Acne

What is Acne?

Acne vulgaris, or simply acne, is a chronic inflammatory skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It often results in the formation of pimples, blackheads, or whiteheads, typically appearing on the face, forehead, chest, upper back, and shoulders. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.

Common Acne Myths

Acne is surrounded by a lot of misinformation, which can lead to people taking the wrong approach to managing it. 

One predominant myth is that Acne is caused by dirt and poor hygiene. While good hygiene is important for overall skin health, acne isn’t caused by a dirty face. It’s a result of excess oil production, clogged pores, and bacterial activity, not superficial dirt. Over-washing or scrubbing your face harshly can actually irritate the skin and worsen acne.

Many people believe that only teenagers can get acne. While acne is most common during teenage years due to hormonal changes, it can affect people of all ages. Adults can experience acne breakouts for various reasons, including hormonal fluctuations, stress, and certain medications.

Another common misconception is that squeezing or picking acne related pimples will make them go away faster. Picking at pimples can worsen inflammation, increase the risk of infection, and even lead to scarring. It’s best to leave pimple-popping to a dermatologist for safe extraction.

There is also the belief that tanning causes acne breakouts to heal or clear up faster. While a tan might temporarily mask the appearance of acne, ultraviolet (UV) rays from the sun can actually irritate the skin and even worsen breakouts in the long run. 

 While some mild acne might improve over time, especially after teenage years, it’s best not to leave it untreated. Early intervention by a dermatologist can prevent scarring and improve your overall skin health. While some acne medications can cause dryness or irritation, these side effects are usually manageable with proper skin care practices.

There is also no definitive link between chocolate or greasy foods and acne breakouts.

Common Causes of Acne

Acne can be caused by a number of factors that clog pores and trigger inflammation. Here’s a breakdown of the common causes:

1. Excess Oil Production: Androgen hormones, particularly during puberty or hormonal fluctuations, kick oil glands (the sebaceous glands which produce an oily substance called sebum) into overdrive. This extra sebum can clog pores.
2. Follicle Plugging: Sebum mixes with dead skin cells, forming a sticky mess that plugs the pore opening. This prevents the sebum from reaching the skin’s surface and creates the perfect environment for bacteria to thrive.
3. Cutibacterium Acnes (C. acnes) Bacteria: This bacteria isn’t necessarily bad, but it loves the clogged, oily environment within pores. It multiplies and contributes to inflammation.
4. Inflammation: The body’s immune system recognizes the bacteria and clogged pores as a threat. It sends white blood cells to attack, leading to redness, swelling, and the formation of pimples.
5. Hormonal Changes: Hormonal fluctuations, such as those that occur during puberty, menstruation, pregnancy, or when starting or stopping birth control pills, can also increase sebum production and contribute to acne.
6. Certain Medications: Some medications, such as corticosteroids, androgens, or lithium, can worsen acne.
7. Diet: While the direct relationship between diet and acne is still debated, some studies suggest that certain foods, such as dairy products and high-glycemic-index foods, may worsen acne in some individuals.

Symptoms of Acne

Acne symptoms come in various forms, ranging from mild non-inflammatory blockages to painful, deep lesions. Here’s a breakdown of the different types of acne blemishes and the telltale signs to watch for:

1. Comedones: These are the non-inflamed, clogged pores that mark the initial stage of acne. They come in two main types:
   • Whiteheads (closed comedones): Small, white bumps that form when sebum and dead skin cells get trapped beneath the skin’s surface. The opening of the pore is closed, giving them a white appearance.
   • Blackheads (open comedones): Similar to whiteheads, but the plug blocking the pore is open at the surface. Sebum reacts with oxygen in the air, causing the plug to turn black. While often called “dirty pores,” blackheads aren’t caused by dirt and picking at them can worsen inflammation.
2. Inflammatory Acne: When bacteria (Cutibacterium acnes) proliferate within clogged pores, the body’s immune system kicks in, triggering inflammation. This leads to the more noticeable and often uncomfortable symptoms of acne:
   • Papules: Small, red, inflamed bumps that develop around clogged pores. They’re tender to the touch but lack pus.
   • Pustules:  Also known as pimples, these are pus-filled bumps that form when white blood cells attack bacteria trapped within the pore. They are typically red at the base and have white or yellow pus in the center.
   • Nodules:  Larger, solid, and often painful bumps that lodge deep within the skin. They can be quite tender and take longer to heal than papules or pustules.
   • Cysts: The most severe form of acne, cysts are large, pus-filled lesions that develop deep within the skin. They can be very painful and are more likely to leave scars after healing.
3. Other Signs:  In addition to the primary blemishes, acne can cause other noticeable symptoms:
   • Redness:  Inflammation around pimples and clogged pores can make the surrounding skin appear red and irritated.

• • Scarring:  Severe acne, particularly nodules and cysts, can leave permanent scars. Early treatment can help minimize scarring.
  • Post-inflammatory hyperpigmentation (PIH):  This temporary darkening of the skin can occur after acne blemishes heal, especially in people with darker skin tones. PIH usually fades over time but can be treated with topical medications.

Possible Complications of Acne

Acne itself isn’t life-threatening, but it can lead to some complications that go beyond the physical appearance of blemishes. 

• Scarring: This is a major concern for many people with acne, especially severe acne. Nodules and cysts that burrow deep within the skin are more likely to leave scars after healing.
• Post-inflammatory hyperpigmentation (PIH): This temporary darkening of the skin can occur after acne blemishes heal, particularly in people with darker skin tones. PIH is caused by excess melanin production triggered by inflammation. While not technically scarring, it can cause discoloration that takes time to fade.
• Psychological effects: Acne can significantly impact a person’s self-esteem, confidence, and social life. Feelings of embarrassment, anxiety, and even depression are not uncommon, especially for teenagers who are already self-conscious about their appearance.
• Increased risk of staph infections: In rare cases, severe acne, particularly acne fulminans, can lead to a serious bacterial infection caused by Staphylococcus aureus. This requires immediate medical attention.

How do you Prevent Acne Breakouts or Worsening a Breakout?

While acne can be influenced by various factors such as genetics, hormones, and environmental triggers, adopting proactive measures can significantly reduce the likelihood of breakouts and promote healthier skin.

Wash your face with a gentle cleanser morning and night to remove dirt, oil, and dead skin cells that can clog pores. Avoid harsh scrubbing or cleansers that leave your skin feeling tight or dry. Use a non-comedogenic moisturizer to keep your skin hydrated. This can help prevent dryness which can trigger oil production and worsen acne. Protect your skin from the sun with a non-comedogenic, broad-spectrum sunscreen with SPF 30 or higher every day, even on cloudy days. Sun exposure can irritate skin and worsen breakouts.

Use a gentle exfoliating scrub or chemical exfoliant (like salicylic acid) 1-2 times a week to remove dead skin cells from the surface of your skin. Be careful not to over-exfoliate, which can irritate your skin. Consider using an over-the-counter (OTC) acne treatment containing benzoyl peroxide. This helps kill acne-causing bacteria and reduce inflammation.

Wash your hair regularly, especially if it’s oily, to prevent hair oils from transferring to your face.

Additionally, throughout the day, your hands come into contact with many surfaces and can harbor bacteria. Touching your face frequently can transfer bacteria to your pores and trigger breakouts.

Chronic stress can also worsen acne breakouts. Practice relaxation techniques like meditation, yoga, or deep breathing to manage stress.

How do you treat Acne?

There are various effective acne treatments available, depending on the severity and type of acne you have. Here’s a breakdown of the most common approaches:

Over-the-counter (OTC) topical medications:  These are readily available at drugstores and a good starting point for mild acne. They come in various forms like creams, gels, and lotions and target different aspects of acne:

• Benzoyl peroxide: Kills acne-causing bacteria and helps reduce inflammation.
• Salicylic acid: Exfoliates dead skin cells that can clog pores.
• Retinoids (adapalene): Promote skin cell turnover and unclog pores.

Prescription topical medications: For moderate acne or if OTC options fail to provide sufficient improvement, a dermatologist might prescribe stronger topical medications:

• Combination medications: Often combine benzoyl peroxide with antibiotics or retinoids to target multiple aspects of acne.
• Tretinoin: A more potent retinoid than adapalene, effective for unclogging pores and reducing inflammation.
• Antibiotics: Topical antibiotics can help target bacteria that contribute to acne breakouts.

Oral medications:  For severe acne, particularly cystic acne, a dermatologist may recommend oral medications:

• Antibiotics: Oral antibiotics work similarly to topical antibiotics but can have side effects like antibiotic resistance with long-term use.
• Isotretinoin: This powerful retinoid medication shrinks oil glands and reduces inflammation. It’s very effective for severe acne but comes with potential side effects and requires careful monitoring by a dermatologist.

Other treatments:  In some cases, alongside topical or oral medications, these additional treatments may be used:

• Light therapy: Blue light or red light therapy can target bacteria and reduce inflammation.
• Comedone extraction: A dermatologist can manually extract blackheads and whiteheads during an office visit.