What is acne?
Acne is a very common skin condition characterised by comedones (blackheads and whiteheads) and pus-filled spots (pustules). It usually starts at puberty and varies in severity from a few spots on the face, neck, back and chest, which most adolescents will have at some time, to a more significant problem that may cause scarring and impact on self-confidence. For the majority it tends to resolve by the late teens or early twenties, but it can persist for longer in some people. Acne can develop for the first time in people in their late twenties or even the thirties. It occasionally occurs in young children as blackheads and/or pustules on the cheeks or nose.
What causes acne?
Acne is due to a combination of factors.
- Familial tendency
- Endogenous and exogenous androgenic hormones
- Acne bacteria
- Innate immune activation with inflammatory mediators
- Distension and occlusion of the hair follicles
Flares of acne can be provoked by:
- Polycystic ovarian disease
- Drugs: steroids, hormones, anticonvulsants, epidermal growth factor receptor inhibitors and others
- Application of occlusive cosmetics
- High environmental humidity
- Diet high in dairy products and high glycaemic foods
The sebaceous (oil-producing) glands of people who get acne are particularly sensitive to normal blood levels of certain hormones, which are present in both men and women. These cause the glands to produce an excess of oil. At the same time, the dead skin cells lining the pores are not shed properly and clog up the follicles. These two effects result in a buildup of oil, producing blackheads (where a darkened plug of oil and dead skin is visible) and whiteheads. The acne bacterium (known as Propionibacterium acnes) lives on everyone’s skin, usually causing no problems, but in those prone to acne, the build-up of oil creates an ideal environment in which these bacteria can multiply. This triggers inflammation and the formation of red or pus-filled spots. Some acne can be caused by medication given for other conditions or by certain contraceptive injections or pills. Some tablets taken by body-builders contain hormones that trigger acne and other problems. Acne can very rarely be caused by problems with hormones. If you develop unusual hair growth or hair loss, irregular periods or other changes to your body, then mention this to your doctor in case it is relevant.
Is acne hereditary?
Acne can run in families, but most cases are sporadic and occur for unknown reasons.
What does acne look like and what does it feel like?
The typical appearance of acne is a mixture of the following: oily skin, blackheads and whiteheads, red spots, yellow pus-filled pimples, and scars. Occasionally, large tender spots or cysts may develop that can eventually burst and discharge their contents or may heal up without bursting. The affected skin may feel hot, painful and be tender to touch.
How is acne diagnosed?
Acne is easily recognised by the appearance of the spots and by their distribution on the face, neck, chest or back. However, there are several varieties of acne and your doctor will be able to tell you which type you have after examining your skin. The most common type is ‘acne vulgaris’.
Can acne be cured?
At present there is no ‘cure’ for acne, although the available treatments can be very effective in preventing the formation of new spots and scarring.
How can acne be treated?
If you have acne but have had no success with over-the-counter products then it is probably time for you to visit your doctor. In general, most treatments take two to four months to produce their maximum effect.
Acne treatments fall into the following categories:
- Topical treatments, i.e. those that are applied directly to the skin
- Oral antibiotics, i.e. tablets taken by mouth
- Oral contraceptive pills
- Isotretinoin capsules
- Other treatments: Light and laser therapy
Skin Care Tips for Acne
The Do’s and Don’ts
Wash your face gently using a mild cleanser, once in the morning and once in the evening, as well as after heavy exercise. Perspiration, especially when wearing a hat or helmet, can make acne worse, so wash your skin as soon as possible after sweating
Consider using a cleanser designed for people with acne. Use gentle products, such as those that are alcohol-free. Do not use products that irritate your skin, which may include astringents, toners and exfoliants. Dry, red skin makes acne appear worse. Use your fingertips to apply a gentle, non-abrasive cleanser. Wash from under the jaw to the hairline, and rinse thoroughly. Using a washcloth, mesh sponge or anything else can irritate the skin.
Scrubbing your skin can make acne worse. Avoid the temptation to scrub your skin. Rinse with lukewarm water or cold water. Do not use hot water, as this can result in additional drying.
Men who have acne and shave should try both electric and safety razors to see which is more comfortable. Shave gently and only when necessary, to reduce the risk of nicking skin lesions.
If you wear makeup, use oil-free, water-based make-up and choose products that are labelled as being ‘non-comedogenic’ (this means they should not cause blackheads or whiteheads) or non-acnegenic (should not cause acne). Remove your makeup at night with mild soap or a gentle cleanser and water.
Be careful in the sun. Tanning damages your skin. In addition, some acne medications make the skin very sensitive to ultraviolet (UV) light. Limit the time you spend in the sun and use an effective sun block.
Be patient and keep using your acne treatment regularly, as some treatments take several weeks before you see much improvement.
Some topical treatments may dry or irritate the skin when you start using them. Using an oil-free moisturiser should help, but some people have to cut down on the frequency and/or duration with which they apply treatments.
No special hair products are necessary in acne. Wash your hair regularly – every day if it is oily.
However, many hair products – including shampoo, conditioner, hair spray, hair gel, may cause plugged pores if they are accidentally exposed to the facial skin or if the hair has frequent contact with the skin. Such exposure will commonly lead to acne on the forehead, sides of the face, or neck (with long hair). Hair products that contain oils to create shine or for moisturizing the hair are especially prone to causing this type of acne.
It is recommended that you shampoo & condition your hair in the shower, followed by cleansing of the face in the sink with cool or lukewarm water.
Dr Rajat Kandhari
Dr Sumit Sethi
Dr Anjali Madan