Acne is a common skin condition that affects millions of individuals worldwide, particularly adolescents and young adults. While often perceived as a mere cosmetic issue, acne can significantly impact psychological well-being and quality of life. This blog is going to discuss about various aspects of acne, including its causes, types, treatment options and the latest research trends.
What is Acne?
Acne vulgaris is a chronic inflammatory skin condition characterized by the presence of comedones (blackheads and whiteheads), papules, pustules, nodules and cysts. It primarily affects areas rich in sebaceous glands such as the face, back and chest.
Epidemiology of Acne
Acne is one of the most prevalent skin disorders with approximately 85% of adolescents experiencing some form of it during puberty. The incidence tends to decline in adulthood, but it can persist or even appear for the first time in adults. The World Health Organization (WHO) has identified acne as a significant public health issue, emphasizing the need for effective management strategies.
How does Acne occur?
In healthy skin, the sebaceous glands make sebum that exits hair follicle through the pore (an opening on the skin's surface). The follicle is lined with keratinocytes, a kind of skin cell. Keratinocytes typically rise to the skin's surface as the body sheds skin cells. Hair, sebum and keratinocytes adhere to one another inside the pore when someone gets acne. This blocks the sebum from rising to the skin's surface and stops the keratinocytes from shedding. Inflammation, including swelling, redness, heat and pain is brought on by bacteria that ordinarily reside on the skin's surface. It can proliferate in clogged follicles when oil and cells combine. Lesions or pimples are caused by germs, skin cells and sebum that leak into the surrounding skin when the wall of the clogged follicle breaks down. And thus acne occurs.
Who gets Acne?
Teens and younger adults are prone to acne. Approximately 95% of individuals between the ages of 11 and 30 have some form of acne.
Girls between the ages of 14-17 and boys between the ages of 16-19 are more likely to have acne. The majority of people experience intermittent acne for a few years before their symptoms start to get better as they age. When a person reaches their mid-20s, acne frequently goes away. Acne can occasionally persist until adulthood. In persons over 35, acne affects about 3% of the population.
Types of Acne Spots
There are 6 main types of spot caused by acne:
- Blackheads – small black or yellowish bumps that develop on the skin; they're not filled with dirt, but are black because the inner lining of the hair follicle produces colour.
- Whiteheads – have a similar appearance to blackheads, but may be firmer and will not empty when squeezed.
- Papules – small red bumps that may feel tender or sore.
- Pustules – similar to papules, but have a white tip in the centre, caused by a build-up of pus.
- Nodules – large hard lumps that build up beneath the surface of the skin and can be painful.
- Cysts – the most severe type of spot caused by acne; they're large pus-filled lumps that look similar to boils and carry the greatest risk of causing permanent scarring.
Types of Acne
Acne can manifest in various forms, each with distinct characteristics:
- Comedonal Acne: Characterized by open (blackheads) and closed (whiteheads) comedones. This type is often less inflammatory.
- Inflammatory Acne: Includes papules (small red bumps), pustules (pus-filled lesions), nodules (larger, painful lumps), and cysts (deep, pus-filled lesions). This type tends to be more severe and can lead to scarring.
- Acne Rosacea: A chronic inflammatory condition that primarily affects adults, leading to redness, flushing, and sometimes acne-like breakouts.
- Hormonal Acne: Often seen in women, this type is linked to hormonal fluctuations, typically occurring around the menstrual cycle.
What causes Acne?
Understanding the multifactorial nature of acne is crucial for effective treatment. The primary factors contributing to acne include:
- Hormonal Changes: Increased levels of androgens during puberty stimulate sebaceous gland activity, leading to excess oil production.
- Sebum Production: Overactivity of sebaceous glands can clog hair follicles, resulting in the formation of comedones (acne).
- Bacterial Colonization: Cutibacterium acnes (formerly Propionibacterium acnes) is a skin bacterium that contributes to inflammation and acne development.
- Inflammation: The immune response to bacteria and other factors can cause inflammation, resulting in painful lesions.
- Diet and Lifestyle: Emerging research suggests that diet, particularly high glycemic index foods and dairy products may exacerbate acne. Stress, lack of sleep and smoking are also linked to increased acne severity.
- Genetics: Family history plays a significant role in determining an individual's susceptibility to acne.
Risk Factors for Developing Acne
The precise reason why some people develop acne and others do not is still a mystery to experts. Nevertheless, they acknowledge that a variety of risk factors might cause or exacerbate acne as follows:
- Hormonal changes due to pregnancy or puberty
- PCOS or other endocrine conditions
- Cigarette smoking
- Poor sleep
- Stress
- Beauty products with high oil content
- Certain medications including lithium, OCP, anticonvulsants, steroids
- A family history of acne
According to a review of PubMed Central, certain foods or diets may have an effect on acne:
- Foods with low glycemic index can help reduce acne lesions.
- Dairy products often seems to worsen acne. So, it's better to avoid them.
- Omega-3 & Omega-6 fatty acids may help reduce acne breakouts.
- Vegetation diet is good for acne.
- Probiotics can help improve acne.
Diagnosis of Acne
Diagnosis is primarily clinical (based on the appearance of the skin). Dermatologists may classify the severity of acne using the following grading system:
- Mild Acne: Comedonal lesions with few inflammatory lesions.
- Moderate Acne: Increased number of inflammatory lesions with some scarring.
- Severe Acne: Numerous inflammatory lesions, nodules, and cysts, often resulting in significant scarring.
Psychological Impact of Acne on Individual
The psychological burden of acne is substantial. Many individuals experience low self-esteem, anxiety and depression due to their skin condition. Studies indicate that acne can lead to social withdrawal, affecting relationships and academic or work performance. Addressing the emotional aspects of acne is essential in comprehensive treatment.
When to seek medical help?
If you have mild acne, speak with a pharmacist about treatment options. If these do not work for your acne or are making you miserable, then visit a doctor. For moderate to severe acne or nodules or cysts, you should consult a doctor since they must be treated carefully to avoid scarring. Avoid the impulse to pick or squeeze the spots. This might result in lifelong scarring. Treatments can take months to work, so have patience & don't expect to see results fast. Once the medications begin to function, the effects are usually positive.
Treatment for Acne
Treatment for acne varies based on severity and type. Here’s a detailed overview of the most common therapies:
Topical Acne Treatments
- Benzoyl Peroxide: An antimicrobial agent that helps reduce bacteria and unclog pores. Available over-the-counter and by prescription, it is effective for mild to moderate acne.
- Salicylic Acid: A beta-hydroxy acid (BHA) that promotes exfoliation and prevents pore clogging. It is often used in combination with other treatments.
- Retinoids: Vitamin A derivatives (e.g., tretinoin, adapalene) are effective in preventing comedone formation and reducing inflammation. They are typically used in moderate to severe cases.
- Antibiotics: Topical antibiotics (e.g., clindamycin, erythromycin) may be used to reduce inflammation and bacterial colonization.
Oral Acne Medications
- Antibiotics: Systemic antibiotics (e.g., doxycycline, minocycline) are prescribed for moderate to severe inflammatory acne. They help reduce bacterial load and inflammation.
- Hormonal Treatments: For women, hormonal therapies (e.g., oral contraceptives) can help regulate hormonal fluctuations, reducing acne severity.
- Isotretinoin: A potent oral retinoid used for severe, resistant acne. It can lead to significant long-term remission but carries potential side effects, including teratogenicity.
Other Acne Therapies
- Chemical Peels: Superficial peels using acids (e.g., glycolic acid) can exfoliate the skin, helping to unclog pores and reduce acne.
- Laser Therapy: Various laser treatments target acne scars and active lesions. These therapies can also help reduce inflammation.
- Photodynamic Therapy: This involves the application of photosensitizing agents followed by light exposure, targeting acne lesions and reducing bacteria.
Importance of Lifestyle Modifications to get Relief from Acne
In addition to medical treatments, lifestyle changes can play a significant role in managing acne:
- Dietary Adjustments: Reducing intake of high glycemic foods and dairy may help some individuals. A balanced diet rich in antioxidants can support skin health.
- Skin Care Routine: Using non-comedogenic products and maintaining a consistent skin care routine can prevent breakouts.
- Stress Management: Techniques such as mindfulness, exercise, and adequate sleep can help mitigate stress, potentially reducing acne flare-ups.
Tips for Reducing Acne
- Cleanse your face twice daily with a salicylic acid or benzoyl peroxide cleanser.
- Avoid overwashing. Don't strip your skin’s natural oil.
- Try to use non-comedogenic products to prevent clogged pores.
- Stay hydrated.
- Avoid touching face to minimize bacteria transfer.
- Exfoliate weekly. It helps to remove dead skin cells properly.
- Avoid sugar and greasy foods.
- Change your pillowcase often.
Acne myths
These factors have little effect on acne:
- Chocolate and greasy foods: Eating chocolate or greasy food has little to no effect on acne.
- Hygiene: Acne isn't caused by dirty skin. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse.
- Cosmetics: Cosmetics don't necessarily worsen acne, especially if you use oil-free makeup that doesn't clog pores (noncomedogenics) and remove makeup regularly. Non-oily cosmetics don't interfere with the effectiveness of acne drugs.
Acne is a multifaceted condition that requires a comprehensive approach to treatment. With advancements in dermatological research and a better understanding of its underlying mechanisms, more effective therapies are becoming available. It is crucial to address not only the physical aspects of acne but also its psychological impact on individuals. As we continue to explore the connections between diet, lifestyle and acne, there is hope for improved management strategies and outcomes for those affected by this common yet challenging condition.
References
- American Academy of Dermatology. "Acne."
- Zaenglein, A. L., et al. "Guidelines of care for the management of acne vulgaris." Journal of the American Academy of Dermatology, 2016.
- Draelos, Z. D. "Diet and acne." Clinics in Dermatology, 2010.
- Kromminga, A., et al. "The role of the skin microbiome in acne." Journal of Clinical Dermatology, 2020.