Acne

Acne is a common, long-term condition affecting hair follicles and sebaceous glands. It causes the follicle to swell and become blocked, resulting in inflammation or sometimes without inflammation. 

Last Updated: February 25, 2024

Acne happens when the sebaceous glands are overly sensitive to the normal amount of androgens in the blood. This is made worse by a bacterium called Propionibacterium acnes, leading to inflammation. The following can also cause acne:

  • Medication  (lithium, steroids, and anticonvulsants)
  • Too much sun exposure
  • Use of occlusive clothing (shoulder pads, headbands, backpacks, and underwire brassieres)
  • Hormonal imbalance (polycystic ovarian syndrome and pregnancy)

 

Acne can start in puberty and last until the early thirties. Males have more acne and more people are affected in cities than in rural areas. Additionally, 20% of patients get severe acne that scars, and hyperpigmentation is common in darker-skinned people. Acne can also show up in newborns, but in most cases, it goes away on its own.

Most of the time, acne only happens on the face but can also occur on the neck, chest, and back.

It can appear as any of the following:

  • Open (blackhead) and closed (whitehead) comedones that are not inflamed
  • Inflamed papules (raised skin growth without pus) and pustules (raised skin growth with pus)
  • Nodules and pseudocysts
  • Scars and spots that are red-colored after an inflammation

 

The level of severity can be mild, moderate, or severe.

  • Mild acne has fewer than 30 spots
  • Moderate acne has between 30 and 125 spots
  • Severe acne has more than 125 spots

Most of the time, a physical examination is enough to diagnose acne but in unusual cases, a dermatologist can perform a skin swab for a microbiological examination to rule out other causes of skin inflammation. Furthermore, hormonal levels in women can be examined as this can also be the source of acne formation.

 

Treatment

Topical medications are the first-line treatment for mild acne. Topical retinoids like adapalene and tretinoin are Vitamin A derivatives that help reduce swelling. Benzoyl peroxide and topical antibiotics kill the bacteria responsible for acne and help reduce inflammation. 

 

Dermatologists usually prescribe these medications in combination as numerous combined formulations are available in local pharmacies. If hormonal imbalances are the suspected cause of acne, anti-hormonal medications are prescribed to decrease oil production and acne formation.

The following are some of the steps that can be done to improve the skin's health and appearance if suffering from acne:

  • Wash the face with warm (not hot) water and a mild cleanser once a day
  • Wash your face after you work out or if you sweat a lot
  • Do not use alcohol, astringents, toners, or exfoliants because they can irritate the skin
  • Remove makeup before going to bed or at the end of the day
  • Choosing a moisturizer without oil to put on the skin after you wash it
  • Don't pick at, pop, or squeeze pimples to avoid scarring.

 

References

Sutaria AH, Masood S, Schlessinger J. Acne Vulgaris. [Updated 2022 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459173/

Oakley, A. (2014). Acne. Retrieved January 14, 2023, from https://dermnetnz.org/topics/acne

Cleveland Clinic (2023). Acne. Retrieved January 14, 2023, from https://my.clevelandclinic.org/health/diseases/12233-acne

Last Updated: February 25, 2024