Acne is the most common, difficult and unsightly problem of teenagers and adulthood, which usually subsides with time, but in some persist for a longer time and subsides with severe scars(disfigurement) leading to social embarrassment and or psychological problems.
Acne is a chronic condition, clinically characterized by whiteheads, blackheads, pimples, nodules, or cysts on the face, neck, back, and shoulders. It can occur in males or females and in all age groups.
Acne is a disease of the skin, occurs when pores of the follicle on the skin become clogged with dirt or dead skin cells, oil, or bacteria.
Acne is commonly called pimples or pimples as acne.
Acne can be classified as Acne Vulgaris medical term usually seen at puberty, and Acne Rosacea, later in life after puberty. Both these kinds occur on the face, but also can involve on neck, shoulder, chest, back, and arms. The presentation may differ on the severity of involvement. Acne Rosacea falls into a different entity.
Clear Skin Centre Doctors advice to:
Do’s and don’ts that would help you keep the pimple away.
Do gently wash your face 2-3 times a day with a mild cleanser.
Don’t touch, pick, pop or squeeze, as your finger carry bacteria.
Do use only water-based moisturizers to keep the skin soft, smooth and hydrated
Don’t smoke and drink alcohol.
DO: Stay hydrated, drink adequate water
Don’t eat foods with processed fat.
Do keep your fingers and hands away from your face
Don’t use excessive make-up products
Do eat plenty of fiber rich foods
Don’t scrub your skin too roughly
Do shampoo your hair often.
Don’t forget to wash off your make-up before sleep
Do exercise regularly
Don’t ignore the severe acne, early treatment can prevent aggravation and scarring
Do change your pillowcases and towels frequently
Don’t ignore the dandruff, if present should be treated
Do keep a check on your medicine for other illness, may aggravate
Don’t use oil based sun-screen or skin care products
Resistant acne and severe forms like cysts and nodules need medical intervention. Consult a doctor at the earliest. Early treatment can prevent aggravation and scarring that might be impossible to treat.
Different symptoms can indicate different types of acne and are further classified as:
Blackheads in which the pore is only partially blocked, and appear as a tiny, dark bump on the skin as clogged hair follicle; the debris inside the follicle gets oxidized
Whiteheads in which the pore is gets completely blocked, and appear as white or skin-colored bumps; because the follicle is completely plugged and is not exposed to the air
Inflammatory acne: depending upon severity and depth of involvement.
Pimples fall into the less inflammatory type of acne, called as a papular and pustular type.
Papules appear as small raised, pink or red bumps (with no white pus). It can cause scarring if you attempt to pop or pick these.
Pustules appear as raised red bumps with white pus.
Nodulocystic acne falls in severe inflammatory type.
Nodules appear as hard, large red painful lumps. Nodular acne tends to heal with dark spots or scarring.
The cyst appears as hard, large, red painful lumps filled with pus. Cystic acne tend to heal with scarring
Acne Vulgaris can be simply classified on the severity of acne as:
Mild Acne: Blackheads and Whitehead fall in this group
Moderate Acne: also called pimples, and include papules and pustules.
Severe Acne: Nodulocystic acne is classified as severe acne, in which scarring is more common
Causes of Acne
1.Genetic predisposition: to acne-prone skin and acne breakouts, as most of the time there is a co-incidence with family members suffering from acne.
2.Hormonal factors: Hormonal fluctuations may occur during puberty, menstrual cycle, pregnancy, or menopause.
3.Certain foods can trigger acne-like oily, fried, or junk foods, and dairy products can lead to acne breakouts. Foods processed in high sugar index white bread, sweets, etc., and beverages such as chips, baked food made with white flour and soft drinks increases blood sugar levels triggers acne.
4.Certain medications: such as oral contraceptives, steroid overuse, or anti-tuberculosis drugs, etc can cause an acne-like eruption.
5.Use of certain makeup: products excessively or heavy foundation makeup can cause oily skin which can clog the pores and result in more acne breakouts and called acne cosmetica.
6.Stress and psychological factors can also be responsible for acne breakouts.
Mostly an oily skin is more prone to cause acne. Increased oils (sebum) produced by the sebaceous glands are triggered by androgen hormones and in some cases, genetics. The reason being that excess accumulated oil gets trapped within the pores and creates a sort of impaction. Other than this, oily or acne skin is prone to produce more dead cells which when come out on our skin surface are unable to shed properly. As these dead cells are unable to shed properly, they stick to our skin and pores, mix with the accumulated oil and produce comedown. This condition is also referred to as Retention Hyperkeratosis, this later gets infected followed by pustular pimple. If not treated in time, the debris then erupts down into the deeper layers of our skin, the dermis, which results in inflammation of our skin ending up with a scar.
However early, prompt, effective and sometimes aggressive treatment is required to lessen the overall long term impairment in individuals
Hormonal acne is seen usually seen in the female reproductive or adult age group.
There are several signs that can suggest being hormonal acne in which you may have an increased level of androgens in the blood.
· Acne is usually get worsens during menstruation or pregnancy.
· Acne is usually associated with irregular menstruations. Acne breakouts or flare-ups are common before the menstrual cycle, getting acne mainly in adult age. If a person did not have acne or very little acne at teenage and then gets a huge acne breakout later in adulthood.
· Acne is associated with excessive hair growth in unusual places. This is known as hirsutism.
· Acne associated with the darkening of the skin around the armpits and body fold.
· Hormonal acne usually does not respond to normal acne medications such as topical retinoids and systemic antibiotics.
Acne is treatment depends upon the severity of acne, age, and cosmetic concern. There are many acne treatments modes which we have been practicing, and have been successful in curing at, they:
Topical medication: such as benzoyl peroxide, retinoids. clindamycin available in the form of cream, lotion or gels, etc., and has been popular over decades in the treatment of any acne. These medicines help unplug your pores and also kill the bacteria and facilitate antibiotics to work better.
Systemic medications: Oral medication is recommended with or without topical medicines to enhance the results.
Antibiotics are useful in controlling bacterial infection and reducing inflammation and are advisable to be used for a short duration to avoid bacterial resistance.
Isotretinoin: is the first-line of treatment for severe acne and works immediately reducing the sebum flow by inhibiting the active sebaceous glands, which is the main culprit in initiating the formation of acne. Due to its potential adverse effects in childbearing age groups needs dermatologist supervision.
Hormone modulating drugs:
Birth control pills
Acne over the lower part of the face such as mandibular area or due to hormonal fluctuations; oral contraceptive pills containing a low level of estrogen and progesterone hormones can be used for a period of six months to suppress sebum production.
Orally give spironolactone can block the male hormone; androgen, which is responsible for increasing sebum production.
Interventional therapy: such as chemical peeling, photodynamic therapy, cryotherapy, intralesional steroids, incision & drainage, laser treatment, may require in resistant cases of acne not responding to above-mentioned measures and therapy
Chemical peels: Dermatologists use a strong chemical solution to the skin, which is overtime, peels the top layers of the skin, and even blocked clogs or blackheads, which may help sometime.
Here it is exposed to controlled pulses of red or blue low-level laser light. It works by shrinking the sebaceous glands, which in turn reduces sebum production and kills the bacteria, thus minimizing the severity of acne lesions. It requires multiple sessions and is expensive; with quite an effectiveness.
Here we use an agent called cryogen usually liquid nitrogen is used to control acne. In this process, cryogen is used to effectively dry up pimples and oily skin, in turn tightening the pores in the skin. This treatment helps in cooling down the superficial skin to a graded degree by applying liquid nitrogen. The treatment is painless and requires no anesthesia.
Intralesional injection of the corticosteroid like triamcinolone into a cyst can help reduce inflammation and prevent scarring. After the injection, the acne cysts will usually shrink and improve over several days. It is essential to be used in conjunction with other treatments to treat the actual infection in the cysts.
Incision and Drainage
If the cysts are large and painful, it may need to be open with a small incision and drain out the infected fluid. This is the best effective procedure is quick and painless, need to be done under aseptic condition.
Intense pulse light (IPL) and Long pulse Nd: Yag are effective in moderate to severe type of acne in combination with topical and systemic treatment; it requires multiple sessions and is expensive.
Intense Pulse Light Laser:-
It is safest, effective, and has FDA clearance for the treatment of acne. It works by releasing yellow, green, red light that is emitted in a series of short pulses that destroy the bacteria and directly target the overactive sebaceous glands that cause pimples.
Long Pulse ND YAG Laser: –
The laser light is derived from its capability to penetrate deep into the skin to thermally and selectively destroy overactive sebaceous glands and reduce acne inflammation. It even accelerates the healing process and stimulates collagen remodeling thereby improving acne scars too. Hence, the Long pulse is a safe, effective, and well-tolerated treatment with long term results and no side effects.
Isolaz a painless technology combines vacuum with a broadband light. The laser device cleanses the pores by vacuuming and extracting the debris and excess oil from deep within your pores. Then the light helps destroy acne-causing bacteria, as well as reducing facial redness.