Acne is an inflammatory skin condition, commonly affecting the face, chest and back. It is one of the most common skin conditions, affecting up to 80-90% of adolescents. Acne may also occur during infancy due to the activation of sebaceous glands by maternal hormones in-utero. It can be a persistent problem, although it spontaneously resolves after a period of 4-5 years in about 70% of people. Approximately 30% of people continue with their acne into adult life. The incidence of acne at the age of 40 is reported to be 1% in men and 5% in women.
Acne is caused by the overactivity of the sebaceous (oil) glands. Sebaceous glands are active due to the hormone testosterone. Testosterone is produced in men from the testes and in women from the ovaries and the adrenal gland. Although testosterone levels are usually normal in people who develop acne, the sebaceous glands are overly sensitive to the hormone. Over production of oil leads to a greasy feel to the skin. In addition, there is a change in the growth of the cells lining the follicular canal (pore). Instead of dislodging normally and being carried away by the oil (sebum) when they die, these cells become sticky and stick to the inner surface of the gland and gradually build up a partial blockage.
The partial blockage of the pore is called a microcomedone and is the starting point of all inflammatory and non-inflammatory spots in acne. Bacteria start to multiply within the blockage, which leads to inflammatory lesions or red papules. As part of the healing process, the body recruits white blood cells which destroy the bacteria but lead to the formation of pus. In some cases the blocked pores remain full of this solidified pus and may never become inflamed, these are known as the blackheads and whiteheads. Some people may go on to develop painful swollen cysts which need urgent treatment as they are more likely to lead to scarring. There are many myths surrounding the causes of acne, which include:
only teenage spots - you'll grow out of it.
eating too much chocolate and too many chips.
not keeping your skin clean enough.
Acne can be a devastating psychological disease commonly affecting the face, neck, chest, shoulders and back. The latest survey by the Acne Support Group shows that 12% of people with acne feel suicidal as a result of having the condition. Whilst it is a very common skin condition, it need not be left untreated and leave a person feeling so desperate that they want to take their own life.
There are many treatments available, which need to be given at an early stage to prevent scarring. Treatments are generally longterm, however with encouragement and support a person can improve their skin substantially.
First line treatment for acne includes creams or gels containing the active ingredients benzoyl peroxide, nicotinamide or salicylic acid, all of which are available from chemists. Topical retinoid treatments can be particularly effective at reducing comedonal (blackhead) type acne. Antibiotics are a very popular treatment for acne as they target the inflammation associated with acne. They can be taken in tablet form, or used topically. Some topical antibiotic treatments are combined with other anti-acne ingredients such as zinc, benzoyl peroxide or retinoids. Other treatments include preparations containing the hormone therapy cyproterone acetate (females only).
For those who have not responded to systemic and topical therapies, isotretinoin, which is a synthetic vitamin A, can be very useful. This is a hospital-only drug and can achieve up to 95% positive results in patients. There are many potential side effects from this drug and hence the patient will need monitoring by their dermatologist.
Generally, treatments need to be taken for two months before any improvement is noticed and used ongoing if necessary. The aim of treating acne successfully is to stop new spots forming and avoid scarring which can be difficult to treat.
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