Written by Dr. Sanjana V.B Bhms,dbrm,cdn
Founder & medical director of siahmsr wellness.in

Reviewed by SIAHMSR

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

What is acne?

 Acne or pimples is a common condition of skin of face, chest or back associated with inflammation and irritation with or without bumps, discoloration and pain . 

 Acne can affect most of the people at some point in their lifetime. Acne vulgaris is a chronic condition affecting more than 85% of adolescents and young adults.

It causes spots, oily looking skin and sometimes skin that’s hot or painful to touch.Acne may mostly appear on various part of the body such as:

Face, back and chest.

 Does acne cause psychological upsets in people?

 Acne is associated with the psychological burden of depression, anxiety, and low self-esteem due to the spots and scarring it causes.

What are the common causes of acne?

•  Hormonal  

Acne develops as a result of hypersensitivity of the sebaceous glands to normal levels of circulating androgens or male hormones.

• Bacteria

 Acne is commonly triggered during adolescence by Cutibacterium acnes, a bacterial species, under the influence of normal circulating levels of androgens.

• Medications

Certain medications such as lithium, steroids, and anticonvulsants may cause eruption of acne.

• UV rays of sun

Over exposure to sunlight.

• tight clothing

 Certain inner outfits such as shoulder pads, headbands, backpacks, and underwire brassieres.

• Oil-based cosmetics and facial massage.

• polycystic ovarian syndrome

•Pregnancy

• female hormones

 A premenstrual flare-up of acne occurs in 70% of female patients. It seems to be from edema of the pilosebaceous duct.

• Genetic factors

 Genes significantly influence the proportion of branched fatty acids found in sebum, with heritability estimates ranging from 50% to 90%.

• Repetitive mechanical trauma

 scrubbing of skin with soaps and detergents cause acne flare up.

• Milk consumption

Several studies have indicated that increased milk consumption and high glycemic load diets are associated with acne in adolescence. This could be due to insulin-like growth factor (IGF) and natural hormonal components of milk.

• Stress

Psychological stress is associated with increased severity of acne, probably by stimulating stress hormones.

• Insulin resistance

Individuals with insulin resistance have increased levels of IGF, which is linked to increased facial sebum excretion.

 What are the different types of acne spots?

Acne spots include blackheads, whiteheads,papules,pustules, nodules and cyst

blackheads  are small black or yellowish bumps breaking out on the skin; these  are black because the inner lining of the hair follicle produces  dark pigmentation (colouring)

whiteheads are a similar to blackheads, but may be firmer and won’t empty when squeezed

papules are small red bumps that may feel tender or sore

pustules are  similar topapules with a white tip in the center, filled with pus

Nodules are large hard lumps that build up beneath the surface of the skin and can be painful

Cysts are the most severe type of spot caused by acne; they’re large pus-filled lumps resembling  boils and carry the greatest risk of causing permanent scarring.

Skin care tips for managing acne

·       Avoid frequent washing of face. Frequent washing can irritate the skin and make symptoms worse

·       Wash the affected area with a mild soap or cleanser and lukewarm water.

·        Make up substances may aggravate or worsen acne. Avoid excessive make-up and cosmetics. Use water-based products that do not clog the pores and these are described as non-comedogenic products. For example, moisturizing lotions that are non-comedogenic or made exclusively for acne prone skin.

·       Completely remove your make-up before going to bed at night.

·       Avoid opening the blackheads or spots by squeezing. This may lead to permanent scarring

·       For applying on dry skin, a fragrance-free, water-based emollient or lotion is advisable.

·       Exercise cannot improve your acne, but may help to better your self-esteem and the hormonal imbalances in general reducing obesity.

·        It is advisable to shower your body after work out, as sweat can irritate your acne.

Treatment for acne 

 Acne is not permanently curable; however, it can be controlled with treatment. Several creams, lotions and gels for treating spots can be prescribed by a dermatologist or healthcare provider. The primary objective of therapy is to resolve existing lesions and prevent the formation of new ones.

Treatments can take up to 3 months to provide a visible result.

Retinoid creams for acne

Topical retinoids are vitamin A derivatives that act by binding to retinoic acid receptors (RARs) and retinoid X receptors (RXRs) within the keratinocytes of skin. The retinoids  are used in acne treatment as creams by skin specialists.

These creams act by normalization of follicular keratinization and loosening the keratinocytes, thereby decreasing the formation of small comedones.

     A very small amount of the cream is sufficient to cover the entire face. The frequency of application should be adjusted to minimize the risk of skin irritation. It is recommended to apply retinoids every other night or every third night. As tolerance improves, the frequency of application can be increased gradually over a few weeks until daily use is achieved.

Moderate  to severe acne may be presenting with prominent comedones, large inflammatory papules and pustules, and nodules with associated scarring, affecting multiple body areas. Topical applications [ creams. lotions] and oral medications  are the primary treatment options for moderate-to-severe acne vulgaris.  Oral medications for acne include oral antibiotics , hormonal therapies

Treatment for acne complications 

Post inflammatory hyperpigmentation or dark spots after acne formation and reduction  can be managed by photoprotection, topical treatments (such as retinoids, azelaic acid, and hydroquinone), and superficial chemical peels (which use salicylic acid or glycolic acid).

Post-inflammatory erythema  or redness can be managed by pulsed-dye laser, fractional micro-needling radiofrequency, intense pulsed light, and topical application of 5% tranexamic acid.

Ice-pick scars can be managed by chemical reconstruction of skin scars (CROSS) using trichloroacetic acid, punch elevation or excision, ablative fractional laser or erbium resurfacing, and filler injection. 

Rolling scars can be managed by subcision, needle-free pneumatic solution injection, and filler injection.

 A combination of ablative fractional laser with subcision can be effective for contoured scars.

Boxcar scar can be managed by excision (if the scar is deep), erbium laser treatment, needle-free pneumatic solution injection, and filler injection. 

Hypertrophic scar or keloid can be managed by pulsed dye laser or intense pulsed light therapy, intralesional injection of triamcinolone, 5-fluorouracil or bleomycin, cryotherapy, radiotherapy, and surgical excision.

Papular scars can be managed by controlled CO2 laser vaporization and light electrodesiccation of each papule.

Diet to prevent acne break outs

http://siahmsrwellness.in/diet-to-prevent-acne-break-out   

References

1.    Layton AM. Disorders of sebaceous glands. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 8th ed. Vol. 42. Oxford: Wiley-Blackwell publication; 2010. pp. 1–89. [Google Scholar]

2.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318060/