Acne, more commonly called as pimples: is the most common skin disorder seen in adolescence. Spontaneous regression usually occurs after 20 years of age, but some patients may continue suffering during adult life. The right treatment for the right patient is the key to treat acne safely and effectively.
The hair in the skin goes through tiny openings called follicles. Each follicle is associated with a sebaceous gland (oil gland) that secretes sebum or oil. These units of hair, follicle and sebaceous gland are called pilosebaceous units (PSU) and are present in large numbers on the face, neck, back, shoulders and chest where pimples tend to occur.
Acne is the most common PSU disorder which develops when the pores of the PSU get blocked.
Acne develops as follows:
- At puberty, normally, girls begin to produce oestrogen and progesterone (female sex hormones) and androgens (male sex hormones). These cause the oil glands to produce oil that normally flows out of the follicle openings.
- Sometimes, excess androgen is produced leading to excess oil production. The PSU opening becomes sticky, making it harder for the oil to get out. Excess of androgens cause the cells of the follicle to multiply and stick together, thus closing the pore.
- Bacteria that are normally present on the skin grow rapidly in the accumulated oil.
All these cause the oil, bacteria and skin cells to accumulate inside the PSU.
If the pore leading onto the skin is open, the accumulated matenal is exposed to the air and darkens, forming a 'blackhead' (B) and if the pore is blocked, the material emulates under the skin, forming a 'whitehead' (C). Sometimes, this matenal breaks through the PSU into the surrounding skin, causing deep, sometimes painful, pus-filled lumps under the skin (papules , pustules , nodules or cysts).
There are different causes of acne, but the main cause is the action of hormones on the oil glands, leading to plugged pores and pimples. Acne is not a serious health threat but severe acne can lead to disfiguring and permanent scarring, which can be upsetting to people affected by the disorder. Acne could be due to the following:
Heredity: If any of the parents had acne, the adolescent is likely to develop it too.
Excess of androgens: Androgens stimulate the oil glands to secrete more oil. Polycystic ovarian syndrome (PCOS) is another very common cause of acne in which there is increase in androgens, leading to the development of acne in combination with oily skin, facial hair and male type baldness.
Environmental factors: Hot humid climate, oil-based cosmetics, pollution, and personal habits like pricking pimples, over-cleansing and the use of harsh soaps may aggravate this condition.
Premenstrual: Acne may worsen the week before a menstrual period, probably due to hormonal changes.
Others: Being tensed or stressed, not getting enough sleep, being on certain medicines, smoking, etc., may damage the skin and make acne worse.
In case of a sudden increase in acne, painful or pus-filled acne, severe or persistent acne, or acne associated with menstrual disorders, do consult your doctor.
The treatment for acne differs from one individual to the other depending on the reason of acne development.
- The goals of acne treatment are to stop new lesions from forming, heal existing ones, prevent inflammation and scarring and minimize the psychological stress caused by this disease.
- Medicines are available in the form of creams, gels, tablets, etc.
- In severe cases, chemical peeling, laser surgery or dermabrasion, etc., may be necessary to remove cysts and/or to correct acne scars.
- In cases of PCOS, where the cause of acne is hormonal imbalance, one may be prescribed hormonal pills (e.g. Ginette 35, Crisanta, Crisanta LS) after undergoing certain blood tests. These are contraceptive pills containing anti-androgenic molecules (that block the activity of androgens) that help reduce oil formation and acne.
- Don't fall prey to products claiming quicker or better results as most of these can be costly, may not be helpful and may cause certain side effects.
Please consult the doctor for the right treatment of acne.
Cleanliness can help reduce bacteria and debris at the site of the pore, but cleanliness alone is not a factor. The following do's and don'ts would help prevent acne, or at least reduce the severity of outbreak:
- Drink lots of water.
- There is little evidence that foods have much effect on acne. Nevertheless, avoiding junk food and eating a healthy diet comprising of fruits, vegetables and foods rich in antioxidants like vitamins and minerals will be beneficial for the skin.
- Choose cosmetic products that suit the skin type.
- Wash hair regularly, treat dandruff, and keep hair away from the face.
- Do not scrub the skin and pick or squeeze pimples all the time.
- Use a mild cleanser/soap that suits the skin type and avoid washing the face too frequently.
- Choose a sun-screen that suits the skin type.
- Sleep on a clean pillow cover.
- Exercising and meditation may help relieve stress and improve overall well-being.
"There is probably no single disease that causes more psychic trauma, general insecurity and feelings of inferiority than acne"
Please consult your doctor for further queries on acne.