Causes of Acne

Generally, acne is caused by the disorder resulting from the action of hormones on the skin's oil gland (sebaceous gland) that leads to plugged pores and outbreaks of lesions commonly called pimples or zits. The plug can expand and even rupture the hair follicle. A ruptured hair follicle spills its contents of oil and debris into the skin where it leads to swelling and causes inflammation. 

Acne is a disease of the Pilosebaceous Units (PSUs). They exist in most of the body and consist of a sebaceous gland connected to a canal, called a follicle, which contains a fine hair. Practically there are hair follicles on all skin except for the palms of the hands and soles of the feet.

The sebaceous glands make the oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, generally called a pore. Keratinocyte cells line the follicle. Inside the follicle, the hair grows up from the deep layers of the skin and exits through a pore. Close to the surface, the oil gland (sebaceous gland) enters the hair follicle where it empties oil (sebum) at a constant rate. The sebum lubricates and prevents drying of the skin. Skin on the face, chest, and upper back has an especially large number of sebaceous glands. These are the areas where acne most likely to occur, while acne lesions may occur on the neck, shoulders, upper arms and so on.

Up to 80% of people in teenagers, and up to 5% of older adults are affected by acne. The severity of acne rises and, typically, reaches its peak around the ages of 17 to 19. Many people may recover from acne by the time they reach their mid-20s without any permanent effects. However, very sensitive people may continue to have the disorder until reaching of their 40s. Although acne is not a serious health threat, severe acne can lead to disfiguring acne scars which can be upsetting to people who are affected by the disorder. Acne can also cause psychological stress and be socially disabling. An early effective treatment is therefore necessary.

Factors That Can Worsen Acne

Several factors contribute to the development of acne. Acne is not an outcome of uncleanliness or infrequent washing. In other words, acne does not result from too much dirt on the skin or in the pores. Too much or hard scrubbing of the skin may actually worsen acne. Chocolate and greasy foods (junk food) are often blamed, but foods seem to have little effect on the development and course of acne in most people. The other factors that can bring acne include:

·        Squeezing or picking at blemishes

·       Altering hormone levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts

·        Pressure from bike helmets, backpacks, or tight collars

·        Environmental problems, such as pollution and high humidity

Skin Care and Acne Treatment

·        Wash your face 2 times a day with a mild cleanser. Make sure you wash your skin whenever it becomes sweaty. Gently wash your face, never scrub your face as this will only make your acne worse.

·        Avoid frequent handling and touching of the skin lesions. This makes them worse and can cause scarring.

·        Avoid exposing your skin to too much cold, heat and sunlight. Sunlight sometimes makes your acne better for a while, but it won't cure it. Too much exposure to sunlight can lead to burning, more rapid skin aging and risk of developing skin cancer.

·        Choose cosmetic products carefully; try to use a water-based moisturizer (oil free). Greasy or oily creams and foundations block the pores and may cause pimples.

·        No scientific research has indicated that certain foods can cause acne, but if you notice that spots increase after you eat certain things, it makes sense to avoid them.

·        Avoid hairstyles that the hair is constantly touching your face. Shampoo your hair regularly.

·        Choose an appreciable, varied diet. Drink lots of water and exercise regularly. If you feel good, your skin will feel good too.

·        Consult a beautician about how your skin should be taken care of.

Mild acne can be treated with medications from drug stores. Ask your pharmacist for advice on products. Try the products for 6 to 8 weeks to find out if they are working - it takes time to get acne under control.

Preventing Early Acne Scars

When an acne lesion has healed, it can leave a red or hyper-pigmented mark on the skin. This is actually not a scar, but rather a post-inflammatory change. The redness or hyper-pigmentation is seen as the skin goes through its healing and remodeling process, which takes roughly 6-12 months. If no more acne lesions develop in that area, the skin can heal. Any color change or skin defect that still present after 1 year is considered to be a permanent defect or scar.

There are certain practices and medications that can help facilitate this healing process.

·        Direct exposure to the sun causes more skin damage and delays healing. Therefore wearing a good sunscreen is important.

·       Using tretinoin (Retin-A, Renova, Avita) speeds up the skin's remodeling process and helps heal post-inflammatory changes.

·        Appropriate formulations of Alpha-Hydroxy Acids (AHAs) and Beta-Hydroxy Acid (BHA) with the correct concentrations and appropriate pH also help the skin's remodeling process.

·         Picking at scabs should be avoided at all costs. Scabs form to protect the healing process underneath them. Pulling a scab off before it is ready interrupts the healing and remodeling process, prolonging the time that post-inflammatory changes will be visible.

However, there are some other current skin care products and medications that can improve mild scarring, but most acne scars are treated with a combination of surgical procedures and skin resurfacing.

Antioxidants and Post-Inflammatory Changes

As we know better about skin damage from free-radicals, it seems that using an antioxidant would help treat post-inflammatory changes or even permanent scars. Unfortunately no good scientific studies have indicated that any oral or topical antioxidant prevents or heals skin damage. Actually, Vitamin E, when applied on skin to heal wounds, has been shown to cause more harm than good. As antioxidant research goes on, scientists may find a formulation that effectively reverses skin damage, but until then any claim of skin rejuvenation through the use of antioxidants is just an advertising.

When to consult the doctor?

·       If medications from drug stores do not work after 6 to 8 weeks.

·       If acne brings psychological distress.

·        If there are big, tender pimples.

·        If the pimples cause scars.

·        If you have dark skin and dark patches form where the pimples used to be.

Depending on the severity of your acne, your doctor may decide to treat you or refer you to a dermatologist. Acne can be treated with medications that are either applied to the skin or taken by mouth. The treatment emphasized on the factors that trigger acne, which are the increased production of sebum that leads to a narrowing of the sebaceous glands and the bacteria that causes acne.

You can continue with the home-treatment while you are being treated medically. Remember that it takes 6 to 8 weeks before the effect of the treatment is visible. Treatment will typically have to continue until the patient reaches their 20s.

Alternatively, the doctor may prescribe a product that combines benzoyl peroxide with a topical antibiotic such as erythromycin (Benzamycin gel), or clindamycin (Duac once daily gel), or treat the outbreak with a topical antibiotic alone, eg. clindamycin (Dalacin T), erythromycin (Eryacne gel), tetracycline (Topicycline).