Acne is an inflammatory disease that
affects the hair follicle units. Specifically, the hair follicle
channel and the associated sebaceous glands that produce sebum or oil.
It's a disease that affects people of all ages, though it's most
frequent in adolescents (80%) and young adults (20-30 years).
How does acne manifest?
There are different types of lesions. The most common are comedons
(blackheads), papules and pustules (impurities filled with pus), and
more rarely cysts and abscess. These lesions are located on the face
and sometimes on the back, chest, shoulders and neck. Acne lesions
produce an aesthetic alteration that frequently causes social and
emotional problems. Furthermore, acne can produce permanent scars on
the face that can alter a person’s image or self esteem.
Fortunately, acne is curable. With timely proper treatment, it's
possible to prevent the development of these undesirable scars while
improving skin complexion and overall physical appearance.
Acne Scars
Some patients with acne have
small scars (dimples, reddish spots), particularly on the face and
back. These scars can be improved through a chemical
peeling with TCA or salicylic acid
(SaliPeel)
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What causes acne ?
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Three principal factors play a role: a
process of abnormal excessive keratinization within the follicle;
excessive sebum (a secretion of the sebaceum glands composed of oil,
keratin, and cellular debris); and bacteria called propionibacterium
acnes.
The first problem is an abnormal keratinization (excess of scales) in
the lowest part of the follicle. This causes sebum retention and a
barrier is formed in the excretory ducts of the glands. The second
factor is when there is an increase in the sebum secretion by the
sebaceous gland. This increase is stimulated by hormonal changes
(secretion of testosterone or masculine hormones) that take place
during adolescence. The retention or sebum obstruction leads to the
development of comedons - a collection of sebaceous material and
keratin retained in the hair follicle and the excretory ducts of the
sebaceous gland. Comedons can be opened (black heads) or closed (white
heads). The black colour is due to the reaction of the air on the
sebum held in the pores.
Eventually, excess sebum held in the ducts produces a swelling of the
walls. Then the follicle is broken and releases oils within the
surrounding skin. This is noted by circumscribed skin elevations or
bumps (nodules) and also by abscess and cysts (an enclosed space
within the skin filled with fluid or other material).
Finally, bacteria in the skin colonize the sebum by the
propionibacterium acnes. It acts on the sebum by demoting it and
producing free fat acids and other substances that induce irritation
and inflammation. This is seen on the skin in the form of red bumps,
nodules and pustules (small skin elevations containing pus, a liquid
with bacteria and cell debris).
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Factors that influence acne
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Very often there are familiar trends that
occur with people that have acne. The hormonal influx is an important
factor in the development of acne. In some patients, acne outbreaks
are produced before menstruation and other physical alterations, such
as an increase in hair on the face (hirsutism) and hair loss
(alopecia).
Diet
Contrary to what most believe, diet is not a determinant factor.
However, some foods seem to be related to the development of acne
lesions. These foods are chocolate, nuts, milk and excess dairy
products, fried foods (especially with lard or fats), foods cooked
with too much oil and butter, pizzas, beer, alcohol, coffee, tea,
spices, excessive iodized salt, pork, seafood (shrimps, oysters) and
excess citrus. Today, dermatologists must recommend avoiding foods
that patients notice can aggravate the process. It is advisable to eat
fresh vegetables and fruits and to drink plenty of water and juice.
Other factors
Other factors that are negative influences
include nervous stress, lack of sleep, seasonal factors (acne improves
in summer and worsens in winter), oily cosmetic application (produces
comedons), and intake of certain drugs (steroids, lithium,
antiepileptics and isoniazide).
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Hygienic Measures
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Acne is a disease that has a very effective
treatment. The majority of the people improve only with some hygienic
measures and local treatments. Some serious types of acne, such as
those that tend to inflame, form scars, or those that result in
psychological stress, can be treated with medicine.
- Facial hygiene is very important. It's advisable to wash the face
twice a day with soap adapted to reduce the excess of sebaceous
secretion. Frequently, this simple measure avoids follicle obstruction
and lesion appearance.
- Also, it's advisable to wash the body and hair frequently. In cases
of oily scalp, hair must be kept away from the frontal skin, since
this can contribute to pore blockage. Oily products shouldn't be used,
such as hair conditioners. If there is dandruff, some special
dermatologist treatments are available, and frequent shampooing is
recommended.
- Cosmetics that are applied on the face may be recommended by the
dermatologist, but they should be oil-free.
- Men with acne in the beard area should test razor blades or
electrical shaving to see which one is more convenient. Shaving must
be performed as soft as possible in order to avoid "carve" lesions,
and the razor should be very sharp.
- Blackheads and inflammatory lesions should not be touched, since any
trauma on the skin may infect or tear the lesions, appearing as scars
later. Sometimes, dermatologists perform blackhead extractions. Some
patients with acne may have many inflammatory lesions (hard or
internal bumps). In these cases, lesions are infiltrated with
anti-inflammatory medicines by jet injectors (needle free).
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Acne Treatments
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Topical preparations prescribed by a
physician must be applied with care. Some of them are administered in
the morning and others at night. A very effective product is topical
tretinoin, a drug that acts by regulating scale excess within the hair
follicle ducts and promote desquamation and enhance comedon removal.
These creams frequently produce dryness and reddening of the skin.
Application must be nocturnal, since tretinoin causes skin
photosensitivity. Products with Salicylic acid are also very useful in
the treatment phase as well as in the maintenance phase.
Salicylic acid eliminates sebum obstruction
within the pores and prevents their re-obstruction.
In addition, this acid hydrates the skin and induces a soft peeling.
Furthermore, Salicylic acid has a synergistic effect with tretinoin,
stressing its action and causing a breakthrough. Finally, products
with salicylic acid and astringent masks are recommended.
Other Treatments
Topical and systemic antibiotics (tetracycline)
are also used to reduce bacteria in acne. In other instances,
contraceptive pills are recommended to reduce the sebum secretion.
Currently, 13-Cis-retinoic acid is the most effective medicine in the
fight against acne. This medication reduces sebum production,
normalizes the process of follicular keratinization, and is a
bactericide against the P. acnes. It begins to take effect after six
to eight weeks.
The duration of the treatment is about 15-20 weeks and the drug must
not be discontinued the treatment has ended. If the treatment is not
completely done or if the dose is insufficient, the risk of
recurrences will increase thereafter. This medicine is quite
expensive, can cause skin dryness (especially on the lips), and is
contraindicated during pregnancy. It's recommended that women who can
procreate and are following this treatment, use contraceptive measures
- during the treatment and up until one month after finishing it.
This medicine can produce fetal deformations if it is taken during
pregnancy. This drug does not have any repercussions for a future
pregnancy since it is totally eliminated from the body very quickly
(15-30 days). Also, it's advisable to take liver enzymes and
cholesterol blood tests due to the fact that it may induce changes in
these processes.
Patients that are being treated with 13 cis retinoic acid should not
sunbathe or be in very warm places, because the skin is more easily
reddened. Improvements induced by this medicine tend to be long
lasting. Patients should not suck the lips since the dampness of the
saliva induces additional dryness. On the other hand, it's advisable
to use specific lip bars with mandelic acid to alleviate the problem.
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Care of acne
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Wash your face twice a day with a foamy soap
free cream or a dermatological soap. If preferred, you can use
cleansing milk.
Apply a tonic twice a day after washing your face. In instances of
excessive oil, astringent towels may be used once or twice a day.
Apply a hydrating product with salicylic acid the
morning and at night.
If you are taking Accutane, apply a lip balm as much as needed to help
lip dryness.
Products with Salicylic acid may be used with tretinoin creams, being cream should only be applied at nights.
Apply an astringent mask twice weekly.
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SeSDERMA