How to Get Rid of Acne

What is Acne?

• Acne is a very common, chronic, skin disease that affects 60-70% of Americans at some time during their lives.

• It is more frequent in adolescence and young adulthood, thought it may present at any age. Acne begins as a noninflammatory comedonal condition and then evolves to the mildly inflammatory papular pustular acne before proceeding to the more inflammatory nodulocystic lesions. Each stage seems to be separated by 2–3 years. It becomes more common and severe, reaching its peak between 14–17 years in females and 16–19 years in males. For most people, acne diminishes over time and tends to disappear, but at 40 years of age 1% of men and 5% of women exhibit acne lesions

What is Acne? Cont’d

• Acne by definition is a multifactorial, chronic disease of the pilosebaceous units. The hair follicles become plugged with oil and dead skin cells. Acne most commonly appears on face, neck, chest, back and shoulders, where there are more sebaceous glands. Acne can be distressing and annoyingly persistent. Acne lesions heal slowly, and when one begins to resolve, others seem to crop up.

• Depending on its severity, acne can cause emotional distress and lead to scarring of the skin. The good news is that effective treatments are available — and the earlier treatment is started, the lower your risk of lasting physical and emotional damage.3

• The treatment should be directed to prevent physical and emotional scarring.

What Causes Acne?

• Acne develops as a result of blockages in follicles. Follicular hyperkeratinization and formation of a plug of keratin (a protein from the skin) and sebum (a mix of naturally occurring oil, and dead skin cells) is the earliest change (a microcomedo). Enlargement of sebaceous glands and an increase in sebum production occur with increased male sex hormones production (androgens). The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo (whitehead or milia). Comedones are the direct result of sebaceous glands' becoming clogged with sebum. In these conditions, the bacteria called Propionibacterium acnes, which lives in the sebaceous glands, can cause inflammation, leading to inflammatory lesions.

What Causes Acne? Cont’d• Genetics: Acne is more frequent in

adolescents which both parents had acne. A family history of acne is associated with early acne appearance.

• Hormonal activity: Increase of androgens (testosterone, dihidrotestosterone and dehydroepiandrosterone sulfate) during puberty, menstrual cycle, pregnancy, post menopause, etc. Insulin growth factor has also been associated with certain type of acne and polycystic ovary syndrome.

Follicular hyperkeratinization

Excess sebum production

Proliferation ofP.acnes

Inflammation

What Causes Acne? Cont’d

• Psychological factors: Most of the recent studies indicate that increase in the level of emotional stress increases the severity of acne flares, probably due to the increase in the production of neuropeptides around the sebaceous glands that also increase sebum production and inflammation.

• Diet: No direct link has been found between acne and diet. In particular, no effect has been established between chocolate, shellfish, or fatty foods. However, the influence of dietary factors on the initiation and course of acne has recently received increased recognition. A connection has been postulated between acne and nutrients with high glycemic index, as well as with milk and dairy products.

What Causes Acne? Cont’d

• Tobacco: Clinical evidence and experimental data showed a straight correlation between smoking habit and post-pubertal acne in which the clinically non-inflammatory type is the most frequent

Signs & Symptoms

• Acne is a polymorphic disease, in other words it is characterized by the presence of different types of lesions simultaneously. In almost all patients comedones (white and black heads), papules and pustules (pinheads and pimples) can be found at the same time. Two main patterns of disease have been described. The first pattern is that of essentially noninflammatory disease, which tends to be an early phase often seen in the peri-pubertal age group.

Signs & Symptoms Cont’d

• There is increased oil production on the face, chest, back and shoulders. This may be accompanied by an increase in pores’ size, blackheads or open comedones. Occasionally noninflammatory whiteheads or closed comedones will also be seen, premonitory of other more significant inflammatory disease. This presentation of the disease is also known as comedonal acne (see fig. 2 - 3)

Signs & Symptoms Cont’d

• The second clinical pattern is that of inflammatory disease, that tends to lead to more scarring. This may span the full gamut from papules (pinheads), pustules (pimples), nodules and cysts and any combination of these. Postinflammatory macular disease may follow resolution and these may be red or hyperpigmented, representing a component of postinflammatory change. Severe forms of inflammatory acne such as nodular cystic disease, with all its potentially destructive sequelae, often occur later in predisposed individuals. (Fig 4 and 5)

• If acne is not adequately treated, physical atrophic (depressed) or hypertrophic/keloid (elevated) scars may occur. (Fig.6)

Fig. 2 Comedonal acne Fig. 3 Comedonal acne (open comedones)

Fig.4 Papular-pustular acne

Fig. 5 Nodulocystic acne Fig 6. Atrophic acne scars(back)

Acne Myths

• Acne is a disease that will improve by itself and has to run its course: Dermatologists know that letting acne runs its course is not always the best advice because without treatment dark spots and permanent scars can appear on the skin as acne clears. Acne treatment helps also increasing the self–esteem of the person.

• Acne is a contagious infectious disease: Patients believe that acne is an infection and that they are infectious to others. Although Propionobacterium acnes is important in the extension of the disease from simple comedones to full blown inflammatory lesions, it is a secondary phenomenon once the disease has been initiated. Thus, acne is not an infectious or contagious disease

Acne Myths Cont’d

• Sexual activity is related with acne: There are misconceptions regarding variably too little or too much sexual activity and acne. First that too much sex or masturbation may worsen acne. Second that somehow when females begin having a regular sex life their acne will be improved. Although acne is tied up with androgen metabolism at the level of the sebaceous glands, there appears no basis to either of these rather strange extrapolations. Acne is occurring at a similar stage as sexual adventure and this may be a plausible reason for the uninformed to associate the two. One may also possibly look at the beneficial effect of oral contraceptives on acne as a possible explanation for improvement associated with the beginning of sexual activity in females.

Acne Myths Cont’d

• Acne is curable: There is a widespread belief that acne is curable and that a course of antibiotics is all that is required. Patients will often make statements such as: ‘the treatment didn’t work because when I stopped the tablets the acne came back again’ or, ‘the acne only improved but didn’t completely disappear’. It must be made clear that continued treatment is required and that there is no cure (although isotretinoin may cause long term remission of the disease).

Acne Myths Cont’d

• Frequent skin hygiene and intense face cleansing improve acne: Not only are the facial cleansing regimens of patients with acne often burdensome, they can be expensive. The evidence for the role of a lack of facial hygiene in acne pathogenesis and for face cleansing in its management is mostly of poor quality. Furthermore, face-washing has been proposed as being traumatizing, and so exacerbating acne and as increasing the skin irritation adverse effects of topical tretinoin and isotretinoin (though not other topical therapies) in acne treatment. Additionally, commonly used soaps and shampoos have been found to be comedogenic when applied to the rabbit ear.

Acne Treatment

• Today, there are many effective acne treatments. This does not mean that every acne treatment works for everyone who has acne. But it does mean that virtually every case of acne can be controlled.

• People who have mild acne have a few blemishes. They may have whiteheads, blackheads, papules, and/or pustules . Many people can treat mild acne with products that can be bought without a prescription. A product containing benzoyl peroxide or salicylic acid often help to clear the skin. This does not mean that the acne will clear overnight. At-home treatment requires 4-8 weeks to see improvement. Once acne clears, a maintenance treatment must continue to prevent breakouts.

Acne Treatment Cont’d

Topical treatment: This is a treatment that is applied to the skin. There are many topical acne treatments, and there is no magic product or regimen that is right for every person and situation. Topical treatment is usually broken down into two categories:• Cleansers: A good part of any topical regimen can include

both mild cleansers that keep the skin clean and minimize sensitivity and irritation and exfoliating cleansers that remove the outer layer of the skin and loosen pore-clogging dirt.

• Topical leave on products: Topical products can help kill the bacteria that cause acne and others work on reducing the oil. The topical medicine may contain a retinoid, benzoyl peroxide, antibiotic, or even salicylic acid.

Acne Treatment Cont’d

Systemic treatment: This is a treatment that works throughout the body and may be necessary for inflammatory (red, swollen) types of acne, including the papular-pustular and nodulocystic forms. Your dermatologist may prescribe one or more of these:• Antibiotics (helps to kill bacteria and reduce

inflammation).• Birth control pills and other medicine that works

on hormones (can be helpful for women).• Isotretinoin (the only treatment that works on all

that causes acne).

Acne Treatment Cont’d

Procedures that treat acne: Your dermatologist may treat your acne with a procedure that can be performed during an office visit. These treatments include:• Lasers and other light therapies: These devices reduce the p. acnes

bacteria. Your dermatologist can determine whether this type of treatment can be helpful.

• Chemical peels: You cannot buy the chemical peels that dermatologists use. Dermatologists use chemical peels to treat 2 types of acne — blackheads and papules.

• Acne removal: Your dermatologist may perform a procedure called “drainage and extraction” to remove a large acne cyst. This procedure helps when the cyst does not respond to medicine. It also helps ease the pain and the chance that the cyst will leave a scar. If you absolutely have to get rid of a cyst quickly, your dermatologist may inject the cyst with medicine.

Outcome

• Waiting for acne to clear on its own can be frustrating. Without treatment, acne can cause permanent scars, low self-esteem, depression, and anxiety.

• To avoid these possible outcomes, dermatologists recommend that people treat acne. When the skin clears, treatment should continue. Treatment prevents new breakouts. Your dermatologist can tell you when you no longer need to treat acne to prevent breakouts.

Quality of Life

• The presence of acne can negatively affect quality of life, self-esteem, and mood in adolescents. Acne is associated with an increased incidence of anxiety, depression, and suicidal ideation. The occurrence of these and other co-morbid psychological disorders should be considered in the treatment of acne patients when appropriate. A strong physician-patient relationship and thorough history taking may help to identify patients at risk for the adverse psychological effects of acne. Successful treatment of acne with isotretinoin qualitatively decreases depressive symptoms and improves quality of life. The effect of other topical and systemic therapies for acne on psychological symptoms has not been assessed.

Quality of Life Cont’d

• In addition to the effect of acne on the patient, family and social relationships may also be strained. Parents may worry about the short- and long-term repercussions of their child’s appearance, such as being bullied at school or having permanent scarring from acne lesions. As teens gain independence during adolescence, their attitudes toward treatment and adherence to the prescribed regimen may be adversely affected. Parents and patients may not always be adequately educated about the causes and treatment of acne, which may further delay or affect successful treatment. Poor adherence to therapy is a barrier to successful acne treatment. There is a positive correlation between treatment adherence and improved quality of life for other cutaneous diseases such as psoriasis and is an important area of future research in the clinical setting of acne treatment.

Where to Get Help?

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