An in-depth guide to acne

Acne is a common skin condition that is characterised by large areas of skin developing blemishes. In this article, an accomplished GP, Dr Amandeep Singh Grewal, sheds a light on the types of acne, why it occurs, and methods of treatment.

 

 

What causes acne?

Acne occurs when the pores and hair follicles of the skin become blocked due to excess oil, called sebum, and debris buildup like dead skin cells. In the skin are bacteria like C. acnes and P. acnes which feed on sebum and skin cells, and overpopulation of them can cause inflammation. The skin then reacts by forming pimples, zits, or blemishes such as:

• Blackheads, which are small black or yellowish bumps that are darker in colour due to oxidised dead skin cells and remnants of the hair follicle.
• Whiteheads, which have a white tip that when expressed will excrete a white fluid or pus.
• Papules, which are small red bumps that may feel tender or sore but do not excrete much when expressed.
• Pustules, which are similar to whiteheads but are more inflamed, so the skin around it will likely be red and sore.
• Nodules, which are painful, solid bumps that are felt underneath the skin.
• Cysts, which are painful, large pus-filled lumps and have the most potential to leave permanent scarring.

Acne can affect anyone and everyone. It is most common in adolescents as their bodies are going through drastic changes and their hormone levels are significantly fluctuating, which can lead to sebum overproduction. Other instances of hormonal changes, like pregnancy and menstruation, are also susceptible to acne formation. A lifestyle where an individual sweats a lot or is experiencing a lot of stress can also make acne worse. Research suggests that diet can influence acne development and that diets that are high in refined sugars, dairy, and processed food can exacerbate the condition. Acne breakouts can also be caused by fungal infections.

It most commonly develops on the face, but it can also occur on the back and the chest.

 

How is acne treated?

There are many approaches to treating acne, ranging from medications to topical creams and ointments, to light therapy, to injections and chemical facial treatments.

Not every individual with acne can be treated the same way, so the process will typically involve a bit of trial and error as the patient works with their doctor or dermatologist to find the right combination of treatments, which can include:

 

Medication

• Over-the-counter topical products in the form of creams, ointments, and serums that contain ingredients like benzyl peroxide, salicylic acid, retinoids, or azelaic acid. There may be some redness and irritation following the use of these products, as well as UV sensitivity. More abrasive and concentrated forms of these medications can be taken orally and are prescribed in severe cases.
• Antimicrobial medication can be taken orally or applied topically as well. They are used to kill skin bacteria or fungi, and popular options include tetracycline and macrolide. They can only be prescribed.
• Hormonal medications like the oral contraceptive or anti-androgen agents to recalibrate hormone levels, particularly the sexual hormones that can have abnormal levels during puberty. The hormonal implant can also be used to this effect, but some patients may find their acne actually exacerbated with using hormonal medication.

Therapy

• Light (photodynamic) therapy, which uses red or blue light waves to kill bacteria, reduce inflammation, and reduce hyperpigmentation and scarring by promoting cellular repair.
• Drainage and extraction, where a trained professional uses specialised tools to manually extract sebum and pus in white- and blackheads.
• Chemical peels, where layers of a chemical solution are applied to the face to remove the topmost layer, promoting new skin growth and removing debris and buildup.
• Carboxytherapy, where carbon dioxide is injected underneath the skin to stimulate the presence of oxygen-rich blood into the area, promoting cell and tissue repair.
• Steroid injections, which can be used for nodules and cystic acne to reduce inflammation and pain.

 

To prevent acne outbreaks and take care of the skin, it is recommended to wash the skin no more than twice a day, as too frequent washing can irritate and dry out the skin, worsening symptoms. Soap or cleanser should be gentle and not heavily fragranced, and the water used should be lukewarm or skin-temperature.  Avoid squeezing and trying to empty pimples at home as this can lead to scabbing, scarring, and infection.

Use clean clothes, wash pads, and makeup brushes on the face, and change the bedsheets regularly. Avoid using products that are oil-based, such as suncream and foundation. Makeup and face paint should always be washed off before going to bed, and wash hair regularly or prevent it from having too much contact with the face to minimise oil transfer.