Acne, also known as acne vulgaris, is a skin disease involving the oil glands at the base of hair follicles. It is a chronic inflammatory skin condition that causes spots and pimples.
It primarily affects areas of the skin with a relatively high number of oil glands which includes the face, shoulders, back, neck, chest, and upper arms.
Whiteheads, blackheads, papules, pustules, cysts, and nodules are all types of acne.
Genetics is thought to be the primary cause of acne in 80% of cases. A frequent factor is excessive growth of the bacterium Propionibacterium acnes, which is normally present on the skin.
It commonly occurs during puberty, when the sebaceous glands activate. During puberty, in both sexes, acne is often brought on by an increase in hormones such as testosterone.
Children and adults may also be affected before and after puberty. Although acne becomes less common in adulthood, it persists in nearly half of affected people into their twenties and thirties and a smaller group continue to have difficulties into their forties.
It affects 3 in every 4 people aged 11 to 30 years. Depending on its severity, acne can cause emotional distress and scar the skin, but it is not dangerous.
Effective treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.
Human skin has pores that connect to oil glands under the skin. Follicles connect the glands to the pores. Follicles are small sacs that produce and secrete liquid.
The glands produce an oily liquid called sebum. Sebum carries dead skin cells through the follicles to the surface of the skin. A small hair grows through the follicle out of the skin.
Pimples grow when these follicles get blocked, and oil builds up under the skin.
Skin cells, sebum, and hair can clump together into a plug. This plug gets infected with bacteria, and swelling results. A pimple starts to develop when the plug begins to break down.
Propionibacterium acnes (P. acnes) is the name of the bacteria that live on the skin and contributes to the infection of pimples.
Research suggests that the severity and frequency of acne depend on the strain of bacteria. Not all acne bacteria trigger pimples. One strain helps to keep the skin pimple-free.
A range of factors triggers acne, but the main cause is thought to be a rise in androgen levels. Androgen is a type of hormone, the levels of which rise when adolescence begins. In women, it gets converted into oestrogen.
Rising androgen levels cause the oil glands under the skin to grow. The enlarged gland produces more sebum. Excessive sebum can break down cellular walls in the pores, causing bacteria to grow.
Other possible triggers
Some studies suggest that genetic factors may increase the risk. Genetics play a role in acne. If both parents had acne, you're likely to develop it, too.
Other causes include:
Some medications that contain androgen and lithium
Using oil-based makeup
Hot and humid climates
Friction or pressure on your skin. This can be caused by items such as telephones, cell phones, helmets, tight collars and backpacks.
Stress. Stress doesn't cause acne, but if you have acne already, it may make it worse.
Acne pimples vary in size, colour, and level of pain.
The types include:
Whiteheads (closed plugged pores): These remain under the skin and are small.
Blackheads (open plugged pores): Clearly visible, they are black and appear on the surface of the skin.
Papules: Small, usually pink bumps, these are visible on the surface of the skin.
Pustules: Clearly visible on the surface of the skin. They are red at their base and have pus at the top.
Nodules: Clearly visible on the surface of the skin. They are large, solid, painful pimples that are embedded deep in the skin.
Cysts: Clearly visible on the surface of the skin. They are painful and filled with pus. Cysts can cause scars.
Prevention and Management Tips
Here are some tips for looking after skin that has acne or is prone to it:
Wash your face no more than twice each day with warm water and mild soap made especially for acne.
Do not scrub the skin or burst the pimples, as this may push the infection further down, causing more blocking, swelling, and redness.
Avoid popping pimples, as this makes scarring likelier.
A specialist can treat a pimple that requires rapid removal for cosmetic reasons.
Refrain from touching the face.
Hold the telephone away from the face when talking, as it is likely to contain sebum and skin residue.
Wash hands frequently, especially before applying lotions, creams, or makeup.
Clean spectacles regularly as they collect sebum and skin residue.
If acne is on the back, shoulders, or chest, try wearing loose clothing to let the skin breathe. Avoid tight garments, such as headbands, caps, and scarves, or wash them regularly if used.
Choose makeup for sensitive skin and avoid oil-based products. Remove makeup before sleeping.
Use an electric shaver or sharp safety razors when shaving. Soften the skin and beard with warm soapy water before applying shaving cream.
Keep hair clean, as it collects sebum and skin residue. Avoid greasy hair products, such as those containing cocoa butter.
Avoid excessive sun exposure, as it can cause the skin to produce more sebum. Several acne medications increase the risk of sunburn.
Avoid anxiety and stress, as it can increase production of cortisol and adrenaline, which exacerbate acne.
Try to keep cool and dry in hot and humid climates, to prevent sweating.
Acne is a common problem. It can cause severe embarrassment, but treatment is available, and it is effective in many cases.
One can do a lot to treat acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, one should consult a dermatologist for treatment options.
When should someone start acne treatment?
Since everyone gets acne at some time, the right time to treat it is when it becomes bothersome or when the potential for scarring develops. This can be when severe acne flares suddenly, for mild acne that just won't go away, or even when a single pimple decides to show up the week before one's prom or wedding.
What can people do to get rid of their acne?
Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink plenty of water a day. One can, however, still control acne despite one's frantic and unpredictable routine. Probably the most useful lifestyle changes one can make is to never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean one is, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as "scarring," but fortunately, it usually isn't permanent. It's just a mark that takes months to fade if left entirely alone.
Open the pores
Occasional visits to an aesthetician who is an expert at safely removing blackheads during a facial can be beneficial.
Cleansing and skin care
Despite what one might read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation.
Mild cleansers: Washing once or twice a day with a mild cleansing bar or liquid will keep the skin clean and minimize sensitivity and irritation.
Exfoliating cleansers and masks: A variety of mild scrubs, exfoliants, and masks can be used. These products may contain salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants.
Retinol: Not to be confused with the prescription medication Retin-A, this derivative of vitamin A can help promote skin peeling.
Antibacterial cleansers: The most popular ingredient in over-the-counter antibacterial cleansers is benzoyl peroxide.
Topical (external) applications: Antibacterial cleansers come in the form of gels, creams, and lotions that are applied to the affected area. The active ingredients that kill surface bacteria include benzoyl peroxide, sulfur, and resorcinol.
Benzoyl peroxide causes red and scaly skin irritation in a small number of people, which goes away as soon as one stops using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide come in contact with fabrics, leaving unsightly white spots on coloured clothes, shirts, towels and carpets.
Reduce the oil
One cannot stop oil glands from producing oil. Even isotretinoin only slows down oil glands for a while; they resume normal activity later. It is possible to get rid of oil on the surface of the skin and reduce the appearance of shine.
Use a gentle astringent/toner to wipe away oil.
Products containing glycolic acid or one of the other alpha hydroxy acids are also helpful in clearing the skin by causing the superficial layer of the skin to peel (exfoliate).
Masks containing sulfur and other ingredients draw out facial oil.
Antibacterial pads containing benzoyl peroxide have the additional benefit of helping to wipe away oil.
What is a good basic skin regimen?
These are all good basic skin regimens that may help with the acne battle:
Cleanse gently twice daily.
Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol. Use a pad containing 2% salicylic acid to help exfoliation each morning.
At night, apply a spot cream containing sulfur to the affected areas.
Use a light skin moisturizer and water-based makeup.
Here are some factors that don't usually play a role in acne:
Greasy foods. Parents often tell teens to avoid pizza, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Though working in a greasy area, such as a kitchen with fry vats, does because the oil can stick to the skin and block the hair follicles. This further irritates the skin or promotes acne.
Dirt. Blackheads are oxidized oil, not dirt. Sweat does not cause acne and is produced by entirely separate glands in the skin. On the other hand, excessive washing can dry and irritate the skin.
Cosmetics. Cosmetics don't necessarily worsen acne, especially if you use oil-free makeup that doesn't clog pores (noncomedogenics) and remove makeup regularly. Nonoily cosmetics don't interfere with the effectiveness of acne drugs.
What other skin conditions can mimic acne?
Rosacea: This condition is characterized by pimples but not comedones and occurs in the middle third of the face, along with redness, flushing, and superficial blood vessels. It generally affects people in their 30s and 40s and older.
Pseudofolliculitis: This is sometimes called "razor bumps" or "razor rash." When cut too close to the skin, growing hairs twist into the skin and produce tender bumps. This is a mechanical problem, and treatment involves shaving less (growing a beard, laser hair removal). Pseudofolliculitis can, of course, occur in patients who have acne, too.
Folliculitis: Pimples can occur on other parts of the body, such as the abdomen, buttocks, or legs. These represent not acne but inflamed follicles. If these don't go away on their own, doctors can prescribe oral or external antibiotics, generally not the same ones used for acne.
Gram-negative folliculitis: Some patients who have been treated with oral antibiotics for long periods of time develop pustules filled with bacteria that are resistant to the antibiotics that were previously used. Bacterial culture tests can identify these germs, leading the doctor to prescribe different antibiotics or other forms of treatment.