Smooth skin with no marks
Acne is a dermatological disease of the hair follicles and sebaceous glands. Acne is caused when excessive secretions from these glands, together with dead skin cells clog the outlet channel of the hair. The plugged pores encourage the growth of bacteria and infection with pus, leading to the uncontrolled spread of acne. As a result, the skin becomes inflamed and active lesions appear, often leaving scars. Acne is most likely to develop on the face, back, shoulders, arms and chest.
There are many contributing factors that can cause acne; hormones, hereditary or genetic predisposition, environmental factors and food. Acne can affect people of all ages, from birth to adulthood, including the over 40s. However, the most common age of onset is in adolescence, between 12 and 16. This is due to hormonal changes, and both women and men may be equally affected. The increase of sex hormones causes an increase in sebum secretion from the sebaceous glands and a thickening of the epidermal cells of the skin. This causes the sebaceous glands to become enlarged and clogged, resulting in comedones or blackheads. Keratin debris and grease then accumulate in the excretory ducts of the sebaceous glands and over-infection with the Propionibacterium acnes bacterium occurs, creating the acne pimple.
Adolescent acne has a major impact on young people. Besides being a source of aggravation and pain, youngsters in particular find it aesthetically embarrassing and often become insecure and socially introverted.
Cosmetic acne is a particular type of acne that primarily affects women and is due to the use of excessively greasy creams or make-up.
Stress is another factor that can lead to increased outbreaks of acne by causing hormonal changes. It can also cause one to touch or handle existing lesions, leading to over-infection of these lesions together with inflammation and peeling that will take longer to heal.
We are seeing more and more presentations of late-onset acne. Each case requires personalised medical treatment based on the severity, type of acne and age of the patient, together with supportive therapy including cosmetic care. Treatment should result not just in curing the disease, but doing so without causing sequelae or physical or psychological scarring.
It is important to treat acne as soon as possible to minimise its effects, the most serious of which is long term scarring. Various types of scars may result, the deepest of which can cause facial disfigurement and sagging skin.
Acne treatment should always be tailored to the individual and carried out by a specialist and may include the following forms:
Topical, medical, aesthetic and cosmetic treatment
Systemic medical treatment
Thorough skin washing with water and specially formulated acne treatment soap is essential for all acne types. It is also very important to avoid touching the lesions in order to minimise inflammation and scarring.
Patients with acne-prone or seborrheic (greasy) skin should try to use non-comedogenic creams with non-greasy carriers. A very liquid carrier should be used, ideally a gel or gel-cream, water or silicone base, formulated with active ingredients for the treatment of acne (keratolytic agents, epidermal turnover regulators, antibiotics, grease secretion regulators, anti-inflammatory agents). Make-up should also be oil free. Aesthetic treatments for this type of skin also help keep it clean and prevent clogging of the pores.
Some types of acne may require treatment with oral antibiotics and in some cases, such as female hormonal disorders, hormone treatment may be prescribed. Such treatments will always be carried out in conjunction with the normal cosmetic-hygienic treatments detailed above and should always be administered under strict dermatological control. For the most severe acne cases with cystic nodular lesions, oral treatment with retinoids such as isotretinoin may be appropriate, however this requires medical supervision in order to monitor possible side effects (liver function).
New acne treatments have been introduced combining acne-specific chemical or mechanical peels (microdermabrasion) with light therapy (biostimulation). The peels renew the layers of the skin, removing the waxy plugs and progressively reducing the diameter of the sebaceous glands. They also include bacteriostatic agents that help remove Propionibacterium acnes bacterium. Diode light therapy using red and blue light is also very useful. The red light is anti-inflammatory, reduces unsightly red lesions and also stimulates collagen synthesis to prevent scarring, while blue light has a direct bacteriostatic action on the bacteria involved in acne.
In some cases surgical manipulation of lesions to empty comedones may be necessary, a treatment that should be carried out by a dermatologist.
Acne can recur years after treatment, so it is important to maintain continued daily care in order to prevent further outbreaks.