What is acne?
It is one of the most common skin conditions in the general population; it is estimated that up to 80% of people have experienced this condition at some point in their lives.
It is characterized by the appearance of comedones (blackheads), papules (pimples), pustules (pimples filled with pus), and sometimes nodules and cysts ( deep pimples) in sebaceous areas such as the face, chest, or back. Blackheads are essential for diagnosing acne: there are rashes that resemble acne (âacneiformâ) but are not actually acne, such as rosacea or folliculitis.
Most cases of acne are exclusively skin-related conditions, although there are severe cases in which the inflammation is so intense that it can lead to fever, joint pain, and abnormal laboratory test results (leukocytosis with neutrophilia).
Why does it appear?
It is the result of a combination of certain factors. First, there is an alteration in the keratinization of the hair follicle (the process by which cells form the outermost layer of the skin, the epidermis), a phenomenon that promotes pore blockage and the appearance of comedones (blackheads). This factor is fundamental and is a sine qua non for the development of acne. The formation of comedones may be intrinsic to the individual or secondary to the use of inappropriate cosmetics (non-oil-free products).
Acne is also caused by an overproduction of sebum due to excessive activity of the skin’s sebaceous glands. This factor is usually the result of hormonal changes (during adolescence or in women of childbearing age).
When a pore becomes blocked and the underlying gland continues to produce sebum, the pilosebaceous unit often bursts due to overflow, leading toinflammation of that functional unit.
Finally, the skin of patients with acne exhibits bacterial overgrowth of a microorganism called Propionibacterium acnes, which promotes infection and inflammation of the lesions.
How is acne treated?
Acne treatment depends on the severity and extent of the lesions, as well as the impact the condition has on the patientâs life. All treatments are aimed at addressing the factors that cause acne: eliminating blackheads (keratolysis), excess sebum, inflammation, and/or infection. The more factors the treatment addresses, the more effective it will be.
Keratolytic agents (retinoic acid, salicylic acid, glycolic acid, pyruvic acid), sebum-regulating agents (retinoids, benzoyl peroxide), anti-inflammatory agents (benzoyl peroxide, tetracyclines, indomethacin), and/orantibiotics (tetracyclines, metronidazole, erythromycin).
Oral retinoids, derivatives of vitamin A, have marked a turning point in acne treatment, as they act on all the etiological factors of acne and produce dramatic improvements with a very high cure rate. The most commonly used due to its safety and efficacy profile is isotretinoin; you can find more information about it here.
There is no one-size-fits-all approach to treating acne: each person has their own type of acne and their own preferences. It is the dermatologistâs job to talk with the patient and work together to determine the best treatment for him or her, weighing the pros and cons of each option.
How are acne scars treated?
Acne scars can be raised (keloids) or depressed (atrophic), and they are treated differently. You can find more detailed information here, although weâll provide a brief summary:
Keloids are usually treated with liquid nitrogen and corticosteroid injections. Non-ablative fractional laser therapy may also be used. To learn more about how keloids are treated, you can find additional information here.
Atrophic scars deserve special mention, as there are several treatment options available that are typically combined. Because of their effectiveness, they are often treated with non-ablative fractional laser therapy; chemical peels using salicylic, glycolic, and/or trichloroacetic acid; or hyaluronic acid fillers. The combination of these treatments usually results in very noticeable improvements in facial acne scars.
Frequently Asked Questions
Yes, although in the vast majority of cases that’s not the case.
It is usually caused by a hormonal change or imbalance (puberty, women of childbearing age who stop taking birth control) or by the misuse of oily cosmetics ( cosmetic acne). In rare cases, it may be a sign of a hormonal disorder (polycystic ovary syndrome, hyperandrogenism from other causes).
There is no scientific evidence that acne is a reflection of liver or bile disorders, poisoning, energy imbalances, or other popular beliefs that lack any rational basis.
Data are available only from a few studies that suggest a link between the consumption of rapidly absorbed sugars and the worsening of acne. It appears that an increase in the glycemic index could worsen this skin condition; therefore, it is recommended to consume sugars in moderation without the need to follow restrictive diets.
No study has demonstrated a clear improvement from the regular use of a hygiene soap or gel. Likewise, there is no evidence that excessive hygiene increases sebum secretion or worsens lesions. In conclusion, it is not necessary to use specific hygiene soaps.
No. Any illness, whether skin-related or not, is likely to worsen due to stress. And it stands to reason that when someone is anxious, they are more likely to pick at their lesions (increasing inflammation and infection) and may be unable to follow a proper treatment regimen due to a lack of time or concentration.
Not necessarily. No study has demonstrated a link between these factors and acne, although it is obvious that excessive consumption of these substances is unhealthy in generalânot just for the skin.
Yes. Provided that the cosmetics are oil-free (non-comedogenic or suitable for oily skin) and this is specified on the packaging. For moisturizers and sunscreens, non-oily formulations are recommended, such as gels, melt-in fluids, or silicones.
This is not a recommended procedure, as the pressure exerted on the skin and the resulting inflammation can damage its middle layer (dermis) and leave a permanent scar.
It depends on each patient, but generally speaking, the most comprehensive and effective option is isotretinoin. It is an oral vitamin A derivative. Treatment continued for 6â12 months achieves acne clearance rates of up to 80%. You can find more information here.
Complete removal is practically impossible, but combining different therapeutic tools (laser, chemical peels) can realistically lead to a dramatic improvement. It is advisable to consult a dermatologist with experience in treating acne scars. You will find very detailed information on this topic here.
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