What is acne? what are its causes?
Acne is a condition which develops in and around the hair follicle and its surrounding oil producing glands. These sebaceous glands produce sebum and the all the major events that cause acne happen at this level. Although the exact cause is unknown we know the following 4 factors are important and treatment is directed at them :
- increase sebum or oil production people with more severe acne produce more sebum than others and this is probably genetically determined.
- blockage of the oil glands with this increased production producing the classical blackheads or whiteheads called comedones.
- bacteria in the deeper part of the hair follicle beneath the sebum blockade then release chemicals which act upon the sebum breaking it down and in the process releasing other chemicals.
- These chemical reactions result in the next important factor we termed inflammation.
It is the bacteria and the resulting inflammation that produces the classical red papules and pustules that we also recognize as acne. In some individuals, the reaction is severe and gives rise to bigger lesions we call nodules and cysts. It is these nodules and cysts that give rise to the scarring we see in acne – sunken scars, pits or a hardened raised swelling. In less severe cases the red marks or brown pigmented marks (after the red marks have settled) still cause distress for many patients. The main goal of treatment is therefore to prevent these scars from developing (these are harder to treat once they have developed) and to treat the cosmetic blemishes (red lumps, white heads, red marks and brown marks)
What are some factors that may be important in acne formation:
- Hormonal factors are important – it is the main reason why acne is seen around puberty and also some woman in their 40s or perimenopausal age group
- Diet – These are not as important but high glycaemic diets boost blood glucose levels and trigger a series of hormonal changes that cause acne. Also the intake of certain milk products and milk may increase acne severity.
- Environment – it is known that oily environments and contact with certain industrial chemicals like chlorinated hydrocarbons can produce acne in the areas in contact with the chemicals.
- Stress is an important exacerbating factor
When should acne be treated?
It is better to treat the acne earlier rather than later and it would be a mistake these days (given the treatment modalities available) to wait and “outgrow” the acne. Many have suffered unnecessarily because the appearance can definitely be improved with treatment and scars can be prevented.
What are the treatments available?
Treatment prescribed depends on the severity and type of lesions present (whiteheads, red papules, nodules or just brown marks) Mild acne is treated with
Topical treatment – this usually consists of a topical antiseptic like benzoyl peroxide or chemicals like salicyclic acid, resorcinol, sulphur, some new amino acids etc. Topical treatment is also prescribed to treat brown and red marks. Oral treatment – first line treatment for mild to moderate acne would consists of antibiotics. More severe cases would warrant the use of oral contraceptives. Then there’s lasers and light therapy (IPL or blue light, red light) to target the bacteria causing acne, or to treat the red marks, the sebum and finally lasers are also used to treat the scars that result from acne Acne scars, once formed, are more difficult to treat involving the use of ablative (eg the CO2 fractional lasers) and non ablative lasers. These may also be combined with minor surgery to remove the scars or replace them with a more aesthetic surgical scar, topical TCA, chemical peels etc