Acne

Acne is a skin condition caused by the accumulation of oil and dead skin cells within the sebaceous glands adjacent to the hair follicle, resulting in acne that appears as a small bulge on the upper part of the hair follicle. Inflamed acne is due to the accumulation of blockages within the skin layers above the subcutaneous fat, accompanied by bacterial infection, resulting in yellowheads, pustules, whiteheads, blackheads, or other types of acne that are painful or not painful when pressed, depending on the body's immune system response. Inflammatory acne caused by a bacterial infection in the deeper layers of the skin can result in nodules or firm cysts that require medical treatment.

What causes acne?

Acne is caused by clogging within the hair follicle caused by exfoliation of skin cells, oil, or sebum excreted from the oil-producing gland through a small duct into the hair follicle leading to its blockage. These factors include:

• Sebum, or oil, is produced by sebaceous glands in the upper layers of the skin and functions as a skin barrier.
• Dead skin cells: Typically, the skin sheds dead cells to make room for new skin cells. Within a hair follicle, this shedding can cause accumulation and blockage, resulting in acne formation, redness, and discomfort.
• Bacteria: Natural bacteria that live in hair follicles and on the skin contribute to the accumulation of blockages and the development of acne.
• Inflammation and the immune response: The body’s immune system responds to bacterial infection or foreign substances entering the body, leading to tissue inflammation and red, swollen acne.

What are the factors that trigger acne?

Acne is due to a variety of both internal and external factors, which can be a single cause or a combination of several factors, such as:

Internal factors

• Hormonal changes, such as higher androgen levels during puberty or before menstruation, can stimulate the sebaceous glands to produce more oil, leading to the accumulation of blockages and the development of acne.
• During pregnancy or premenstrual period, Increased progesterone levels during pregnancy or in the premenstrual phase can contribute to the inflammation of hair follicles and acne formation.
• Genetics: A family history of acne or persistent acne can increase the likelihood of developing acne.
• Certain medical conditions, such as polycystic ovary syndrome.
• Stress: Increased cortisol levels due to stress can trigger acne formation.

External factors

• Certain foods, such as those high in sugar, chocolate, or starchy carbohydrates, However, the food that causes acne varies from person to person.
• Certain medications, such as those containing corticosteroids, testosterone, or lithium
• Some cosmetics and skincare products, such as face powder or certain creams, can cause irritation, allergies, or clogging of the pores.
• Environmental factors such as dust, smoke, air pollution PM2.5, or unhygienic environments
• Weather conditions such as hot and high humidity weather.

Which parts of the body are the most prone to acne?

• Face, nose, cheeks, chin, and forehead
• Chest
• Shoulder
• Upper back
• Sebaceous glands in various parts of the body

How many types of acne?

There are 2 main types of acne: non-inflammatory and inflammatory acne.

1. Non-inflammatory Acne
   • Comedones are acne caused by the accumulation of excess sebum, dead skin cells, or debris in the hair follicles. There are 2 comedone types:
     • Whiteheads are clogged pimples caused by internal factors such as hormonal levels, blockages by oil glands, dead skin cells, or heredity. External factors are birth control pills, cosmetics, dust, and air pollution, resulting in white bumps under the skin leading to inflammation and inflamed acne.
     • Blackheads are open comedones caused by excess sebum, hair follicles, and dead skin cells that clog pores and react with oxygen and melanin, or pigment, in the skin to form visible blackheads. Blackheads are the most common and least serious type of acne.
   • Pimples are commonly found on the face, appearing as small bristles caused by a hair follicle containing many small hair tufts within the same hole. It occurs when the hair follicle becomes clogged with fat and dead skin cells.
   • Acne aestivalis (Acne Mallorca) is an open-head acne caused by UVA rays and heat from sunlight or hot temperatures, and it appears as a small, pimple-like lump or red bump-like inflamed acne.
2. Inflammatory acne
   • Papules are inflammatory acne that is dark red to purple, darker than the natural skin. They are painful acne, usually caused by whiteheads infected by bacteria triggering severe inflammation.
   • Pustules, or yellowheads, are inflammatory acne that appears as a large, red, swollen bump at the base with yellow, swollen pus on top. They form when white blood cells die after engulfing bacteria, causing inflammation and pus formation. Pustules can be small or large.
   • Nodules, or acne nodules, are severe inflammatory pimples beneath the skin's surface. They resemble the larger versions of cystic acne but are smaller, with red nodules that feel like hard lumps under the skin without a head. It's most common on the face, back, and chest. Treating nodules takes time and may result in scarring.
   • Malassezia folliculitis occurs when the hair follicles become inflamed due to a fungal infection caused by Malassezia species. It appears like red bumps with itching, influenced by hot and humid weather or a weakened immune system.
   • Acne conglobata is a severe inflammatory acne characterized by large solid nodules of acne that develop from the inflammation of the sebaceous glands under the skin of the face producing more sebum than usual until it becomes clogged pores, swollen acne with severe pain even without pressing. The pain can extend to the surrounding skin and may not subside quickly. It is advisable to consult a dermatologist for diagnosis and treatment.
   • Acne cysts are large, red, and raised pimples with a pocket of pus and blood underneath. They occur due to severe inflammation beneath the skin's surface. Acne cysts are the most painful type of acne, with many heads clustered together to form a solid cyst that can enlarge to a larger size. Left untreated, it can lead to chronic acne, scars, or large pitted holes. It is crucial to see a dermatologist for diagnosis and treatment.

How is acne diagnosed?

Dermatologists diagnose acne by evaluating the skin's condition to determine the type of acne and lesions, including assessing the severity, inflammation, size, and color of the acne area, considering the pain levels, and its impact on mental well-being. Additionally, dermatologists may inquire about various factors to identify potential causes or contributing factors for acne, such as:

• Recent diet or consumption of high-sugar foods
• Family history of acne
• Stress levels
• Menstrual cycle
• Pregnancy
• Sleep patterns
• Use of cosmetics and facial cleansers
• Taking certain medications or discontinuing certain medications
• Travel history to different locations

In some cases, dermatologists may request a skin biopsy for further examination in a medical laboratory to rule out other medical issues.

How is acne treated?

The primary goal of acne treatment is to reduce inflammation, prevent new acne formation, and prevent scarring. Dermatologists may recommend oral or topical medications based on the age, type, and severity of acne. These medications aim to reduce sebum production, normalize cell shedding, combat bacteria, and decrease inflammation.

Topical medications:

• Topical antibiotics, such as benzoyl peroxide, may use in combination with other topical medications to inhibit bacterial growth and reduce sebum production.
• Retinoids, vitamin A derivatives, help treat acne and acne marks. They help normalize cell shedding and reduce the recurrence of acne. They can also help improve the appearance of acne scars.
• Azelaic acid and salicylic acid have antibacterial properties, dissolve blackheads and whiteheads, and reduce cell shedding in hair follicles.
• Sulfur, or zinc, effectively dissolves blackheads and whiteheads.

Oral medications:

• Antibiotics help slow down or halt bacterial growth and inflammation. Dermatologists may prescribe oral antibiotics with topical agents for moderate to severe inflammatory or persistent acne.
• Oral contraceptives can help regulate and balance androgen hormones, which are one of the causes of acne in females.
• Anti-androgen agents are hormonal treatments that antagonize androgen hormones to reduce the activity of sebaceous glands.
• Retinoids, or isotretinoin, a vitamin A derivative, help treat acne by opening up hair follicles, allowing other medications to work effectively, preventing new acne formation, and reducing the appearance of acne scars.

The choice of treatments depends on the individual's condition and should be a decision of the dermatologist after a thorough evaluation.

Acne Therapies

In those who have severe inflammatory acne that has not responded to treatment with topical and/or oral medications. The dermatologist may consider other treatment options, such as:

• Light therapy: This involves high-intensity LED light exposure to stimulate the skin cell regeneration process and reduce the appearance of wrinkles.
• Chemical peeling: This treatment uses chemical substances to exfoliate dead skin cells and promote the growth of new skin cells.
• Comedone extraction: Healthcare providers may consider this treatment to address non-responsive whiteheads, blackheads, or cystic acne, to improve the cosmetic appearance of the treated area. However, this procedure may cause scarring and may require additional skin care.
• Steroid injection: In cases of severe inflamed acne, healthcare providers may administer steroid injections directly into the affected area to accelerate the healing process and reduce pain. However, a potential side effect may be thinning of the skin and darkening of the injected area.

How to prevent acne?

• Wash Cleanse your face with gentle skin cleansers and apply mild moisturizers.
• Regularly wash your face, bathe, and shampoo your hair to remove dirt, dust, and bacteria.
• Avoid using products that irritate the skin, such as harsh scrubs or fragranced face masks.
• Choose non-comedogenic and sunscreen-containing cosmetics or consider using medical-grade cosmetics.
• Be cautious with shaving and use gentle creams suitable for your skin.
• Avoid consuming high-sugar or high-fat foods.
• Minimize direct exposure to sunlight for extended periods.
• Avoid touching your face with unclean hands.
• Engage in regular exercise and get sufficient restful sleep.
• Practice stress management and relaxation techniques.

Acne: Troublesome Skin Condition, Accelerated Treatment for Scar Reduction

Acne is a common skin condition that affects both men and women of various ages, typically occurring during adolescence and continuing into adulthood. Acne can negatively impact one's self-image and confidence in social settings. However, acne can be resolved with consistent and regular skin care.

For individuals with severe forms of acne, such as acne conglobata, fungal acne, acne cysts, or treatment-resistant acne, it is advisable to seek specialized dermatological care. Dermatologists possess expertise in analyzing skin conditions and determining the underlying causes of acne to provide targeted treatments. Additionally, certain types of acne can result in regular, hypertrophic, or keloid scars, which may require more complex treatment interventions. Dermatologists can recommend appropriate treatments to help patients recover from acne as quickly as possible, reduce the recurrence of acne, and restore the skin to its original condition.