Acne is a very common disorder resulting from the influence of hormones and other factors on the skin’s oil glands (called sebaceous glands). Although acne is not a serious health concern, it can be a source of significant emotional distress
Pathogenesis- the mechanism in which acne develops
Practitioners regard acne as a disease of the “pilosebaceous units”. Pilosebaceous units consist of a sebaceous gland and hair follicle. These units are found in abundance on the face, upper back, and chest. The sebaceous glands make an oily substance called “sebum”. Sebum empties onto the skin surface through the opening of the follicle (called a pore). Cells called “keratinocytes” line the follicle
In acne, the hair, sebum, and keratinocytes that fill the follicle produce a “plug”. The plug prevents the sebum from emptying onto the skin surface through the pore. This mixture of sebum and keratinocytes allows bacteria (Propionibacterium acnes; P. acnes), that normally lives on the skin, to grow in abundance. This then causes inflammation which causes the wall of the follicle to expand. Finally, the wall of the follicle bursts/breaks down and spills its contents into the nearby skin. This leads to more acne pimples.
The cause of acne is multifactorial and rather complex. One important factor is an increase in hormones called androgens (male sex hormones), which increase in boys and girls during puberty and increase in women during their normal menstrual cycle. Several factors contribute to acute acne flares: Oil from skin products, sport helmets/straps, environmental irritants (pollution and humidity), squeezing/picking pimples, harsh exfoliation, stress, among many others
Treatment is aimed at reducing several factors involved in the formation of acne pimples: clumping of keratinocytes in the follicles, increased sebum production, bacteria and Inflammation
There are a multitude of treatment options for acne. The following are just a few examples: Benzoyl Peroxide and Sulfur-based washes, topical prescription treatments such as Tretinoin and topical antibiotics such as Clindamycin, oral antibiotics such as Doxycyline, oral Spironolactone (commonly used in adult female cystic acne) and Accutane
Besides prescription treatment for acne, the basics of proper skincare is vital to improving acne.
- Gentle Cleanser: Use a simple cleanser that is very gentle and does not contain harsh exfoliants. Unless otherwise directed by your doctor, avoid salicylic acid and benzoyl peroxide products. Use your fingers to cleanse your face and avoid brushes, wash clothes, etc.
- Avoid picking at acne: Squeezing/picking at acne lesions can lead to dark pigmentation, scarring and the development of new acne lesions
- Wear Sunscreen: Many acne treatments make your skin extremely sensitive to the sun. It is important to wear a SPF of 30+ every day
- Choose everything oil-free/non-comedogenic: Any product that you apply to your face (cleanser, moisturizer, sunscreen, makeup, etc) should have “oil-free” or “noncomedogenic” written on the bottle
For more information about acne please visit the American Acne Foundation