What is acne?

There are many holes on the surface of your skin. These holes are called pores. Dirt, dead skin cells, bacteria, and oil can block the pores on the surface of your skin. The blockage of these pores results in the development of pimples. If this condition occurs repeatedly, then you may have what is known as acne.

According to a 2012 study, over 650 million people were affected by acne globally in 2010. Over 90% of Westerners are affected by this condition. Acne is not a fatal condition, but it can cause some pain, especially when it is severe. People who have acne may also experience depression and emotional distress.

By appearing on one’s face, acne can affect a person’s self-esteem. Severe cases can cause permanent scarring.

There are many treatments for acne, and effective ones at that. These treatments can reduce the incidence of pimples, and also minimize scarring.

What causes acne?

The main cause of acne is blockage of the skin pores with dead skin, bacteria, or oil. The pores of your skin are openings to follicles. Each pore opens to a follicle. The follicle is a structure made up of an oil gland and hair.

The oil gland is known as the sebaceous glands. It releases oil, which is known as sebum. The sebum lubricates your skin and keeps it soft. When the sebaceous gland releases this sebum, it flows up the hair, out of the pore, and then onto your skin.

If there is a problem with the lubrication, it can result in acne. Acne occurs when:

• Your follicles produce too much oil
• There’s a lot of dead skin cells in your pores
• You have bacteria building up in your pores

These factors contribute to the development of pimples.

Symptoms of Acne

Acne can occur on any part of your body. In most cases, it develops on the shoulders, chest, neck, back, and face.

People who have acne may notice pimples with a white or black coloration. Both types of pimples are called comedones.

Blackheads occur on the skin surface. The oxygen in the air gives them that black appearance. Whiteheads lie just under the surface of your skin, so the lack of oxygen is responsible for their white appearance.

Blackheads and whiteheads are the most common type of acne, but there are other types. These include:

• Pustules: these forms of acne are small and red, and usually have pus at their tips.
• Papules: they are small bumps, also with a red appearance. They are caused by infected or inflamed hair follicles.
• Nodules: these lumps are solid and painful and are located under the surface of the skin.
• Cysts: These lumps are large, and also lie beneath your skin. They contain pus and are always painful.

Acne may also be categorized as mild, moderate, or severe.

Mild acne is mostly whiteheads and blackheads, alongside a few papules and pustules.

Moderate acne is more widespread than the mild form. There’s a large number of blackheads and whiteheads, plus many more papules and pustules.

Severe acne is usually painful, and far more widespread than moderate or mild acne. It is made up of large pustules, cysts, nodules, and papules. Scarring is also common in severe acne.

Medical Management of Acne

Acne treatment depends on its severity. Sometimes, you may have to undergo treatment for a couple of months before seeing an improvement.

If all you have is a couple of whiteheads and blackheads, then your pharmacist will give you some over-the-counter creams or gels containing benzoyl peroxide.

Topical creams for acne

Benzoyl peroxide

Benzoyl peroxide is more of an antiseptic. It reduces the bacterial population on your skin surface.

Benzoyl peroxide also reduces the number of blackheads and whiteheads. It also has anti-inflammatory properties. Benzoyl creams should be used once or twice daily.

The cream should be applied at least 20 minutes after the shower. You don’t have to exclude any part of your body. Apply it to all parts affected by the acne. Note that benzoyl peroxide can be irritating to the skin, so you should use it sparingly.

This cream also increases the sensitivity of your face to sunlight, so avoid the high heat of the sun.

Some common side effects of benzoyl cream include:

• Dryness of the skin
• Peeling or redness of the skin
• Itching, stinging, or a burning sensation

These side effects are usually mild and resolve soon after you’ve completed your treatment.

Topical retinoids

Topical retinoids work by peeling off the dead cells from your skin surface. By so doing, they prevent these dead skin cells from building up and blocking your skin pores.

Examples of topical retinoids are adapalene and tretinoin. They are available as cream or gels and should be applied once a day, preferably before bedtime.

Topical retinoids should be applied to the face at least 20 minutes after showering. These creams should be applied sparingly and try not to expose yourself to the high heat from the sun, and ultraviolet light.

Topical retinoids should not be used by pregnant women. There are chances that it may cause birth defects.

Side effects of topical retinoids include stinging and irritation of the skin.

Topical antibiotics

These creams kill the bacteria on your skin. They exist as gels or lotions and should be used at least once a day.

Usually, treatment lasts for 6-8 weeks. Once you’ve applied it for 8 weeks, you should stop so that the bacteria will not develop resistance to it.

Side effects of antibiotics are rare. But if they occur, they include:

• Skin peeling
• Burning and redness of the skin
• Irritation of the skin

Antibiotic tablets for acne

Oral antibiotics are usually combined with topical treatment. They are recommended for severe forms of acne.

In most cases, your doctor may prescribe tetracycline. However, this particular antibiotic is not recommended for breastfeeding women or pregnant women.

Breastfeeding or pregnant women should take another kind of antibiotic called erythromycin. It is safer. You may notice an improvement after about 6 weeks of treatment.

Your doctor may prescribe a course of oral antibiotics lasting for 4-6 months. However, this depends on your reaction to the drugs.

Hormonal therapies for acne

Hormonal therapies are usually prescribed for women experiencing this condition. They are mostly prescribed if you experience acne flares during your periods, or if your acne is associated with polycystic ovary syndrome.

Your GP may recommend a combined oral contraceptive pill whether you are sexually active or not.

Combined pills are very effective against acne in women, but the full benefits may not be seen until after a year.

An example of hormonal therapy for acne is co-cyprindiol. It is used for severe forms of acne that are resistant to antibiotics. It also reduces sebum production.

The effects of this medication may be seen after at least 2 months of usage.

Some side effects of co-cyprindiol include:

• Low libido
• Weight loss or weight gain
• Sore breasts
• Headaches
• Spotting and bleeding between periods

Isotretinoin (Roaccutane)

These capsules are effective in the treatment of severe acne. They may have some attendant side effects, so you must take them only by your GP’s prescription.

The effects of isotretinoin are usually seen after 7-10 days of treatment. In some cases, your GP may recommend a blood test before treatment, and during treatment as well. Isotretinoin may increase your skin sensitivity to the sun, as well as skin dryness.

Isotretinoin is recommended for adults and teenagers with severe acne.  However, it should not be given to children under the age of 12, or children who have not yet attained puberty.

Isotretinoin should not be taken by people who:

• Have a history of allergy to isotretinoin, soya, or other medicines
• have fructose intolerance.

Tips for preventing acne

Preventing acne is somewhat difficult. However, there are some steps that you can take to prevent it. These include:

• Washing your face twice daily with an oil-free cleanser
• Minimising the amount of stress that you put yourself through.
• Shower after exercising
• Avoid oily makeups
• You can remove excess oil from your face with an over-the-counter acne cream
• Do not wear tight clothing
• Remove your makeup and clean your skin well before going to bed.

Takeaway

You must consult your GP for guidance on how to manage your acne.

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