Acne – The Hear UP

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  • Acne is the most common of all skin conditions.
  • It is almost universal during puberty.
  • Acne affects almost 90% of people at some stage during their life.
  • Comedones are the hallmark of acne vulgaris.
  • Acne vulgaris is more common among teenagers and more severe in males.
  • Acne Treatment should be commenced early to prevent scarring.
  • The patient should be counseled that the improvement may not be seen immediately for at least a few months.
  • Mild to moderate acne is treated with topical preparations.
  • Moderate to severe acne is treated with systemic antibacterial preparations.
  • Hormonal treatment with co-cyprindiol (cyproterone with ethinylestradiol) is only used in women.

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What is Acne?

Acne vulgaris is a common, usually self-limiting, multifactorial disease that involving inflammation of the sebaceous follicles of the skin in the face and upper trunk.

Acne is a chronic, inflammatory skin condition that results in spots and pimples, especially on the face, shoulders, back, neck, chest, and upper arms.

What are the types of Acne?

The following are the most common types of acne;

  • Blackheads – These are small black or yellowish bumps that develop on the skin.
  • Whiteheads – These are Similar in appearance to blackheads, but more firm and they do not empty when squeezed
  • Pimples (pustules) – These are small red bumps that may feel tender or sore.
  • Papules – These are similar to papules, but they have a white tip in the center due to pus formation.
  • Cysts – These are large pus-filled lumps with the greatest risk of forming a scar.
  • Nodules – These are painfully hard and large lumps that build up beneath the skin

During puberty, the sebaceous gland is activated so there are more chances of developing acne in that stage, but it can occur at any age. It is not dangerous, but it can cause;

  • Skin scars
  • Spots
  • Oily skin
  • Sensitive skin that’s hot or painful to touch

How Acne occurs?

Acne usually occurs when hair follicles become plugged with oil and dead skin cells. Bacteria worsen the condition by causing infection and inflammation.

  • Small gland known as Sebaceous glands is present near the surface of the skin. The glands are attached to hair follicles.
  • Sebaceous glands secrete an oily substance called sebum which lubricated the hair and skin.
  • In acne, there is over secretion of sebum from sebaceous glands. This excess sebum along with dead skin cells, debris and bacteria forms a plug in the follicle, which results in acne.

 

During puberty increased androgen activity triggers the growth of sebaceous glands which results in enhanced sebum production.

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What are the factors involved in Acne?

The four primary factors involved in the formation of acne are;

  • Increased sebum production
  • Sloughing of keratinocytes
  • Bacterial growth
  • Inflammation

 

What are the Risk Factors?

The most common Risk factors for acne are as follows;

  • Genetics – Family history
  • The menstrual cycle
  • Hormonal changes
  • Anxiety and stress
  • Hot and humid climates
  • Using oil-based makeup more frequently
  • Squeezing pimples will worsen the condition
  • Medications like steroids, lithium, androgens
  • Continues Friction against the skin

Acne in males

During puberty, there are more levels of testosterone in the body. Testosterone enhances the production of sebum from a sebaceous gland that results in acne.

Acne in females

Hormonal changes in female occur during;

  • Periods (menstrual cycle)
  • Pregnancy
  • Polycystic ovary syndrome (POS)

 

How Acne Can be Prevented?

  • Wash face with soap and water twice daily can help prevent acne. Particularly when you face more sweating and dirt.
  • Avoid picking, popping, and squeezing pimples, as it may lead to infection and scarring.
  • Avoid skin rubbing and scrubbing
  • Use sunscreen when going outdoors, as too much sunlight has damaging effects on the skin.
  • Avoid oily skincare products.
  • Avoid stressful conditions.

Diagnosis of Acne

Diagnose of acne can be done by careful examination of the skin. It involves examination of face, chest or back for the different types of spots, such as blackheads or sore, red nodules.

The doctor also looks for different signs and symptoms;

  • Mild soreness
  • Pain
  • Itching
  • Lesions over the;
    • Face
    • Neck
    • Upper chest
    • Back
    • Shoulders
  • Comedones, that are the hallmark of acne vulgaris
  • Inflammatory papules
  • Pustules
  • Ecstatic pores
  • Acne cysts
  • Scaring

What is the Treatment for Acne?

Treatment of acne involves the use of Topical and Oral preparations. The goal of treatment is to prevent the formation of new acne lesions, heal existing lesions, and prevent or minimize scarring.

Topical Preparations

Topical preparations for acne include;

  • Benzoyl peroxide
  • Azelaic acid
  • Topical Antibacterial like
  • Topical Retinoid

 

These preparations are used for Mild to moderate acne, comedones, and inflamed lesions.

Benzoyl peroxide

Benzoyl peroxide (Benzac AC, Acnestar ) is effective against;

  • Mild to moderate acne
  • Comedones
  • Inflamed lesions

Treatment is usually started with low strength; if acne does not respond to the treatment after 2 months then topical antibacterial is recommended.

Azelaic Acid

Azelaic Acid (Aziderm)  is effective against;

  • Mild to moderate acne
  • Comedonal acne of the face

It has antimicrobial and anticomedonal properties. It causes less local skin irritation as compared to benzoyl peroxide.

Topical Antibacterial

Topical erythromycin and clindamycin are used against;

These are usually recommended to avoid the oral use of antibacterial.

To avoid antibacterial resistance;

  • Use non-antibiotic antimicrobials (benzoyl peroxide, azelaic acid)
  • If one antibiotic is effective then do not change it without any reason
  • Do not continue treatment for more than recommended

 

Topical Retinoid

Topical retinoid is effective against;

  • Inflammatory lesions
  • Comedones
  • Mild to moderate acne

Retinoid (TRETINOIN) and Adapalene (ADACLENE) are used as a topical retinoid.

Treatment with topical retinoid should be continued for several months until no new lesions are formed.

Oral Preparations

Oral preparations for acne include;

  • Systemic Antibacterial
    • Oxytetracycline
    • Tetracyclin
    • Doxycyclin
    • Minocycline
    • Clindamycin
    • Erythromycin
  • Oral Hormone
  • Oral Retinoid

Systemic antibacterial treatment

Systemic antibacterial used for the treatment of acne are as follows;

  • Oxytetracycline
  • Tetracyclin
  • Doxycyclin
  • Minocycline
  • Clindamycin
  • Erythromycin

 

  • Systemic antibacterial treatment is useful for inflammatory acne when topical treatment is not useful or it may be used with topical treatment.
  • If there is no result after 3 months then another oral antibiotic should be used.
  • Maximum improvement occurs after 4 to 6 months if treatment
  • In severe cases, the treatment can be continued for 2 years.

 

Oral Hormone Treatment

Co-cyprindiol (an Oral Hormone), is used for the treatment of moderate to severe acne. It has anti-androgen properties. Sebum secretion and hair growth depend on androgen. Co-cyprindiol decreases sebum secretion and it is also used for hirsutism.

Oral hormone treatment is recommended to treat moderate to severe acne in the female.

It is recommended when topical and oral antibacterial therapy does not produce the desired outcome.

Co-cyprindiol also has contraceptive properties.

Oral Retinoid

Oral Retinoid used for the treatment of acne is isotretinoin.  It reduces sebum secretion. Isotretinoin is used for the systemic treatment of;

  • Scarring
  • Severe acne
  • Nodulo-cystic and conglobate acne
  • Acne which has not responded to a systemic antibacterial
  • Acne which is associated with psychological problems

Isotretinoin is useful in women who develop acne in the third or fourth decades of life. Since acne in this age is usually not responsive to antibacterial. Isotretinoin is given for at least 4 months (16 weeks).

Side-effects of isotretinoin include;

  • Severe dryness of the skin and mucous membranes
  • Nose bleeding
  • Joint pains

Isotretinoin is teratogenic and must not be given to pregnant women. Treatment with Isotretinoin should be stopped if psychiatric changes occur during treatment.

Visit https://www.drugscaps.com/product-category/face-care/ to find products online.

Home Remedies

Below mentioned are some home remedies for acne;

Tea tree oil – Tea tree extract has natural antibacterial and anti-inflammatory properties. Teat tree oil can be added in creams, gels, or essential oil.

Jojoba oil – Waxy substances in jojoba oil helps to repair skin. Jojoba oil can be added in creams, gels, essential oils, and clay face masks. It can also be applied directly to acne sore with the help of a cotton pad.

Aloe Vera – Aloe Vera has antibacterial and anti-inflammatory properties. Aloe Vera can be added to creams or gels.

Honey – Honey has anti-oxidant properties that help to clear clogged pores from debris. Honey can be directly applied to pimples using a cotton pad or a clean finger.

Green Tea – Green tea contains antioxidants. Green tea extract can be applied to the skin or it can be used as a drink.

 

 

Visit https://www.drugscaps.com/product-category/face-care/ to find products online.

References

  • Rosacea and Acne. (2016). In British national formulary 70. London: BMJ Publishing and the Royal Pharmaceutical Society.
  • Maxine A. Papadakis

Dermatological Disorders In Current Medical and Diagnosis Treatment. Mc Graw-Hill Education, 55th Edition, 2016. (page: 127-129)

Acne Vulgaris In Pharmacotherapy Handbook. The McGraw-Hill companies, 7th edition, 2009. (page: 179-185)

 

 

  • Revol O, et al. Psychological impact of acne on 21st-century adolescents: Decoding for better care. British Journal of Dermatology. 2015;172(suppl.1):52.

 

 

  • Acne: Tips for managing. American Academy of Dermatology website. aad.org/public/diseases/acne-and-rosacea/acne#tips. Accessed March 11, 2018.

Melnik, B. C. (2015, July 15). Linking diet to acne metabolomics, inflammation, and cosmogenesis: An update. Clinical, Cosmetic, and Investigational Dermatology, 8, 371–388
ncbi.nlm.nih.gov/pmc/articles/PMC4507494/

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