Acne Vulgaris

Dr Noureen Ahmad

General Practitioner, Belgium

Acne vulgaris is a common skin condition which is a result of chronic inflammation of the skin. 80% of people with acne are aged between 11-30. Acne can disappear with age, however in some individuals the fl are up of acne can fl uctuate.

The skin exists of pores (hair follicles) and sebaceous glands which produce an oily-substance (sebum) to lubricate the skin and the hair. In puberty, when the body matures and develops, more hormones are produced. These androgen hormones stimulate the sebaceous glands to produce even more sebum which can block the pores and cause the accumulation of dead skin cells in these pores, thus stimulating bacteria growth (P acnes). This results in swelling and redness, which leads to the onset of acne.

Other causes of acne can include the use of corticosteroids, hormonal imbalance in women at menstruation, pregnancy or PCOS (polycystic ovary syndrome). The latter is a medical condition in which women can experience symptoms of irregular menstruation cycles, excess androgens (leading to excess facial and body hair), weight gain and cysts in the ovaries. These women can develop infertility problems and are further referred to gynaecologists for further investigation and therapy.

Acne neonatorum, or baby acne, is acne in new-born babies or infants and is often seen on the nose and cheeks. The main cause is unknown, but it is believed that it could be the effect from the maternal hormones during pregnancy. However, this form of baby acne is innocent and resolves itself and does not require treatment.

Diagnosis of acne is usually made by the doctor based on the skin condition. There are usually spots on the face, back and sometimes on the chest. These spots can be blackheads (small black bumps), whiteheads (white bumps), papules (red bumps) and pustules (red bumps with pus). Some acne lesions can result in nodules (red hard lumps) and cysts (pus filled lumps) which are painful and have a high chance of giving permanent scars.

There are three forms of acne; mild acne is when there are only black- and whiteheads and some papules while moderate acne is with pustules. Severe acne is with nodules and cysts and is usually on many parts of the body.

Despite the physical scars, acne does cause emotional scars and affects more than just the appearance. It can lead to low self-esteem, poor self-image, depression and anxiety, which can all seriously affect one’s social life. Thus, it is important to treat acne to reduce the physical and mental scars.

Treatment of acne depends of the severity of the condition. It can usually takes several months before acne can start improving. There are practical tips to avoid further irritation of the skin such as washing the face two times a day with an anti-comedogenic, anti-allergic and anti-fragrance cleanser or soap. It is also advisable to avoid too much makeup or buy products which contain water-based emollients as they can block pores.

Regular exercise and smoking cessation have also a positive effect on acne. Noteworthy to mention is that acne does not improve by picking of squeezing at the skin lesions. It can make the acne worse and lead to scarring. At this moment, studies have not shown that certain foods are associated with acne.

Treatment for mild acne exists of local treatment with creams or gels containing benzoyl peroxide, which is usually available over the counter in pharmacies and has to be used for four to eight weeks. If there is no improvement after this period, then local antibiotics or local retinoids can be added by the doctor.

Moderate acne requires stronger treatment and the doctor may start prescribing with oral antibiotics (lymecycline or tetracycline) tablets for eight weeks.

For women with moderate acne, an oral combined contraceptive pill can be prescribed with anti-androgen hormones. For severe acne, oral retinoids can be used, however these medications have many side effects and additional advice by a dermatologist is necessary.

Acne treatment requires patience and can take weeks to months before it starts to work properly. Usually this treatment must be continued for months, even years and will be reassessed by the doctor regularly.

(Please always consult a doctor or specialist to diagnose health conditions and follow the advised plan of a qualifi ed doctor)