Acne is an inflammatory disorder of the pilosebaceous units of the skin, arising mostly during adolescence. Most acne lesions occur over the face, neck, upper arms, chest, and upper back. Acne complications are caused by worsening of the primary acne lesion i.e., when there is inflammation or infection of the comedo.
The comedo is the primary lesion of acne. This refers to the plugged up hair follicle which is enlarged with pent-up sebum, dead skin cells, and other debris. It may appear as a white, yellow, or blackish spot on the skin. The white lesions are due to a comedo which has not reached the skin surface, and are called whiteheads. Yellow or black lesions are due to a comedo which is exposed to air, leading to oxidation of the sebum with black oxidation products. These are termed blackheads.
Inflammation or infection of the comedo causes other lesions to arise, such as papules, pustules, nodules, and cystic acne. These represent aggravated forms of acne.
Scarring is the most feared sequel of acne, and affects approximately a tenth of people who have had acne. Since acne scars worsen with age, many patients may present for acne treatment in middle age. Scars due to acne may be classified in different ways. One common system is:
- Atrophic scars
- Hypertrophic or keloid scars
Self-Care for Acne
Acne affects 90% of adolescents. It is important to realize that both the patients and their family have many misguided beliefs about how and why acne starts. These should be dispelled by giving out correct information.
Firstly, children should be reassured that they are not to blame for the acne through their misbehavior or poor hygiene.
Chocolate and fatty foods do not have any documented effect on acne, despite popular belief in their causative role. Thus children with acne need not be penalized unduly.
Thirdly, the aim of medical treatment is to prevent the eruption of new acne lesions and not to shrink the existing ones. For this reason, the topical therapy should be used over the whole skin, rather only over the lesions.
Acne is caused by changing hormone levels around the time of puberty, rather than by individual dietary habits. It is affected by genetic predisposition and immune reactions as well.
- Washing the face two times a day with mild soap which doesn’t dry out the skin, and avoiding astringent soaps.
- Using non-comedogenic makeup may help a proportion of patients. Greasy makeup may clog the follicle openings and exacerbate acne.
- Scrubbing the skin too hard may injure the follicles and introduce infections.
- Squeezing or picking at comedos may rupture the follicle wall and make the infection spread to the neighboring area, and increase the chances of scar formation or hyperpigmentation.
- Reducing the level of stress which may exacerbate acne in some patients.
- Checking the medications you take, such as anticonvulsants and anabolic steroids, to make sure they are not the cause of the acne.
- Avoiding touching the spot or your face to keep from spreading the infection.
- Shaving so as not to injure the skin, using a sharp blade. Electric razors are to be preferred. Shaving cream or mild soap should be used first to soften the hairs so that minimal force is required.
- Keeping out of the sun or use sun screen whenever you go out, because several topical preparations used for acne promote skin peeling or increase the risk of photosensitivity. Though a suntan may hide some blemishes for a while, it will worsen the outcome and reduce the quality of the skin over the long term.
- Keeping your scalp and hair dry and clean by shampooing your hair three or four times a week.
- Avoiding pressure on the skin by tight-fitting equipment or clothing.
- Awareness of pollution or humidity in the surroundings.
Reviewed by Afsaneh Khetrapal, BSc (Hons)