Acne

What IS acne?

Acne is the most frequent cause of what we all recognise as 'spots'. It is a very common skin condition that affects most young people, especially in teenage years. It appears in males and females equally. It is usually at its worst between 16 and 19 years of age. Most people find that the condition goes away by the time they reach their mid-twenties. Some people, however, continue to have acne into their 30s and 40s.

Acne is characterised by the presence of 'comedones' (whiteheads and blackheads) and spots filled with pus (pustules). Inflamed nodules and cysts can also be present in more severe forms. The effects of acne can be mild, including a few spots on the face, upper chest and upper back. More seriously, it can cause scarring of the skin, cause embarrassment and reduce self confidence (continued below).

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Acne (Continued)...

In normal skin, small sebaceous (oil-producing) glands lie just under the skin's surface. The oil keeps the skin smooth and supple. Small holes (pores) on the skin allow the sebum (oil) to travel to the skin surface, and hairs also grow through these pores. Some people produce more sebum than others, and as a general rule, the more sebum you produce, the more greasy your skin appears.

During puberty, the production of male sex hormones (androgens) increases in both boys and girls, and this stimulates the sebaceous glands to produce more sebum. At the same time, the dead skin cells lining the pores are not shed properly, and these therefore plug the exit to the skin surface. This results in a building up of oil, producing blackheads (where you can see a darkened plug of oil) and also whiteheads. Note: The black coloured tip to a blackhead is not dirt, as people used to think. It is due to the shade of the skin pigment.

Additionally, the acne bacterium (propionbacterium) exists on all skin surfaces, usually without causing any problems. However, for people who have a tendency to get acne, the excess oil creates a perfect environment where the bacteria can multiply. The bacterium produces waste products and fatty acids that irritate the sebaceous glands and causes them to become inflamed as well as forming pus-filled or red spots.

Although acne is easily recognised by the existence of spots and their distribution on the face, neck, back or chest, there are several varieties of acne. Your doctor will be able to tell you which sort you have by looking at your skin.

In rare circumstances, some diseases in females can cause acne - or make it worse if it already exists. These conditions include polycystic ovary syndrome and other conditions that that produce excess male hormone to be formed in the adrenal gland or the ovary

Types of acne

Acne vulgaris

Acne conglobata
This is the most severe form; it is characterised by large nodules and cysts rupturing under the skin, producing scars.

Acne cosmetica
This is a mild non-inflammatory form of acne, often triggered by thick, greasy make up.

Actinic acne
This rare form of acne can follow exposure to sunlight.

Some acne myths

Acne is NOT caused by the following:

• Bad hygiene. On the contrary, too much washing (and especially scrubbing) can aggravate the condition



• Stress



• Poor diet. There is no evidence that chocolate, sweets or fatty foods cause acne or make it worse. However, a healthy diet will promote good health generally.

Acne cannot be cured by:

• Sunbeds or sunbathing


• Drinking large quantities of water in an attempt to flush one's system.

Acne can appear a lot in the same families, but this does not mean that you are bound to get acne if your parents had the condition.

What are the symptoms?

First symptoms are small red spots that are tender to the touch that later become pimples containing fatty acids. Depending the severity, the inflammation will disappear over a few days or weeks.

Severe acne can cause scars on the skin. People with severe acne Psychological stress and/or loss of self esteem and therefore, early treatment and management is important.

What worsens acne?

• For a female, having a menstrual period will exacerbate the spots. The progestogen-only contraceptive pill may contribute to worsening symptoms too.



• Being in a place where there are chemicals and grease - or in a damp or hot environment that causes sweating



• Rubbing, picking at or squeezing pimples



• Wearing thick, greasy make up can make acne worse, although most make up products do not have this effect



• Wearing tight clothes that may rub the skin eg. shirt collars, bra straps, headbands



• A small number of drugs can worsen the symptoms eg. phenytoin (prescribed for epilepsy) and steroid creams (prescribed for eczema), anabolic steroids (taken illegally for body-building purposes).

Skin care for individuals with acne

Wash twice a day with mild soap and lukewarm water. Avoid exfoliating substances or abrasive soaps. Scrubbing can produce more inflammation, so be gentle. Do not allow the hair to fall onto the face regularly.

Avoid oil-rich face creams which may clog pores. Instead, use a water-based moisturiser.

Although there appears to be no direct link between certain foods and acne, avoid any foods that you think may be affecting your acne.

Mild acne can be treated with over-the-counter preparations. Follow the instructions for usage carefully. Consult a doctor if these do not work within two months or if the acne is producing scars or large pimples.

If you wear make up, choose brands that are oil-free and water-based so that pores do not become clogged. Opt for products labelled 'non-comedogenic'. This means that they do not specifically cause blackheads or whiteheads.

Acne Treatment

Effective treatment depends on the type and extent of the acne. Your doctor will either offer treatment or refer you to a dermatologist (a consultant doctor specialising in skin conditions). Treatment is generally focused on factors that trigger acne. These are:

• Increased amount of sebum, leading to the plugging of the sebaceous glands



• Bacteria that cause acne

• Topical treatments. These are applied directly to the skin



• Oral contraceptive pills (OCP)


• Oral antibiotics (tablets taken by mouth)



• Isotretinoin capsules



• Other medications

Acne scars may be removed by dermabrasion or laser treatment, performed by a dermatologist or plastic surgeon.

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