Acne vulgaris (commonly called ACNE, ZITS, SPOTS, BLEMISHES, PIMPLES, PUNGGOD IN BACOLOD & ILOILO, BUGAS-BUGAS IN BOHOL & DUMAGUETE) is a common skin condition, caused by changes in the pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland via androgen stimulation. It is characterized by non-inflammatory follicular papules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. Acne vulgaris affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in non-inflammatory forms.
Acne is most common during adolescence and frequently continues into adulthood. The cause in adolescence is generally an increase in male sex hormones, which people of both genders acquire during puberty. For most people, acne diminishes over time and tends to disappear—or at the very least decrease—after one reaches one's early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will carry this condition well into their thirties, forties and beyond.
The face and upper neck are the most commonly affected, but the chest, back and shoulders may have acne as well.
Causes of Acne
Acne develops as a result of blockages in follicles. The bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the skin, which results in redness and may result in scarring or hyper-pigmentation.
There are many products available for the treatment of acne. Treatments show little improvement within the first two weeks, instead taking a period of approximately three months to improve and start flattening out.
A combination of treatments can greatly reduce the amount and severity of acne in many cases. Those treatments that are most effective tend to have greater potential for side effects and need a greater degree of monitoring, so a step-wise approach is often taken.
There are a number of treatments that have been proven effective:
Widely available OTC bactericidal products containing benzoyl peroxide may be used in mild to moderate acne. The gel or cream containing benzoyl peroxide is rubbed, twice daily, into the pores over the affected region. Bar soaps or washes may also be used and vary from 2 to 10% in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide also prevents new lesions by killing P. acnes. Unlike antibiotics, benzoyl peroxide has the advantage of being a strong oxidizer (essentially a mild bleach) and thus does not appear to generate bacterial resistance. However, it routinely causes dryness, local irritation and redness.
Care must be taken when using benzoyl peroxide, as it can very easily bleach any fabric or hair it comes in contact with.
Externally applied antibiotics such as erythromycin, clindamycin, stievamycin, or tetracycline kill the bacteria that are harbored in the blocked follicles. While topical use of antibiotics is equally as effective as oral use, this method avoids possible side effects including upset stomach and drug interactions.
Oral antibiotics used to treat acne include erythromycin or one of the tetracycline antibiotics (tetracycline, the better absorbed oxytetracycline, or doxycycline, minocycline, or lymecycline). Trimethoprim is also sometimes used. However, reducing the P. acnes bacteria will not, in itself, do anything to reduce the oil secretion and abnormal cell behavior that is the initial cause of the blocked follicles. It has been found that antibiotics such as minocycline also improve acne. It is believed that minocycline's anti-inflammatory effect also prevents acne.
In females, acne can be improved with hormonal treatments. If a pimple is large and/or does not seem to be affected by other treatments, a dermatologist may administer an injection of cortisone directly into it, which will usually reduce redness and inflammation almost immediately. This has the effect of flattening the pimple, thereby making it easier to cover up with makeup, and can also aid in the healing process. Side effects are minimal, but may include a temporary whitening of the skin around the injection point; and occasionally a small depression forms, which may persist, although often fills eventually.
A group of medications for normalizing the follicle cell lifecycle are topical retinoids such as tretinoin (brand name Retin-A), adapalene (brand name Differin), and tazarotene (brand name Tazorac). Like isotretinoin, they are related to vitamin A, but they are administered as topicals and generally have much milder side effects. Topical retinoids often cause an initial flare up of acne and facial flushing.