Acne

Acne is a skin condition where the sebaceous gland follicle becomes inflamed. It mainly occurs in areas with the most active sebaceous glands, such as the face's T-zone (forehead, nose, and chin), back, neck, throat, and shoulders.  

During puberty, the body produces more hormones, including androgens, which stimulate the sebaceous glands, leading to increased sebum production. Each sebaceous gland has a pore through which sebum is released. Sebum keeps the skin and hair supple, is water-resistant, protects against dehydration, and boosts the skin's resilience. 

However, thicker sebum combined with dead skin cells can block the pores, causing blackheads. A blackhead, or comedo, can appear as either a black or white spot. Those with a white spot are deeper and can block the entire pore. Additionally, scaling can occur over the gland's excretory duct, further clogging the pore. The sebaceous glands contain bacteria that convert sebum into fatty acids. As the sebum accumulates, the clogged follicle expands and can eventually burst. This allows irritants to enter the surrounding skin, causing inflammation and resulting in acne spots and pimples. 

Acne can be worsened by several factors, including: 

• Genetics (family history of acne) 
• Hormonal factors (menstruation and pregnancy) 
• Polycystic ovarian syndrome 
• Stress 
• Cosmetic use 
• Friction from clothing 
• Climate changes 

Acne presents in many forms, with common types including: 

• Acne vulgaris: The most frequent type, involving comedones, spots, and pustules in varying degrees. 
• Acne comedonica: Mild acne dominated by comedones rather than inflammation. 
• Acne conglobata: Severe acne featuring large and double comedones, nodules, and cysts, often resulting in scars. It mainly affects young men and may persist into adulthood. 
• Acne excoriée: Worsened by picking or squeezing pimples, leading to scarring. 
• Acne tarda: Similar to acne vulgaris but occurring in adults. 
• Acne ectopia (hidradenitis suppurativa): Caused by hair follicle inflammation, often in the groin or armpits. 
• Acne fulminans: A rare, severe outbreak with inflamed pustules that rapidly turn into open wounds, accompanied by fever, fatigue, blood disorders, and joint pain. 

Acne is usually found on the face's T-zone (forehead, nose, and chin), but also on the back, chest, shoulders, neck, and throat. It can appear as: 

• Blackheads (comedones): Open black comedones with a black plug or closed white comedones with a white spot. 
• Pimples or spots: Clearly defined raised areas on the skin. 
• Pustules: Visible skin cavities filled with pus. 
• Subcutaneous inflammation, nodules, and cysts: Nodules are firm, deep skin lumps that may leave scars, while cysts are closed fluid-filled cavities. 

Symptoms vary in combination and severity, and when acne is no longer active, scars and marks may still be visible. 

Proper treatment can reduce or eliminate acne. Cleanse the skin once or twice daily with lukewarm water, avoiding soap, scrubbing, or exfoliating. Do not squeeze blackheads, pimples, or spots, as this may worsen the condition and cause scarring. Avoid smoking, as it negatively impacts the skin. While healthy eating, adequate hydration, and moderate alcohol consumption do not directly influence acne, they certainly do not make it worse. Be cautious with makeup, as some products can clog sebaceous glands. Shower with lukewarm water after exercise, as sweat and friction can aggravate acne. Moisturising creams can also help.

Despite these measures, more intensive acne treatment may be needed, depending on the severity.

Non-medicinal

A first step can be deep cleansing, where comedones are removed with a small needle to reduce inflammation and prevent scarring.

Medicinal

Medicines aim to clear acne quickly, with different treatments for mild, moderate, or severe cases. Mild acne features comedones with minimal inflammation, moderate acne has both comedones and inflammation on the face, while severe acne may involve widespread inflammation, comedones on the torso, or acne conglobata with scarring. 

Topical treatments are suitable for mild cases, while moderate to severe acne may require oral medication. Psychological support may also be part of the treatment. 

Read the leaflet carefully before starting any medicine. Avoid antibiotics if you have a history of allergic reactions, and complete the prescribed course. 

Topical products like benzoyl peroxide gel, adapalene gel, or tretinoin cream help prevent clogged pores. Antibiotics, such as clindamycin or erythromycin, can be applied to the skin or taken orally, and the contraceptive pill may help some women. For moderate cases unresponsive to other treatments, isotretinoin may be considered. 

Alternative acne treatments

Microdermabrasion, where the top skin layer is removed, can complement medication to help calm and reduce acne over time.

Acne scars

Acne scars form where the skin heals with different tissue structure, making them visible. Treatments include: 

• Chemical peeling: Uses an acidic liquid to remove the top skin layer. 
• Laser treatment: Burns off the epidermis in layers. 
• Combination treatments: Involving sandblasting, tretinoin cream, and laser to enhance connective tissue. 

Psychosocial well-being

Acne can severely affect quality of life, leading to feelings of shame, insecurity, and even depression. If these feelings persist, consult a doctor and consider seeing a psychologist or dermatologist.

Additional risks and side effects

Always read the medication leaflet. Avoid antibiotics if previously allergic, and complete the course.

Potential side effects include:

• Bleaching: Benzoyl peroxide may bleach fabrics, hair, or metal. 
• Hyperpigmentation: Skin irritation from benzoyl peroxide or tretinoin increases dark spot risk, especially in darker skin tones. 

Pregnancy and breastfeeding

Avoid acne treatments such as adapalene, tretinoin, clindamycin/tretinoin gel, doxycycline, and isotretinoin during pregnancy or breastfeeding.

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