tetracyclines, minocycline, etc.

Isotretinoin can also be given per os and helps to treat cases of moderate and severe acne.

Changes to your lifestyle, alongside acne treatment

Skin care

The most important lifestyle change that acne patients can make is to incorporate into their daily routine a skincare routine tailored to their skin’s needs. Consult your dermatologist and make a plan with him or her for the most effective skincare routine, which will help adjunctively to drug therapy.

Nutrition

Studies have shown that diet is linked to acne in many ways. Foods high in sugar make acne flare-ups worse. Dairy foods, on the other hand, do not seem to have as strong an effect, but cow’s milk can worsen acne¹.

Mental Healthω

In recent years, more and more studies have emerged showing the influence of mental health on the occurrence of acne. A holistic approach to treating acne would include working with mental health professionals, as it is considered a sign of severe stress. Take home message: acne is an extremely common disease with complex causes and complex treatments. The good news, however, is that it is treatable and systematic skin care, adherence to treatment and regular visits to the dermatologist are all things that synergistically restore skin health.

Bibliography:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884775/