Acne

Acne is a common skin issue that arises when hair follicles become obstructed by a build-up of oil and dead skin cells. This can lead to the development of blackheads, whiteheads, and spots. Although it is most frequently seen in teenagers, it can occur at any age.

Normally, oil produced by the skin moves up through the hair follicles to the surface. However, when dead skin cells block the follicles, the oil becomes trapped. This creates an environment where bacteria can grow, causing inflammation and spots to form.

What are Common Causes of Acne?

Acne is commonly associated with hormonal changes, particularly during puberty, when increased oil production raises the likelihood of breakouts. Other factors that can trigger or worsen the condition include:

• Hormonal shifts during menstrual cycles or pregnancy
• Starting or discontinuing contraceptive pills
• Certain medications, including corticosteroids, lithium, and barbiturates
• Oils from the scalp, cosmetics, or cooking products
• Dietary influences

Improper handling of acne, such as squeezing spots or over-scrubbing, can exacerbate the condition. Additionally, friction from tight clothing, helmets, or backpacks, as well as environmental factors like humidity and pollution, may irritate the skin further.

Certain lifestyle and health factors also play a role, Additional risk factors include:

• Hormonal imbalances, for instance due to polycystic ovary syndrome (PCOS)
• Smoking
• Poor sleep patterns
• High stress levels
• Using skincare or beauty products with high oil content
• Family history of acne

The risk of acne is highest during puberty due to the hormonal changes driving increased oil production. However, for many, acne improves with age, and breakouts may diminish or cease entirely in adulthood.

Different Types of Acne

Acne typically starts with a lesion referred to as a comedone. The most common types of acne lesions include:

• Whiteheads (closed comedones): Small spots that are sealed at the surface, containing a white pus-filled tip.
• Blackheads (open comedones): Spots with a dark surface caused by oxidation when oil reacts with air, rather than dirt.
• Papules: Small, tender, pink bumps that indicate inflammation.
• Pustules: Inflamed spots with a red base and a pus-filled tip, commonly associated with inflammatory acne.
• Nodules: Large, firm, and painful spots that develop deep beneath the skin.
• Cysts: Deep, pus-filled, and painful blemishes that often result in scarring.

How to Diagnose Acne?

A healthcare professional can diagnose acne by examining your skin. In most cases, additional testing isn’t required. However, a bacterial culture may be conducted if certain patterns of acne are present or if persistent large pus-filled spots suggest a possible infection.

During the skin examination, the provider may also inquire about factors that could contribute to acne, such as:

• Levels of stress
• Family history of acne
• Breakouts occurring during the menstrual cycle (if applicable)
• Current medications

However, if you experience a sudden and severe outbreak, particularly as an adult, your provider might recommend further tests to investigate potential underlying conditions.

What are Treatment Options for Acne?

The treatment for acne depends on its severity:

1. Mild Acne

• Mild acne can often be managed with over-the-counter (OTC) products, such as medicated creams, cleansers, and spot treatments. Common active ingredients include:
• Benzoyl peroxide: Helps dry out spots, prevent new breakouts, and eliminate acne-causing bacteria.
• Salicylic acid: Works to exfoliate the skin and prevent blocked pores by removing dead skin cells and reducing bacteria.

2. Moderate Acne

If symptoms persist despite using OTC treatments for several weeks, it may be necessary to consult a dermatologist. They can prescribe treatments to control symptoms and reduce the risk of scarring, including:

• Prescription-strength benzoyl peroxide.
• Topical antibiotics such as clindamycin or erythromycin to target bacteria.
• Retinoids (e.g., retinol) to help unclog pores and improve skin renewal.
• In some cases, oral antibiotics or hormonal contraceptives may be recommended.

Antibiotics are usually prescribed for a limited time to minimise the risk of resistance.

3.Severe Acne

For more severe cases, a dermatologist may recommend a combination of the following treatments:
Oral antibiotics alongside topical therapies.

• Topical retinoids to prevent pore blockage.
• Hormonal contraceptives or oral isotretinoin (commonly known as Roaccutane), a vitamin A-based treatment reserved for severe acne that doesn’t respond to other options. Isotretinoin can have significant side effects, so it is prescribed with caution and under close supervision.

4.Procedures for Severe Acne and Scarring

To manage severe acne and minimise scarring, dermatologists may suggest medical procedures, including:
Photodynamic therapy (PDT): A treatment that uses a special light or laser combined with medication to reduce bacteria and oil production.

• Dermabrasion or microdermabrasion: These exfoliate the skin by removing its outer layers, with microdermabrasion being a gentler option. Both are effective for improving the appearance of scars.
• Chemical peels: These remove the outer layer of skin, revealing smoother, less damaged skin underneath. They are particularly useful for mild acne scarring.
• Cortisone injections: These help to reduce inflammation and speed up healing, especially for large cystic spots. Cortisone injections are often used alongside other treatments.

A tailored treatment plan from a healthcare professional ensures the most effective approach to managing acne based on individual needs.

What is the Role of Skincare Routine in Managing Acne?

Cleanse your skin gently: Use a mild, non-drying soap (such as Dove, Neutrogena, Cetaphil, CeraVe, or Basics).

• Choose the right cosmetics: Opt for water-based or "non-comedogenic" products. These are specially formulated not to block pores or trigger acne in most individuals.
• Remove dirt and makeup: Make sure to wash your face once or twice a day, especially after physical activity, to remove dirt and makeup.
• Avoid over-cleansing: Refrain from scrubbing your skin or washing it too frequently, as this can irritate your skin.
  Shampoo your hair daily: Particularly if your hair is oily, regular washing can help prevent oils from transferring to your skin.
• Keep hair off your face: Try combing or pulling your hair back to avoid it touching your face, as this can introduce oils and dirt.

Role of Diet and Lifestyle Modifications for Acne Control

Certain dietary habits may influence the severity of acne:

• Low glycaemic index diet: Reducing intake of high glycaemic foods, such as refined carbohydrates and added sugars, may help lessen acne lesions.
• Milk products: For some people, consuming milk and ice cream seems to worsen acne, though cheese and non-dairy milk products appear to have little effect.
• Healthy fats: Omega-3 and omega-6 fatty acids, found in certain foods, may help reduce acne breakouts.
  Vegan and vegetarian diets: While these diets offer general health benefits, there is limited evidence to suggest they directly impact acne treatment.
• Probiotics: Although probiotics, found in foods like yogurt and fermented products, may have positive effects, there is not yet strong evidence supporting their role in treating acne.

Adopting a balanced skincare routine, alongside mindful dietary and lifestyle choices, can support acne management.

What are Myths and Misconceptions about Acne?

Certain factors have minimal impact on acne:

• Chocolate and greasy foods: Contrary to popular belief, eating chocolate or greasy foods has little to no effect on the development or severity of acne.
• Hygiene: Acne is not caused by dirty skin. In fact, excessive scrubbing or using harsh soaps and chemicals can irritate the skin, potentially worsening acne.
• Cosmetics: Cosmetics, particularly non-oily, non-comedogenic products, do not typically exacerbate acne. Using oil-free makeup that doesn't clog pores, along with regularly removing makeup, will not interfere with acne treatments.

Conclusion

Beyond the physical impact, acne and acne scars can lead to anxiety and affect self-esteem and social relationships. Stress is a common trigger for acne, so managing it through proper sleep and relaxation techniques can make a difference. If needed, talking with family, joining a support group, or consulting a counsellor can provide valuable emotional support.

Acne can be difficult to manage, but there are various effective treatments that can help control breakouts and aid in skin healing. If breakouts continue to be painful or persistent, a dermatologist can work with you to develop a personalised treatment plan that not only targets your skin's needs but also helps minimise scarring.