ACNE

Acne is a skin disease that occurs when the hair follicles are blocked with dead skin cells and oil. It normally causes blackheads, whiteheads, or pimples, and often appears on the forehead, face, upper back, chest, and shoulders. It is also described as a disease of the pilosebaceous units in the neck, skin, chest, face, and upper back.

Acne is common among teenagers even though it affects individuals of all ages. This is because the disease first appears during early puberty which is the adolescent stage when androgenic stimulation prompts excessive generation of sebum and anomalous follicle keratinization, colonization by propionibacterium acnes (a Gram-positive bacterium) and local inflammation.

Acne affects about 9.4% of the global population with the highest rates witnessed among the adolescents. The incidence of acne ranges from one region and country to another and between ethnic groups. The prevalence of the disease varies from 0.1% in northern Tanzania to a high of 17% in Iraq. Other studies have revealed a prevalence of 3.9% in Germany and 8.1% in China.

A survey conducted in a section of Kakamega County in Kenya indicated a prevalence of 11.2% among the adolescence and women below 25 years. Effective treatments of acne are available but the disease can be persistent. Bumps and pimples are the most common and they tend to heal slowly but when one disappears, others seem to crop up.

Depending on its severity, acne can lead to low self-esteem, emotional distress, and scars on the skin. The earlier you commence treatment the better control of the problem you will witness.

Causes

Acne is caused by four main factors:

  • Bacteria
  • Excess oil production
  • Excess activity of a type of hormone (androgens)
  • Hair follicles clogged by dead skin cells and oil

Risk Factors

Acne may be worsened by:

  • Certain medications: Examples include drugs containing testosterone, corticosteroids, or lithium.
  • Age: Acne affects people of all ages but it is very common among adolescents.
  • Hormones: Androgens are hormones that increase in girls and boys during puberty and lead to the enlargement of the sebaceous glands as well as making more sebum. Sebum production can also be affected by hormonal changes associated with pregnancy and use of contraceptives.
  • Diet: Surveys have proven that certain dietary factors that include carbohydrates-rich foods such as chips, bagels, and breads, may worsen acne.
  • Stress: Stress can equally worsen acne.
  • Family History: If both parents had acne, their child/children are likely to develop it too due to genetics.
  • Oily or Greasy substances: A person may develop acne where the skin comes to contact with creams and oily lotions or with grease in the workplace or even in the kitchen with fry vats.
  • Pressure or Friction on the Skin: this may be caused by items such as cell phones, telephones, tight collars, helmets, and backpacks.

Symptoms

The signs and symptoms of acne vary from one person to another depending on the severity of one’s condition:

  • Blackheads (open plugged pores)
  • Whiteheads (closed plugged pores)
  • Small red, tender bumps (papules)
  • Large, solid, and painful lumps beneath the skin surface (nodules)
  • Pimples that are papules with pus at their tips
  • Painful, pus-filled lumps under the surface of the skin (cystic lesions)

When to see a Doctor

Most people tend to use self-care remedies to control acne but when they fail to work, it is important to see a doctor. He or she can recommend stronger medication that can help heal them. However, if acne is severe or persists even after seeing a doctor, you may be required to seek medical treatment from a dermatologist – a doctor who specializes on skin complications.

Seek immediate medical attention after using skin product and you experience:

  • Difficulty breathing
  • Faintness
  • Tightness of the throat
  • Swelling of the eyes, lips, face, or tongue

Treatment

After you try out different remedies and the fail to work, it is advisable to seek medical attention from the doctor especially a dermatologist – skin care profession. Treatment also depends on age, type of acne, and its severity.

In most cases, topical drugs and medications taken by mouth (oral medication) are used in combination. However, pregnant women are not allowed to use oral prescription drugs for acne. Talk to the doctor about benefits and risks of medications and other remedies you are considering.

Topical Medications

The most common topical medications for acne include:

Antibiotics: They work by killing excess skin bacteria and minimize redness. For the first couple of months of treatment, you may use both an antibiotic (applied in the morning) and a retinoid (applied in the evening). Antibiotics are mostly combined with benzoyl peroxide to minimize the probability of developing antibiotic resistance.  

Retinoids and retinoid-like drugs: They come as gels, creams, and lotions. These drugs originate from vitamin A and they include tazarotene (Avage, Tazorac), adapalene (Differon), and tretinoin (Retin-A, Avita). They are applied in the evenings, three times a week before applying them daily to allow the skin to adopt them. They help prevent plugging of the hair follicles.

Dapsone: This is often used for inflammatory acne particularly in adult females with acne. The recommended Dapsone is Aczone which is 5% gel and applied twice daily. Side effects include dryness and redness.

Salicylic acid and azelaic acid: Azelaic acid occurs naturally in animal products and whole-grain cereals. It contains antibacterial properties that help to treat acne by preventing plugged hair follicles. It is highly effective when used alongside erythromycin. Prescription azelaic acid such as Finacea or Azelex is the best alternative during pregnancy and breast-feeding period.

Oral Medications

Antibiotics: Taken to minimize bacteria and fight inflammation. The first choice for acne is tetracycline such as doxycycline or minocycline. Best used alongside benzoyl peroxide and topical retinoids.

Combine oral contraceptives: The four combined oral contraceptives approved by FDA are Yaz, Ortho Tri-Cyclen, and others that combine progestin and estrogen. They are used alongside other acne medications for effective results.

Anti-androgen agents: the most common is spironolactone (Aldactone) that may be prioritized by adolescent girls and women if oral antibiotics do not help. It functions by blocking the effect of androgen hormones present on the sebaceous glands. Potential side effects include painful periods and breast tenderness.

Isotretinoin: Isotretinoin: (Sotret, Claravis, Amnesteem) is a very strong drug for individuals whose severe acne does not respond to all the mentioned treatments. This drug must be taken through doctor’s recommendation and under close supervision because of its potential side effects. The possible side effects include increased risk of suicide and depression, ulcerative colitis, and extreme birth defects.

Therapeutic treatment includes chemical peel, extraction of whiteheads and blackheads, lasers and photodynamic therapy, and steroid injection among others.

Several other home remedies or herbal medicines for treating acne exist but remember to seek medical attention immediately you experience severe side effects.

Sources

https://www.mayoclinic.org/diseases-conditions/acne/diagnosis-treatment/drc-20368048

https://www.webmd.com/drugs/2/drug-1344/benzoyl-peroxide-topical/details

https://www.healthline.com/health/anti-androgen

https://www.webmd.com/skin-problems-and-treatments/acne/understanding-acne-treatment#1

https://www.medicinenet.com/acne/article.htm

https://www.researchgate.net/publication/283853851_Acne_vulgaris_in_general_population_of_rural_western_Kenya_Cross-sectional_community_survey