Overview and facts

Acne is a common name for Acne Vulgaris; pimples, zits and blemishes are the names for acne. It is a common skin disease and can manifest in its various forms. Skin being the largest and most complex organs of all; has numerous sebaceous glands all over it. Only a sq. inch of our skin withholds 100 sebaceous glands in it. Acne is formed in these sebaceous glands. Acne is commonly found in the regions of face, neck, shoulders, chest, back, upper arms and upper legs. 

Symptoms

Acne can manifest as both; symptomatic or asymptomatic. Usually symptomatic is associated with the inflammatory acne. Mild itching, irritation, pain at the site of acne is common. Usually dryness around the acne site is also seen but that can be relevant to medications as well. The Acne area will appear red and has mildly increased temperature along with swelling due to the inflammatory changes.

Diagnosis

Acne is easy to diagnose based on their appearance and the skin type of the patient. The non-inflammatory acne may appear as just white or black spots in the widened follicle (blackheads and whiteheads). Being such a common skin disease most of the people can self diagnose it. A dermatologist can help diagnosing acne by complete and thorough physical examination and in some cases bacteria cultures are also done to confirm the acne. Acne can be graded from I to IV depending upon the severity of the Acne.

• Grade I: Mild Acne
• Grade II: Moderate Acne
• Grade III: Moderately severe Acne
• Grade IV: Severe Acne

Causes

Acne is such a diverse condition that it can be caused by dozens of factors including diet, physical conditions, mental conditions, environmental factors, genetics and allergies. A brief overview of all possible causes is given below:

• Diet:
  • Certain patients get Acne due to excessive use of cottage cheese, cream cheese and skimmed milk.
  • Excessive use of refined sugars as in that of soft drinks, candies, sweets and white bread causes Acne.
  • Lower levels of Vitamins A and E also increases the dead cells in the skin which ultimately leads to clogged pores and Acne.
  • Use of certain medications including steroids, amphetamines, and halogens also causes Acne.

Physical Conditions:

• Increased hormonal activity generates more sebum and activates its release which usually leads to acne formation. Puberty and menses are two most common examples of hormonal role in acne formation. Hormones that are usually linked with Acne are testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I).
• Hyperactive sebaceous glands are also a known cause of Acne. These are common in oily skin and the skin that reacts to cosmetics.
• Follicle fallout caused by the removal of the dead cells within the follicle can also cause clogged follicle and entrapment of sebum causing Acne. Abnormal shedding of skin cells can also clog the pores as usually seen in the changing seasons.
• Bacterial induced Acne is also common. The bacteria Propionibacterium acnes are a regular resident of all skin types; it’s part of the skin’s natural sebum maintenance system. When the follicle is clogged these bacteria rapidly multiplies and induces inflammation that leads to death of bacteria and pus production, forming Acne.

Mental conditions - Stress is one of the major causes of Acne. The exact relevance of stress to the Acne is unknown.

Environmental factors:

• Exposure to warm humid climates and dirt can also cause Acne.
• Halogen exposed areas (iodide, fluoride, chloride, bromide) can also affect people and can cause Acne. This is usually observed around factories, laboratories and chemical deposit areas.

Genetics - Many of the patients suffering from Acne have confirmed family history of the Acne at sometime.

Allergies - Some allergies also induce inflammatory changes. These allergies include dirt allergy, food allergy, cosmetic allergy and chemical allergy. These inflammatory changes trigger the bacterial growth and the dead cell clogging.

Types - Acne can be subdivided into two main groups:

• Non Inflammatory Acne (Comedones)
  • When the sebum and the dead cells remain confined within the follicle walls, they are called whiteheads as they appear as small white spots.
  • When the pore is exposed to the outer surface and the sebum, which contains the skin pigment melanin, oxidizes turning into a brown/black color. This is called as blackhead. This blackhead is not formed because of dirt and cannot be washed away.
• Inflammatory Acne
  • If there is a break in the follicle wall but the follicle is not exposed in the skin, due to excess components; the white blood cells proliferate inside causing a hard, solid growth like elevation in the skin. This is called as papule.
  • A several day old papule may cause the death of white blood cells, follicle lining cells and bacteria. These dead cells hence cause pus and will appear as yellow elevation under the skin; usually referred as pustule.
  • The total collapse of a follicle breaching the deeper layers of skin is referred as nodule; which is a solid elevation and is very painful.
  • A very large affected area filled with pus is formed in severe cases of acne. This is called cyst.
  • After the Acne is removed, a red inflamed area is left behind known as macula.

Treatment & care

• Be gentle while you wash or shave your skin. Avoid unnecessary plucking, threading and face waxing.
• Stay away from sun and too much humid areas especially beaches.
• Avoid dirt, and the things you are allergic to.
• Do not squeeze the pus or the whole follicle may break down causing cysts.
• Ask the dermatologist for the best treatment option available for you. The common treatments available are:

Medications

• Topical antibiotics including tetracycline, erythromycin and clindamycin. Other topical medications that can be used are topical retinoid, azelac acid, salicylic acid, sulfur and benzoyl peroxide.
• Systemic treatment includes oral administration of antibiotics, Oral antibiotics (erythromycin, tetracycline, minocycline, doxycycline), hormones (birth control pills, spironolactone) and Isotretinoin.  
• Certain multi vitamins may also help.

Phototherapy - Phototherapy is done under supervision of a dermatologist or a cosmetologist by specially trained staff. This includes laser therapy, blue light therapy, red light therapy and photodynamic therapy. 

Detoxification - It is an alternative treatment approach which includes dietary and habitual changes leading to a long term relief promise.

Home remedies

• Aloe vera is widely used for Acne treatment.
• Topical use of boric acid mixed with water.
• Egg white application is also done.
• When you feel the pain of pimple getting appear, apply some freshly grounded black pepper on the spot.