Acne: Facts, Causes and Treatment Options

What is Acne?

Acne vulgaris (or just acne) is a chronic-term skin condition characterized by areas of blackheads, whiteheads, pimples, greasy skin, and sometimes scarring. The gravity of the problem varies from individual to individual and contrary to what many think, acne is not an exclusively “puberty” disease.

For most cases, prognosis is excellent. Most people experience their worst symptoms during their teens and eventually grow out of it by the age of 20. However, permanent physical scarring is not uncommon, especially in individuals who failed (or delayed) to seek medical treatment. [1]

What are the causes of acne?

The pathogenesis of acne is not fully understood, but many factors are involved in its appearance. Modern research has shown that the main culprit behind the disease is “bad” genetics which are estimated to be the cause in 80% of cases. Cleanliness and exposure to sunlight don’t appear to be involved and how diet contributes is still unclear. However, we do know that smokers are in a higher risk. [2]

In most cases the condition manifests in the face, upper chest, and back. Often it causes (due to the patient’s altered appearance) an intense psychological burden, anxiety and low self-esteem. Cases of depression and thoughts of suicide have also been reported in the medical literature. [3]

Acne OTC rarely gets the job done
Acne OTC rarely gets the job done

When OTC fails you…

Now, you are probably reading these lines because you have already tried the various over-the-counter (OTC) products with not much, if any success. The only option you have left is to visit a dermatologist, who can give you a sound medical opinion and prescribe you with stronger and more effective medication.

Among others, a dermatologist will also help you to:

  • Understand and take your acne under control
  • Make lifestyle changes that will improve your condition
  • Teach you how to avoid scarring and further skin damage
  • Improve already established damage
  • Examine you for possible hormonal disorder (polycystic ovaries, congenital adrenal hypertrophy, thyroid function disorders)

After a thorough examination, your dermatologist will decide on the type of the treatment you should be given. Depending on the type, severity and the underlying causes of your acne and other factors (e.g. age and sex) you might be prescribed something to apply on your skin (topical treatment) or take by mouth (oral medication) or a combination of both. It should also be mentioned that the dermatologist may alternate treatments depending on the season and the patient’s response to treatment. Now let’s learn a bit more about the aforementioned therapies.

If you believe that you have acne please get the opinion of a medical specialist immediately. All you have to do is pay a quick visit a dermatologist. Today, with the rise of technology you even have the option to seek advice for acne treatment online by a doctor, just by sending a few photos of yourself. Remember, delaying treatment will only make things worse as the disease rarely improves by itself. Not to mention all the nasty scaring that might eventually develop!

Treatment Options

In teens with mild acne the preferred course of action is topical treatment with cleaning soaps, creams that control oiliness, topical antibiotics, retinoids, azelaic acid and benzoyl peroxide.

In serious cases, a dermatologist will use a topical treatment with oral antibiotics. You should be aware that the effectiveness of the antibiotics after discontinuation of treatment is about 50%. Some of the antibiotics used for the treatment of acne include tetracycline, minocycline and azithromycin and are usually administered for a period of 3-6 months.

Retinoids
The most effective treatment is oral retinoids (isotretinoin), with an estimated efficiency of 80%. Retinoids are a type of vitamin A that speeds up cell division, preventing skin collagen from breaking down.

Recommended only for severe or chronic cases or when the patient wishes to eliminate acne permanently. Patients in this group are followed regularly and have to submit blood tests on a montly basis. The dosage depends on the weight of the patient and is administered during seasons without strong sunlight as it causes photosensitivity.

Please be aware that retinoid treatment is suitable for ages of 12 and older. Pregnancy is a strong contraindication. Common side effects of retinoid therapy include dryness of the skin and mucosa, back pain, menstrual disorders, hand dermatitis. The higher the dosage the higher the risk for side effects. Hematologic and biochemical disorders are sometimes observed, including an increase of transaminase (enzymes indicative of liver function), cholesterol and triglycerides. In most cases these problems are reversible and disappear completely after treatment discontinuation.

In rare cases, re-treatment might be required for optimal results.

Other treatments
When there is a hormonal disorder, e.g., polycystic ovary syndrome, treatment with contraceptives or hormones may provide relief help. Other therapies when oral therapy is not applicable, include laser, photodynamic therapy and chemical peeling. Their effectiveness is smaller when compared to isotretinoin. Laser therapy can also greatly help with scarring.

How To Apply Topical Retinoids

Scar Treatment

Scars are the undesirable effect from the healing process of the acneic skin. They are very common in mild-severe cases, especially when the patients has not seeked medical intervention. They develop when a pore or hair follicle is filled with sebum, dead skin cells and bacteria. Eventually, the pore swells and breaks.

If that break occurs near the skin, the healing process does not cause permanent scaring. However, if the rupture occurs deep enough, then the skin is filled with inflammatory elements and bacteria destroying the healthy skin and leaving behind large permanent scars. Briefly, some treatments for scaring are the following:

1) Soft tissue fillers: In this therapy, a filler is injected directly into the scars with a very small needle to temporarily improve the skin's appearance.

2) Chemical peel: During a chemical peel, a chemical solution is applied to the skin. Over the next two weeks the chemical penetrates the skin and the skin... peels off! Essentially, part of the scarred skin are destroyed in a controlled way and new skin replaces it.

3) Dermabrasion: This is a technique that uses a wire brush or a diamond wheel with rough edges to remove the upper layers of the skin. The device rotates rapidly, taking off and leveling the top layers of the skin. This process injures the skin and causes it to bleed. As the wound heals, new skin grows in the place of the damaged skin

Tip: Don't use vitamin E on scars. You may have heard the myth that applying vitamin E to a scar will help it heal faster. However, a study from the University of Miami showed that applying the nutrient directly onto a scar has the opposite result! Vitamin E actually made matters worse for 90% of the patients with 33% of them put vitamin E developing dermatitis. [4]

Subject with acne scars on left, and one day after scar revision surgery
Subject with acne scars on left, and one day after scar revision surgery

Acne Laser Treatment

Some tips for the summer season…

For the summer period, patients with acne should have the following in mind:

Moderate sun exposure and salt water usually help with acne. However, excessive exposure aggravates the condition. There is also some symptom relief due to good mood and lack of stress during the holidays.

Don’t forget to use a sunscreen! Especially for those who have recently completed treatment with isotretinoin and those who use topical treatment that often makes skin photosensitive. The same is true for women using contraceptives (to treat acne) to avoid the risk of melasma. It is a good idea to ask your dermatologist to recommend you a specific sunscreen as many of them are not designed for oily skin and acne sufferers.

References

1) Vary JC Jr (November 2015). "Selected Disorders of Skin Appendages-Acne, Alopecia, Hyperhidrosis". The Medical Clinics of North America 99 (6): 1195–1211.
2) Bhate, K; Williams, HC (March 2013). "Epidemiology of acne vulgaris.". The British journal of dermatology 168 (3): 474–85. doi:10.1111/bjd.12149. PMID 23210645
3) Goodman, G (July 2006). "Acne and acne scarring–the case for active and early intervention". Australian family physician 35 (7): 503–4. PMID 16820822
4) http://www.webmd.com/

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