Acne is Your Enemy, But How?
Acne or pimples is a very common problem, especially in adolescents. Almost every one of us has borne its brunt at least once in our lives. While some escape its clutches unscathed, there are others who are left with residual effects like pigmented spots and pitted scars for life. However, it can be prevented and it’s after effects minimized by taking simple yet effective precautions and taking timely consultation.
ACNE-I
What is Acne?
Acne vulgaris commonly known as pimples is a soreness of the sebaceous glands (oil glands) of the skin. These glands are mostly found on the face, upper back, upper chest and shoulders. They secrete sebum, which is a type of fat or oil required to prevent drying up of skin. These are under the influence of hormones which are required for development of reproductive system and become active around puberty. Hence, acne is often an early manifestation of puberty.
How?
The exact cause of acne is difficult to pin point. Usually, there is more than one factor involved. However there are 4 major causes:
1. Follicular hyper-proliferation leading to blockage of the glands. It occurs under the influence of androgen hormones.
2. Excessive sebum production, usually due to hormonal influence or dietary causes, leads to plugging of the ducts of glands.
3. Activity of Propionibacterium acnes, a type of bacteria which usually live in the sebaceous glands in humans and break down the sebum into fatty acids.
4. Acne prone skin is more prone to inflammation as compared to normal skin, and some amount of underlying inflammation is always present in acne prone skin.
Why?
Acne are flared up by a number of factors, and by taking certain measures, these factors can be taken care of.
· Some young females with acne have an association with irregular periods, hirsutism, precocious puberty etc. This point to PCOS (Poly Cystic Ovarian Syndrome).
· Many medications like anabolic steroids, corticosteroids, B-complex vitamins, anti-tubercular drugs, halogenated compounds and phenytoin can lead to acne.
· Stress leads to flare due to release of endogenous steroids.
· Oily cosmetics containing parabenes, mineral oils etc. can irritate the skin leading to aggravation of existing acne. Improper cleansing and leaving make-up on for long periods also aggravates acne.
· Foods with high glycemic index, chocolates, dry fruits, carbonated drinks, dairy products especially milk can also lead to a flare-up.
· Excessive sun exposure and hot and humid climate also aggravates acne.
· Use of over the counter steroid ointments over the face for a long time also leads to acne, hirsutism, thinning of skin and facial erythema (redness) due to dilated blood capillaries.
Where?
The primary site is the face, upper chest and upper back. On the face, acne is found on the cheeks, forehead and chin. It starts as a comedone (blackhead), which increases in size to become a papule, which might become filled with pus gradually. If picked with nails or instruments, these can burst under the skin, leading to intense inflammation, abscess formation, large nodules and cysts eventually leading to depressed or hypertrophic scars.
Having active acne or scars of acne has great psychological impact on the patient. Psychological and psychiatric issues faced by 30–50% of adolescents with acne.
Acne-II Treatment:
Diet:
1. Patients prone to acne should avoid high glycemic index foods, milk, processed foods, foods with high fat content. Increased intake of seasonal fruits, freshly cooked food and plenty of fluids is encouraged.
2. If there is an underlying hormonal cause like PCOS, it should be treated simultaneously for better outcome.
3. Regular cleansing of the face with a mild cleanser helps in keeping the skin clean. Over-zealous cleaning with strong antiseptics however, leads to excessive drying of the facial skin, which stimulates the oil glands to produce more sebum, thereby worsening acne. Maintenance of skin pH is very important.
4. Do not use harsh chemicals, paints and low- grade cosmetics on the face.
5. Patients with active acne should avoid facials and sharing of make-up or make-up equipment. Make-up brushes etc should be cleaned before and after every use.
6. Remove make-up after it is not needed. Also avoid use of oily cosmetics.
7. Avoidance of dusty environments and pollutants helps in reducing flare-ups.
8. Do not use over the counter creams for self-treatment of acne. Consult a dermatologist to know the treatment that works best for you.
Medical Treatment:
Depending on the severity and grade of your acne, your dermatologist will prescribe you either a topical ointment to be applied on the face, or a tablet to be taken orally, or both.
· Topical antibiotics: these are used as first line of treatment in mild acne. These act by reducing the Propionibacterium acnes population in the sebaceous glands and hence reducing the infection and inflammation.
· Topical retinoids: these agents act by reducing the hyperproliferation of the epidermis and thus reduce the clogging of the ducts of the sebaceous glands. They should, however be NOT used in PREGNANCY as they can damage the growing fetus. Also, they may cause sun-burn and should not be used for long periods.
· Topical Azelaic acid and benzoyl peroxide: these agents have both anti-microbial and keratolytic properties. These are safe in pregnancy and also help in reducing scarring. However, they may cause irritation and sunburn in a few patients and should only be used under supervision of a Dermatologist.
· Oral antibiotics: Depending upon the cause of acne and the severity, a dermatologist can prescribe either one or a combination of antibiotics.
· Oral Retinoid: These are used in patients with severe acne, and need constant monitoring for side effects. Again, these are NOT to be used in PREGNANCY or in females planning for a pregnancy.
· Hormones: In patients with underlying hormonal abnormalities, either oral contraceptive pills or anti-androgen medicines might have to be used. However, en endocrinologist should be consulted before starting these medicines.
Management of Acne Scars:
Acne scars need special care. Superficial scars respond to topical and oral treatment. For deep scars and pigmentation, some sort of procedural intervention may be required. These can be:
· Chemical peels: different types of chemical peels are used to treat active acne as well as post acne scars.
· Surgery: various types of scar revision surgery is available, depending on the type and number of scars present. The outcome of medical plus surgical treatment is usually favourable.
· LASER treatment: a variety of LASERS are available for scar revision. Being an office procedure with minimal downtime, these are the preferred treatments for acne scars these days. However, after any procedure, rigourous sun-protection is to be followed for best results.
· Dermabrasion and derma roller treatments can be used to even out the skin
· Fillers can be injected in cases of depressed scars.
