Acne – the basics

Acne is a common dermatological condition that affects most people at some stage in their life. Because acne is regarded as “normal” and over-the-counter products are readily available, most people will not seek treatment from their General Practitioner. However, for some, acne will become significant enough to require medical management.

More than 80% of people will develop some degree of acne between age 11 – 30 years. Acne is usually mild and transitory, however, it can lead to complications including scarring, dyspigmentation and psychological issues such as anxiety, depression and, rarely, suicide.

Pharmacological treatment for acne is based on the severity of the symptoms and the impact of the condition on the patient. Treatment ranges from topical medicines for mild acne to oral isotretinoin for severe acne.

Questions asked in the acne consultation

  • The duration of acne symptoms, sites affected and the typical appearance (i.e. their acne may be unusually severe or mildon the day they present)doctor-consultation-700x466
  • Possible aggravating factors, such as use of cosmetics, skin products or sunscreens
  • Use of medicines that may cause acne, e.g. antipsychotics or lithium.
  • Anabolic steroids are associated with acne (particularly on the trunk), and should be enquired about if there is otherevidence for this suspicion.
  • Menstrual history and oral contraception in females
  • Treatments that have been trialled, including over-the-counter medicines, and how long they were trialled for
  • Psychological and sociological effects of their acne

What causes acne? (Pathophysiology)

There are four main factors that lead to an acne lesion (a “pimple”):

  • Sebum production
  • Increased follicular keratinisation
  • Propionibacterium acnes follicular colonisation
  • Release of inflammatory mediators

Hormonal changes during puberty increase sebum production.
Predisposition to hyperkeratinisation leads to occlusion of hair follicles and sebaceous ducts, forming open or closed comedones.
P. acnes bacteria in the follicle breaks down sebum into fatty acids and peptides and may rupture the follicle wall.
This causes an inflammatory response and the formation of papules and pustules.
Deeper inflammation leads to nodules and cysts.
Scarring may then occur as deeper lesions heal.

General treatment advice for all levels of acne severity

  • managing-acneWash the face gently with warm water and mild soap or cleanser, twice daily.
  • A plain face-wash (not medicated) is sufficient, although products containing benzoyl peroxide or salicylic acid can be effective.
  • Avoid rough scrubbing should be avoided. It increases the inflammatory response of the skin.
  • Patients with sensitive skin, e.g. atopic dermatitis or eczema, should avoid soap, and remember that some anti-acne cleansers may also cause irritation and contact dermatitis.
  • Apply acne products to all areas usually affected by acne, not just to individual lesions or pimples.
  • Remember that the skin takes several weeks for new cells to form and progress through its layers to the surface.
  • Any effective treatment including including topical and prescription products will start acting on the newly forming cells right away but it will take several weeks, or months before the results become apparent on the surface.
  • Even if you have not “changed” any products you use, your skin can change and the way the product was manufactured can change. So do regularly check that your facial products, including cosmetics and sunscreens, are not contributing to your acne.