Acne is one of the most common skin conditions. It occurs in people of different ages and races, ranging from adolescents to adults. This skin condition can be challenging to treat, but understanding the root factors influencing its development can help people with the condition get faster solutions.
Acne is a common skin condition in which the hair follicles beneath the skin become blocked, leading to the outbreak of lesions like whiteheads and blackheads, commonly called pimples.
Contrary to the popular belief that acne affects only teenagers, 80% of people between the ages of 12 and 30 experience some form of acne, meaning adults, too, can be affected.
Sebum (the oil that the skin produces to prevent drying out), dirt, occlusive skincare products, and dead skin cells are some of the things that can clog skin pores, leading to acne.
Acne treatment can be challenging sometimes, and for some people, attempts to treat it even appear to worsen it. This may be because they have not addressed the underlying cause, they are using the wrong skincare products, or they are using the right skincare products but in the wrong way.
There are several possible causes of acne, including:
Acne comes in different forms, and determining the type of acne you have will make the treatment process faster and easier.
The types of acne include:
This common inflammatory skin condition mainly affects the face but can also affect the upper arms, torso, and back. It manifests as papules (inflamed bumps without pus), pustules (contains pus), or nodules (hard, larger, inflamed, and painful bumps). It also causes whiteheads (tiny, raised, white, or skin-colored bumps) and blackheads (small black or dark-colored bumps).
Although acne vulgaris can affect people of all ages, teenagers are most likely to experience it.
Some of the causes of acne vulgaris include:
Treatments for acne vulgaris include salicylic acid, clindamycin, erythromycin, benzoyl peroxide, and topical retinoids.
This type of acne is a chronic inflammatory skin disorder that typically affects the nose and cheeks. The exact cause of rosacea is unknown, but it is more frequent in women and middle-aged and older adults, though it can be rather severe in men, fair-skinned individuals, and those with a family history of rosacea.
Some symptoms that distinguish acne rosacea from other skin conditions include:
Acne conglobata is a rare but severe form of nodulocystic acne, a type of acne with cysts and nodules. The acne appears as deep burrowing abscesses on the thighs, upper arm, back, shoulder, and chest, as well as double or triple-interconnecting comedones, cysts, and inflammatory nodules.
Bodybuilders who use androgenic anabolic steroids—manufactured forms of testosterone usually abused by musclebuilders—are prone to developing acne conglobata.
A steroid like prednisolone and retinoids like isotretinoin can be used to treat this form of acne.
Acne mechanical is a form of acne that forms as inflammatory papules and pustules. They are caused by friction from constant rubbing, stretching, and squeezing of the skin combined with heat, pressure, and occlusion. Athletes involved in sports that involve constantly rubbing or stretching body parts are at risk of getting acne mechanica.
Some factors may influence the development of acne, including:
According to studies, 63% of women see an increase in the frequency of inflammatory acne lesions in the last few days of their menstrual cycles. The underlying cause of acne in these women is tied to hormones.
Androgen, the hormone responsible for growth and reproduction in both males and females, stimulates androgen receptors in the oil glands and root of the follicles that produce hair, causing sebum and a protein called keratin to accumulate in follicles, resulting in open and closed papules that serve as a growth medium for Propionibacterium acne.
Insulin is another hormone that can indirectly play a role in acne development because it stimulates the release of androgen from the ovary in females. People with health conditions like PCOS have high insulin in the blood, which triggers the release of excess testosterone, leading to symptoms like acne and excess hirsutism.
Acne is common in teens because most of them are in the stage of puberty, which is characterized by increasing and fluctuating hormones. However, some people develop acne in their 30s, 40s, and even 50s. This is known as "adult-onset acne." Adult acne is more common in women than males because of hormonal fluctuations during menstruation, pregnancy, perimenopause, and menopause.
Some factors that may influence this include;
During puberty, the body produces testosterone, which in females maintains muscle and bone strength, and encourages the growth and development of the penis and testicles in males. An increase in testosterone levels can cause acne.
Because the sebaceous glands are hormone-sensitive, they overproduce sebum in response to elevated testosterone levels.
According to studies, over 40% of pregnant women in their late 20s and early 30s have acne. The root cause of pregnancy acne is unknown, and treatment options have limitations due to the need to keep the fetus safe in its mother's womb. However, pregnancy-related acne may be linked to an increase in reproductive hormones, particularly progesterone, which may increase the amount of sebum the skin produces.
There are different treatment options for acne, including:
Topical treatments can be beneficial in mild and moderate acne. They can be used alone or in combination. To choose the best topical treatment for your condition, seek the help of a licensed aesthetician or a dermatologist. First-line topical treatments for acne may include the following:
Before adding topical products with active ingredients like retinoids and benzoyl peroxide to your skincare routine, consider speaking with a skincare expert, particularly a dermatologist first. They will help in assessing your skin type, diagnosing the cause of your acne, and recommending how best to use the products.
Some oral treatment options for acne include antibiotics, isotretinoin, spironolactone, and hormonal contraceptives.
In cases of moderate to severe acne, oral antibiotics can be used as the first line of treatment along with a topical agent such as benzoyl peroxide.
Hormonal medications are an effective second-line treatment for acne in women, regardless of the underlying hormonal disorders. Some clinical research has found that estrogen-containing oral contraceptives can be beneficial, whereas those containing solely progesterone can aggravate acne.
When oral contraceptives are ineffective, spironolactone can come into play. According to a 2011 research, spironolactone can be used alone in a higher dose of 50-200 mg/d, as it has proven effective in improving acne.
Menstrual abnormalities, feminization of a male fetus, and increased potassium levels are a few possible side effects of spironolactone.
It is important not to self-medicate on antibiotics. The idea behind seeing a dermatologist for your acne is that they can recommend tests to find out if bacteria is the cause of your acne. Treating acne that's unrelated to bacterial causes using antibiotics will not yield positive results but instead lead to antibiotic resistance, a state where bacteria no longer respond to the antibiotic medications you take.
Light and laser therapy are currently widely used in acne treatment since they appear safe and have few or no adverse effects. This acne treatment method uses LED light therapies such as red light, blue light, and infrared light.
Red light penetrates deep into the skin, immediately affecting sebaceous glands and reducing inflammation. Blue lights also produce anti-inflammatory effects on acne. On the other hand, infrared lasers may lower the size of the sebaceous gland, resulting in less sebum production.
According to a 2015 study, using just blue light (415nm) for 8-20 minutes twice weekly for four weeks reduced 60-70% of inflammatory acne lesions but had no impact on non-inflammatory acne lesions. In the same way, blue-red light therapy lessens inflammatory lesions while having a less noticeable effect on non-inflammatory acne lesions.
Laser treatment can be an efficient part of an acne treatment approach, even though the results may be unpredictable for everyone. Studies have shown that laser lessen the look of acne, but you may need to pair it with other acne treatments for the best results. Because laser treatments take time to produce visible results, you may require more than one session to achieve the desired outcomes. Tools and techniques for laser treatments include the following:
For many people, acne seems like a chronic skin condition that is difficult to manage or treat. But there are things one can do to effectively prevent acne, manage it, and even get rid of it.
Some helpful strategies for preventing and controlling acne breakouts include:
With a proper skincare routine, you can prevent and manage the spread of acne. Utilizing products that contain benzoyl peroxide, salicylic acids, and retinoids may be a stepping stone for a good and stable routine. A proper skincare routine should include:
Another way to prevent acne is by avoiding anything that irritates your skin. Some products can trigger acne on the skin, especially for acne-prone skin.
Oily products, comedogenic products that clog pores, and excessive exfoliation can trigger acne on the skin. Therefore, be sure the word "non-comedogenic" is written on the product before applying any product to your skin.
Diet can significantly affect acne. A high-glycemic diet like bread, white rice, cakes, and cookies can raise blood sugar, leading to inflammation and increased sebum production, which can worsen acne. So, it's important to avoid these foods and instead opt for healthy fats, proteins, and a moderate amount of low-glycemic carbs.
Aside from its impact on self-esteem, acne can cause complications like:
Post-inflammatory hyperpigmentation is a skin disorder that occurs after skin injury or inflammation, making the skin produce extra melanin. It can be managed using photoprotection, and topical treatments, such as retinoids and azelaic acid.
Post-inflammatory erythema refers to skin redness at a particular location due to skin inflammation. Intense pulse light, pulse dye laser, and 5% topical tranexamic acid can all be beneficial in treating this.
Scarring from acne occurs as a result of inflammation of acne blemishes. Acne scars are most common in more severe types of acne, particularly those resulting from cysts and nodules that rupture and cause harm to surrounding skin. To reduce the chances of having acne scars, avoid picking at your acne and get it treated right away.
Treatments for acne scarring include:
The use of antibiotics is essential in acne treatment, but one limitation of this treatment protocol is antibiotic resistance.
Antibiotic resistance occurs when bacteria develop the ability to withstand medications intended to destroy them.
Recently, there have been some worries regarding antibiotic resistance. Due to this reason, several antibiotics, such as clindamycin and erythromycin, are no longer used to treat acne due to high resistance rates. According to a 2020 study, tetracyclines such as doxycycline, minocycline, and sarecycline are still the first-line therapy options for acne due to their proven safety and efficacy.
Shortening the course of treatment to as little as three to four months is crucial to prevent antibiotic resistance. Alternatively, consider other treatment options such as topical retinoids, benzoyl peroxide, topical salicylic acid, topical azelaic acid, or hormonal therapies.
If you have tried all available treatment protocols for acne and they have all proven abortive, then it is time to consult your dermatologist for professional care. Some skincare practices work better for specific skin types, and a dermatologist can help you figure out your skin type. Also, some treatment protocols require the advice and supervision of a licensed aesthetician or dermatologist to avoid worsening your condition.
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