Acne or ‘acne vulgaris’ is a common skin condition that affects the oil glands of the skin as well as its hair follicles. Your skin has tiny holes also known as pores that can get blocked by bacteria, dead skin cells, oil, and dirt. These can lead to whiteheads, blackheads, and pimples on your face.
Acne usually appears on the face, forehead, chest, and shoulders. It is a common phenomenon among teenagers across the world but can also affect people of all ages. Although it is not a life-menacing situation, the severity of acne can cause emotional distress and leaves skin scars.
Types of Acne
This type of acne includes blackheads and whiteheads.
Blackheads or open comedones occur when a pore is clogged by the combination of sebum and dead skin cells. The top of the pore stays open even if the rest of it is clogged. Whiteheads or closed comedones are also caused by the clogging of sebum and dead skin cells. However, unlike blackheads, the top of the pore closes up.
Pimples that are red and swollen are known as inflammatory acne. Although sebum and dead skin cells contribute to this type of acne, bacteria can cause an infection deep underneath the surface of the skin and result in painful acne spots that are hard to get rid of. Examples of inflammatory acne include papules, cysts, pustules, nodules, etc.
What are the symptoms of acne?
A person who has acne can have any of these flaws:
- Blackheads open at the surface of your skin giving it a black appearance.
- Whiteheads are closed under the surface of your skin giving your skin a white appearance.
- Papules are small, red, raised bumps that are caused by inflammation of hair follicles.
- Pustules are tiny red pimples that have pus at their tips.
- Nodules are solid, nasty lumps occur beneath the surface of your skin.
- Cysts are large, awful lumps that are found underneath your skin and contains pus.
What are the Causes of Acne?
Some of the causes of acne are listed below:
Acne can occur due to an increase in hormone production among teenagers. During puberty, both boys and girls produce excessive levels of androgens, which signal the body to make more sebum, the oil that is produced in the skin’s oil glands.
The androgen hormones,namely, testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA) are all associated with acne. Pregnancy can also increase androgen levels and lead to sebum formation.
Excessive sebum clogs the openings to hair follicles and leads to the growth of bacteria. This makes blackheads or whiteheads form on the skin’s surface. Clogging can break the follicle wall which in turn allows sebum to leak into nearby tissues and leads to the formation of papules or pustules.
Sometimes, oral contraceptive pills might trigger acne in women. Some injectable contraceptives and intrauterine birth control devices (IUD) can also cause acne. Steroids taken by athletes can also lead to acne formation.
Factors that may worsen acne:
Studies have shown that milk consumption, indulging in carbohydrate-rich foods like bread, chips, etc are associated with the formation of acne. Also, some studies have suggested that eating chocolates may worsen acne. Vitamin B12 might also trigger skin outbreaks similar to acne or worsen pre-existing acne.
Certain medications may worsen pre-existing acne. Examples of such medications are lithium, iodides, hydantoin, glucocorticoids, etc.
Studies have suggested that stress may either cause or worsen acne. Severe acne is associated with high-stress levels and in some cases, hormonal changes seen in premenstrual syndrome.
Obstruction of skin follicles as a result of wearing chinstraps or helmets can worsen pre-existing acne.
Myths Associated With Acne
Eating greasy foods does not have much effect on acne. Although, working in a greasy area can irritate the skin or leads to acne as the oil can stick to the skin and block the hair follicles.
Acne does not occur because of dirty skin. However, scrubbing the skin too hard or washing the face with harsh soaps irritates the skin and can make acne worse.
Cosmetic does not worsen acne if you use oil-free make up and remove makeup regularly.
Risk Factors Associated With Acne
Acnes are more common among teenagers but people of all ages can get it.
If your parents have acne, chances are that you will get it too. Genetics play a big role in your skin type, specifically how much oil your skin produces.
Studies suggest that certain hormones, especially androgens increase oil production in your hair follicles. Other than that, your hormones can be affected by factors such as stress and medications. When you are stressed, your body releases a hormone called cortisol that increases the skin’s oil production and in turn, increases the probability of acne.
High glycemic foods can worsen acne by increasing the blood sugar level and insulin that leads to increased inflammation and oil release. Examples of high glycemic foods include potato chips, French fries, soda, oatmeal, etc.
The longer you delay in cleaning your skin, the more opportunity the bacteria have to stick around and infect pores. Items that you use regularly such as phone, face towels, and pillowcases can collect bacteria and irritate your skin if not washed regularly.
Home Remedies for treating Acne
Some home remedies for treating acne are listed below:
Apple Cider Vinegar:
ACV is made of fermenting apple cider or unfiltered juice from pressed apple that can fight many types of bacteria and viruses. Apple cider vinegar is comprised of organic acids that can kill acne. However, applying apple cider vinegar can cause burns or irritation to your skin so you should use it in small amounts with diluted water.
Honey and Cinnamon Mask:
Honey and cinnamon can fight bacteria and reduce inflammation of the skin. They have anti-inflammatory, antioxidant and antibacterial properties that help in reducing acne.
Tea Tree Oil:
Tea tree oil is an essential oil that is extracted from the leaves of ‘Melaleuca alternifolia’ a small tree originating in Australia. This oil can fight bacteria and reduce skin inflammation. However, use it in small amounts with diluted water.
Applying green tree directly on your skin can help reduce acne. The major antioxidant in green tea known as ‘epigallocatechin-3-gallate’ (EGCG) has been shown to reduce sebum production and help fight bacteria.
Aloe vera is a tropical plant whose leaves produce a clear gel. This gel, when added to lotions or creams can be used to treat rashes, burn and other skin conditions. Aloe Vera consists of salicylic acid and sulfur which can help fight skin inflammation.
Fish Oil Supplements:
Fish oils contain two types of omega-3 fatty acids namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA and DHA can help decrease skin inflammation, manage oil production and thus helps in preventing acne. You can get omega-3 fatty acids by eating salmon, walnuts, chia seeds, sardines, etc regularly.
When to see a doctor?
When home remedies do not help clear your acne, you should visit a doctor. It is best to visit a dermatologist who can prescribe stronger medications. Sudden onset of severe acne might signal some underlying disease that requires medical attention.
For some women, acne might persist for decades with flares being a common occurrence a week before menstruation. This type of acne clears up without treatment in women who use contraceptives.
The Food and Drug Administration (FDA) warns that some popular nonprescribed acne lotions or cleansers can cause serious reactions leading to skin damage. Seek emergency medical help if you experience symptoms like faintness, difficulty in breathing, swelling of eyes, face, lips, tongue and tightness in the throat after using any skin product.
Acne Management and Prevention tips
Different kind of treatments exists for acne. These include alpha hydroxy acid, anti-hydrogen medications, antibiotics, etc. Acne treatments help in reducing inflammation, hormonal manipulation, killing C. acnes, normalizing skin cell shedding and reducing sebum production. Recommended therapies for treating acne include topical retinoids, benzoyl peroxide, or oral antibiotics.
Acne: Diagnosis and Treatment
The evaluation of a person with suspected acne should be undertaken while taking into account the family’s history of acne, review of the medications taken, signs of excessive production of androgen, cortisol and growth hormones. Comedones should be present to diagnose acne otherwise it might suggest a different skin disorder.
If non-prescribed acne products do not help you in treating acne, a dermatologist can help you treat acne by prescribing stronger medications. Acne medications can help treat acne by fighting bacteria and skin inflammation. The treatment regime your doctor prescribes depends upon your age, skin type and severity of acne.
Some of these medications are listed below:
- Retinoids and retinoid-like drugs:
These drugs are derived from vitamin A and include tretinoin, adapalene, and tazarotene. It can be used in the forms of creams, lotions, and gels. These drugs help in preventing clogging of hair follicles.
These drugs kill excess skin bacteria and reduce redness. The antibiotics are combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide and erythromycin with benzoyl peroxide.
- Salicylic acid and azelaic acid:
Azelaic acid is found in whole-grain cereals and animal products. It has antibacterial properties that help fight inflammation and bacteria. However, it should not be taken during pregnancy as it can cause skin irritation. Salicylic acid helps prevent clogged hair follicles and is available in both was-off and leave-on products.
Dapsone 5 percent gel is recommended for treating inflammatory acne. However, it has side effects that include redness and dryness.
- Oral Antibiotics:
Oral antibiotics help reduce bacteria and fight inflammation. The first choice for treating acne is tetracycline, such as minocycline or doxycycline or a macrolide.
- Combined oral contraceptives:
Combined oral contraceptives are approved by FDA for acne therapy in women who also wish to use them as contraception. These products combine estrogen and progestin.
- Anti-androgen agents:
The drug spironolactone can be considered for women and adolescent girls. It helps in blocking the effect of androgen hormones on the sebaceous glands. Side effects include breast tenderness and painful periods.
It is a very powerful drug that helps in preventing acne if other medications do not work. However, the drugs have serious side effects like ulcerative colitis, increased risk of depression and suicide, etc.
- Lasers and photodynamic therapy:
Light-based therapies can help treat acne formation. But further study is needed to determine its effectiveness.
- Chemical peel:
This procedure uses repeated applications of a chemical solution such as salicylic acid, glycolic acid or retinoic acid.
- Extraction of whiteheads and blackheads:
The doctor may use special tools to gently remove your whiteheads and blackheads if it has not been cleared up with topical medications. Side effects may include Acne Scar.
- Steroid injection:
Nodular and cystic lesions can be treated by injecting a steroid drug injection into them. However, the side effects may include thinning in the treated area.