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Acne

Acne

Also known as acne vulgaris, pimples

Overview

Acne is a common condition, which most of us have dealt with at some point in our lives. Acne, or acne vulgaris, is a skin condition where the pores and hair follicles of the skin get clogged with sebum, which is an oily, wax textured substance secreted from the skin glands. Although the face is the most commonly affected part, acne can occur anywhere on the body like the chest, shoulders and upper back. 
 
Acne is mainly of two types, comedogenic and non-comedogenic. Comedogenic acne is mainly non-inflammatory and can be seen in the form of whiteheads and blackheads. Non-comedogenic acne, on the other hand, is inflammatory and may be red, pus-filled, and painful.
 
The treatment of acne comprises topical, systemic, and lifestyle remedies. In topical remedies, your doctor will prescribe ointments or cleansers. Systemic therapy consists of either antibiotics or hormonal preparations to keep the acne at bay. Lifestyle changes for acne majorly include a clean diet, better hydration and regular exercise. Timely treatment of acne can be of great help in preventing acne scars in future. 

Key Facts

Usually seen in
  • Children between 13 to 18 years of age
  • Adults between 25 to 40 years of age   
Gender affected
  • Both men and women but more common in women

Body part(s) involved
  • Skin
Prevalence
  • Worldwide: 9.4% (2015)
Mimicking Conditions
  • Acne keloidalis nuchae
  • Acneiform eruptions
  • Folliculitis
  • Perioral dermatitis
  • Rosacea
  • Sebaceous hyperplasia
  • Syringoma
  • Tuberous sclerosis
  • Hidradenitis suppurativa
 
Treatment
Specialists to consult
  • General Physician
  • Skin & Hair Specialist
  • Gynaecologist

Symptoms Of Acne


Acne, also known as acne vulgaris, is a recurrent skin condition. In this, the pores and hair follicles of the skin get clogged with sebum. Acne can be seen in the form of pimples, blackheads or comedone, or nodes of the skin. Following are the symptoms of acne:
  • Reddened and painful skin around the acne spots. 
  • Skin that may become darker or scarred over time.
  • Fever and joint pain may occur in rare but severe cases of acne. 
Some of the symptoms based on the type of acne are:

1. Comedogenic acne (Non-inflammatory acne)

  • Closed comedones (whiteheads): small round lesions that contain whitish material (sebum and dead skin cells).
  • Open comedones (blackheads): small round lesions that appear as bumpy dark spots.

2. Non-comedogenic acne (Inflammatory acne) 

  • Red and painful areas on the skin. 
  • Small, reddish bumps that may or may not be filled with pus which develops from comedones. 
Furthermore, these can be presented in various forms. The most common ones include:
  • Papules: These are small painful bumps like eruptions on the skin.
  • Pustules: These types of pimples have pus collected in them and are red in color.
  • Nodules: These are large, painful, solid pimples that are deep in the skin.
  • Cysts: These deep, painful, pus-filled pimples can cause scars.
In some cases, a person may also suffer from a severe form of acne known as nodulocystic acne. In this, there are knots of the skin that are hardened mass larger than 5 mm and usually present in the area of the back and neck.

Causes Of Acne



The common causes of acne are:
 
1. Hormonal conditions
Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormone changes during midlife, particularly in women, like PCOS and pregnancy, can lead to breakouts too. Menstrual cycle is one of the prime causes of hormonal acne seen in women. 
 
2. Genetic factors
Your genes may be somewhat responsible for the development, course, and severity of acne. However, acne is not a result of a single gene, but a series of different genes which can increase your risk of acne. 
 
3. Environmental factors
Environmental factors such as sunlight can lead to the worsening of acne along with promoting skin aging. Also, climatic conditions, such as humid weather, can worsen acne problems in certain individuals due to the overstimulation of sebaceous glands.
 
4. Lifestyle factors
Certain food products, such as dairy, products made from dairy, sugary foods, can cause acne.  Also, stress and increased weight are two major causes of acne affecting many individuals. 
 
5. Health conditions
Certain metabolic diseases such as diabetes may cause acne in some individuals. Also, use of medications such as tablets and creams containing lithium, corticosteroids, or testosterone can result in acne.  
 
6. Chemicals/products
The application of some perfumed products, such as cosmetics, hair products, and soaps, can result in acne in some individuals. Irritation of the affected skin area by either scratching or pulling or pressing or using tight garments such as headband, scarves around face and neck can cause acne.

Check out this video to know about the causes of acne in detail.
 

Risk Factors For Acne




Almost everyone is at the equal risk of developing acne at some point in their lives. The common risk factors for acne include: 
  • Age: People of all ages can get acne, but it's most common in teenagers.
  • Hormonal changes: The changes in hormones which are common during puberty or pregnancy can up the risk of acne
  • Family history: Genetics plays a role in acne. If both of your parents or if any of your immediate family members had acne, you're likely to develop it too.
  • Greasy or oily substances: You may develop acne where your skin comes into contact with oil or oily lotions and creams.
  • Food: Studies indicate that consuming certain foods including carbohydrate-rich foods, such as bread, bagels and chips may worsen acne.
  • Friction or pressure on your skin: This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
  • Stress: It doesn't cause acne, but if you have acne already, stress may make it worse.

Diagnosis Of Acne

If you are suffering from acne, your dermatologist will diagnose your acne by looking at them. The doctor may notice what type of acne you have and where the breakouts appear on your face or other parts of the body. This helps your dermatologist to create an effective treatment plan for you. 
 
In women of childbearing age who are suffering from acne, one should go for tests that are done after a history of dysmenorrhea or hirsutism is taken such as:

Prevention Of Acne


Skin care

If you are suffering from acne frequently, here are some of the preventive tips to avoid acne breakouts:

Wash your face after sweating: If you sweat after going out or wearing a hat or helmet, it can worsen your acne so it is advised to wash your skin as soon as possible after sweating.

Stay away from irritating scrubs: It is advised to make use of  your fingertips to apply a gentle, non-abrasive cleanser, rather than using a mesh sponge or an abrasive cloth that can irritate the skin.

Be kind to your skin: It is advised to use gentle products, which are alcohol-free. Products like astringents and exfoliants may irritate your skin and therefore should not be used if you suffer from acne. Scrubbing is also bad for your acne as it can irritate your skin. 

Go lukewarm: It is advised to rinse your face with lukewarm water after face wash. Avoid too cold or hot water if you have acne.

Shampoo regularly: If you have oily hair, it could be the reason for your acne on your forehead; therefore, it is advised to shampoo daily to get rid of the excess oil. 

Let your skin heal the natural way: Do not pop, pick, or squeeze your acne. This would not only worsen your acne problem but your skin will take longer to heal and. It may also increase the risk of scarring.

Stop touching your face: Your hands carry germs, which transfers to your face when you touch it and can cause flare-ups.

Be careful of sun and tanning: Sun is not your best friend, especially when it comes to skin conditions. Tanning damages your skin and certain acne medications make the skin quite sensitive to ultraviolet (UV) light. 


Diet & Acne

Certain foods are known to promote inflammation in the body, thereby resulting in acne outbreaks. In addition to that, diet can also affect hormone levels, making your acne worse. Following food items can cause acne breakouts:
  • Foods that are high in fat content example milk and meat
  • Foods with a high sugar content leads to high insulin levels, altering other hormones that can cause acne.
  • Foods and beverages high in sugar content
  • Fast foods and snack foods also lead to skin conditions like acne. 
In some patients, chocolate consumption was related to past or current acne.
Therefore it is advised to eat healthy and stay away from foods that could trigger your acne. Consult your dermatologist or a nutritionist to know what foods to avoid in order to achieve better and clear skin. 

While the exact cause for acne is not known, the appearance and recurrence can be lowered by making simple lifestyle changes. One of these changes includes adding foods to your diet that help in fighting acne.

Here are some foods that help in reducing the appearance of acne and blemishes.

Celebs affected

Kendall Jenner
In Jan 2019, American top model and socialite, Kendall Jenner, shared on her Instagram profile that suffering from acne was a debilitating problem for her and has been battling this condition since teen years.

Specialists To Consult

 
Acne that is recurrent, pus-filled, and painful should only be treated under expert medical supervision as they may have the tendency to leave deep scars. You can visit a skin specialist who can best evaluate your condition and rule out the correct treatment for your acne. If you are suffering from acne, it is best to consult:
  • General Physician
  • Skin & Hair Specialist

Treatment Of Acne




Acne can be treated successfully by either topical anti-acne preparations or by oral anti-acne preparations. Some dermatologists also suggest a combination of both therapies. Here are some commonly used therapies listed to guide you about the treatment process:

1. Topical therapy

  • Retinoids, such as retinoic acid, tretinoin, and adapalene, are used either alone or with other topical antibiotics. 
  • Antimicrobials, such as azelaic acid, are helpful in treating normal acne and post inflammatory pigmentation of acne as well.
  • Topical antibiotics, like clindamycin, azithromycin, and lotion, are effective in treating acne.
  • Anti-acne agents like salicylic acid, are used as topical gel for seborrheic and comedonal acne. These are also useful in treating pigmentation caused after healing of acne. Topical benzoyl peroxide is taken in combination with adapalene, available in the gel base. Topical dapsone is useful in papular and comedogenic acne. Dapsone (aczone) 5% gel twice daily is recommended for inflammatory acne, especially in women with acne. Side effects include redness and dryness.


2. Systemic therapy

  • Antibiotics like Doxycycline, helps in controlling inflammation and affects secretion of free fatty acids. Minocycline is taken in the form of capsules once a day. Other antibiotics, such as amoxicillin, erythromycin, and sulfamethoxazole, are also used sometimes for acne. Ciprofloxacin is used in the case of acne caused by pseudomonas. 
  • Oral Isotretinoin is used to control the production of sebum and reduce inflammation. Isotretinoin (Amnesteem, Claravis, others) is a derivative of vitamin A. It may be prescribed for people whose moderate or severe acne hasn't responded to other treatments.
  • Low dose estrogen may also be prescribed along with cyproterone acetate for treating severe recurrent acne.
  • Spironolactone is prescribed to males dealing with acne issues. It is helpful in reducing the production of androgens and blocking the actions of testosterone.
  • Combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. They are products that combine progestin and estrogen. You may not see the benefit of this treatment for a few months, so using other acne medications with it for the first few weeks may help.


3. Other treatments

  • Dermabrasion: In this procedure, the top layer of your skin is removed with the help of a rapidly rotating brush or another device. This is helpful in removing surface scars. It may also reduce the intensity of deeper acne scars. 
  • Chemical peel: In this procedure, a chemical solution is applied to the scar tissue to remove the top layer of skin. This helps in minimizing the appearance of deeper scars.
  • Skin needling: In this procedure, a needle-studded device is rolled over the skin to stimulate collagen formation in the skin. 
 
Acne is a painful side effect of oily skin. Do not worry, here are a few things you could try to improve your skin care game, especially if you have oily skin.


Complications Of Acne

Acne when ignored for long can become severe and ultimately lead to scar formation. However, acne is more than just a skin condition. Some of the common complications include:
 
1. Scars: Pitted skin (acne scars) and thick scars (keloids) can remain long-term after acne has healed. Scars left by acne can affect both teenagers and adults. Scars are a result of acne breakouts, penetrating deep into the layers of the skin. The longer you have inflammatory acne, it is highly likely that you will develop acne scars. Therefore, it is best to seek timely treatment for this condition and prevent the formation of acne scars. 
 
2. Skin changes: After acne has cleared, the affected skin may be darker (hyperpigmented) or lighter (hypopigmented) than before the condition occurred.

3. Emotional well-being: Acne can affect more than your skin. It can have a significant impact on your emotional well-being. According to studies, people with acne can lead to low self-esteem, poor self-image, anxiety, depression, decreased quality of life and a feeling of being all alone. Moreover, severe and chronic acne can take a toll on your confidence as well.
 

Alternative Therapies For Acne

Honey


Ayurveda

Ayurvedic science believes that acne is the result of the ventilation of Vata, Pitta, and Kapha doshas in the body. Here is a list of some herbs that can help you heal your acne faster.
 
Turmeric (Haldi): Turmeric has anti-inflammatory, antibacterial, and antifungal effects which can help relieve acne problems. You can apply a thin paste of turmeric over the affected area after consulting your doctor. 
 
Honey (Sahed) and Lemon (Nimbu): Honey and lemon have antibacterial properties that could help in healing your acne. However, you must be careful before applying lemon directly to your face as it may irritate your skin. 
 
Neem leaves: Neem offers anti-inflammatory, antibacterial, antifungal, and antiviral activity. Neem works well against both gram-negative and gram-positive bacteria and hinders the growth of acne-causing bacteria such as staphylococcus epidermidis and propionibacterium acnes (P. acnes). You can ground fresh or dried neem leaves into a soft paste by adding water and apply it on your face. You can wash it off after 10-15 minutes with warm water.
 
Pimples can be caused due to various reasons. Try these home remedies to get rid of them. 
 

Homeopathy

Unlike conventional treatment, homeopathy treatment for acne claims to treat this condition from its root without causing any side effects. Some of the homeopathic medications that are helpful in treating acne are:
  • Pulsatilla – This is helpful in treating acne associated with the onset of puberty in teenage girls. It can also help treat acne in pregnant women or those facing acne due to menstruation. 
  • Silicea –  This is helpful in treating cystic acne, which appears like boils. Along with that, slow healing acne and those acne which leaves pitting scars can be treated with this homeopathic medicine. 
  • Sulfur – Sulphur is helpful in treating blackheads and whiteheads, which are not deep and are present over a large area. 
Acne scars not only mar the appearance and reduce confidence but they are also not very easy to get rid of. Here are some effective natural remedies to help remove acne scars.


Do only teenagers get acne?
No. While acne may predominantly show up during your teens, it can be a part of adulthood as well. It can also be a result of PCOS, menopause, pregnancy, stress, certain medications, and other hormonal problems. This is because hormonal changes can lead to excess oil production, which can increase the risk of acne in adults. There are more such myths.

Home-care For Acne

Here are some ways to take care of your skin at home, if you have acne:

Be gentle with your skin. Use a mild cleanser in the morning and evening. Avoid scrubbing your skin as it can make your acne worse.
 
Avoid certain products, such as facial scrubs, astringents, and masks. They tend to irritate skin, especially sensitive skin which can worsen acne. Excessive washing and scrubbing can also irritate skin.
 
Refrain from touching your skin too often. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin.
 
Shave carefully. Men and women both can use this tip while shaving facial hairs. Men should soften their beard with some soap and water before applying the shaving cream. The same applies for women too, facial hairs are delicate and pre softening is required before shaving. Shave lightly and only when you have to.
 
Avoid over exposure to sun. Many acne medications can make your skin prone to sunburn. Consult your doctor to know more about the reaction of the cream with sun rays.
 
Choose your makeup carefully. Use oil free makeup. Look for the word “non-comedogenic” on the label. Products with a ‘non-comedogenic’ label means that the makeup will not clog up your pores.
 
Use medications wisely. If your doctor has recommended any treatment plan for acne, it is important to give the treatment some time to show effective results. If acne treatment works, you might notice some improvement in your skin condition within 4 to 6 weeks. It might take more than 3 months for the skin to clear up.
 
Avoid using different products all at once. Do not use a new acne product every week as it can irritate the skin and cause fresh breakouts on the skin, making it difficult to treat the condition.

Watch this video to know about natural ways to deal with acne or pimples.
 

Living With Acne

Acne is not a simple skin problem as it can take a toll on your emotional health as well. It makes people think that they are less attractive which in turn makes them feel embarrassed and self-conscious all the time. This is especially severe in teenagers as this thought process makes them miss out on being active in class, taking up sports and getting a job. 

Instead of feeling anxious or suppressing your feelings, take it out. Talk about your feelings with your friends or close ones. You can even ask your doctor on how to treat it and deal with the feelings. Make sure to complete your course of treatment and follow your doctor’s advice without fail to fix your acne.

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Frequently Asked Questions

References

  1. Sutaria H. Amita Masood Sadia, Schlessinger v. Acne Vulgaris.Treasure Island (FL): StatPearls Publishing; 2021 Jan.External Link
  2. Acne: Overview.Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006.External Link
  3. Acne vulgaris. American dermatological association.February 19, 2020.External Link
  4. Acne: Who gets and causes. American academy of dermatology association.External Link
  5. Acne: diagnosis and treatment. American academy of dermatology association.External Link
  6. Acne: Tips for managing. American academy of dermatology association.External Link
  7. Kraft John and Freiman Anatoli. CMAJ. 2011 Apr 19; 183(7): E430–E435.External Link
  8. Shmerling Robert H., Does diet really matter when it comes to adult acne? Harvard health blog;Aug(19)2020.External Link
  9. Acne can affect more than your skin.American academy of dermatology association.External Link
  10. Acne scars:Who gets and causes. American academy of dermatology association.External Link
  11. Mohammad A. Alzohairy. Therapeutics Role of Azadirachta indica (Neem) and Their Active Constituents in Diseases Prevention and Treatment.Evid Based Complement Alternat Med. 2016; 2016: 7382506.External Link
  12. Tan J K L, Bhate K. A global perspective on the epidemiology of acne.Br J Dermatol.2015 Jul;172 Suppl 1:3-12.External Link
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