Acne vulgaris (commonly named as acne) is a very common skin disease. Acne is also known as pimples or zits. Usually acne is formed because of the excess oil getting trapped in the pores of the hair follicles Although acne is most common in adolescence boys and girls but it may appear in all ages. Acne may sometime inflammatory or prone to scarring. It also has some psychological effects like depression and low self esteem.
different forms of acne :
- Whiteheads – Whitehead is medically called a closed comedo because this type of comedo has an obstructed opening to the skin. It is consists of a dilated and clogged hair follicle filled with skin debris, bacteria, and sebum. Whitehead is a primary sign of acne.
- Blackheads – Blackhead is also known as open comedo. Unlike whiteheads it has a wide opening to the skin and is capped with a blackened mass of skin debris.
- Papules – Papules are small bumps found on the surface of skin with no visible fluid. It may varies in colors like brown, purple, pink or red. Papules sometimes formed in clusters.
- Pustules – Pustules are small elevation of skin. Pustules are filled with pus or necrotic inflammatory cells. Pustules are generally red in colour.
- Nodules – Nodules are large solid pimples, that are generally painful and are embedded deep in the skin. Nodular acne can easily cause scars.
- Cystic acne – Cystic acne is a type of nodular acne with an actual cyst forms underneath the acne lesion.
Symptoms of acne : Some skin problems like rosacea, pseudofolliculitis or razor rash and folliculitis may mimic acne.
Presence of comedons ( whiteheads and blackheads ), papules, pustules, nodules are the common symptoms of acne.
Complications : Some acnes like papules, pastules and nodules are inflammatory in nature. The most common complication regarding acne is scarring. The scar is created due to the presence too much collagen in one spot. Scar created by acne may be classified in following types :
- Ice pick scars: It is the most common type of scarring created by acne.
- Box car scars: These scars are similar to chickenpox scars.
- Rolling scars: Rolling scars often give a wave like appearance to the skin.
- Hypertrophic scars: These type of scars are thickened and raised above the skin.
Cause : The blockage in the hair follicles is the primary cause behind acne. The earliest change is hyperkeratinization and formation of plugs named as micro comedo, that is filled with keratin and sebum. Then the micro comedo may transform into an open comedo (blackhead) or closed comedo ( whiteheads ). The inflammation is caused by the infection of bacterium Propionibacterium acnes and leads to inflammatory lesions like papules, infected pustules or nodules.
The following conditions may have some contribution to the formation of acne :-
- Hormonal : It is seen that during puberty, an increased secretion of androgens (a steroidal sex hormone ) cause the follicular glands to grow larger and make more sebum. For this reason acne is more common in adolescence .
- Genetic : Acne may be hereditary and this has been supported by twin studies. It is also seen that acne susceptibility is likely polygenic in nature.
- Psychological : There may be some relation between increased level of stress and severity of acne.
- Infection : The infection of Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis may also cause acne.
- Diet : The diet with high glycemic load may worsen the condition.
- Certain medication : Some medication like corticosteroids drugs or lithium are known to aggravate acne.
Acne myths : There are some myths regarding acne, the myth are as follows :
- Having more chocolates and sodas aggravate acne
- Poor hygiene causes acne
Management of acne : The first step to manage acne is to keeping the skin clean to prevent the formation of microcomedones. Washing the face for once or twice with mild cleansing face wash may helps to minimize acne. Exfoliation or scrubbing may help to remove the dead cells thus opening the pores and reducing blackhead formation.
- Antibiotics :Topical application or oral doses of antibiotics like erythromycin, clindamycin and tetracyclines may helps to reduce the activity of P. acne.
- Benzoyl peroxide : Topical application of benzoyl peroxide is seem effective for mild to moderate acne.
- Hormones : The combined oral contraceptives are help to improve the acne in females.
- Topical retinoids : Application of topical retinoids ( tretinoin, adapalene, and tazarotene ) is effective in reducing inflammation.
- Oral retinoids : Oral retinoids like isotretinoin is very effective for severe acne. But isotretinoin may have some side effects like dry skin, nose bleeds, muscle pains etc. This treatment is not suitable for pregnant woman because of the increased the risk of having baby with birth defects.
Comedo extraction : Comedo extraction is helpful to treat acne. Comedo extraction is done through using gentle pressure around the pore opening in case of blackheads and by making incision with a large needle or a blade in case of whiteheads . This procedure should be done by a dermatologist or cosmetologist otherwise it may cause scarring and tissue damage.
Injection : Injection of corticosteroids into the inflamed comedone is effective for immediate relief.
Light Therapy : Light therapy is helpful to treat acne.
Laser surgery : Laser surgery can be used to reduce the scars, that are created by acne.
Surgical lancing : Surgical lancing is effective for people with cystic acne. The pus are drained out through this procedure.