What is Acne?
Acne is a chronic skin condition which causes varying degrees of skin irritation. It generally results in zits, pimples or swellings that can be mild or severe.
Acne is the most common skin disorder in teenagers. However, it can affect individuals of any age. (1)
Although acne is not a deadly disease, it can negatively affect your self-image. Acne patients tend to report psychological and emotional distress as a result of the condition. (2)
The sebaceous glands in your skin produce sebum, a type of oil. They are typically attached to the hair follicles found throughout the body.
Certain areas of the body have high numbers of these oil-producing glands, including your face, back and chest. (3)
Sebum plays an important role in keeping your skin and hair lubricated. However, when too much sebum is produced the hair follicles become blocked.
Bacteria on the surface of your skin which although generally harmless can contaminate the blocked follicles and infect them. Pimples and other lesions will often appear as a result.
Acne can be caused by genetics or hormone imbalances. This is why acne is quite common in teenagers, due to puberty causing hormonal changes. (4)
The symptoms of acne can include some or all of the following lesions:
Blocked hair follicles are known as comedones. They are commonly called whiteheads or blackheads.
If a comedo is open, it is considered a blackhead. If the comedo is closed by skin, it is known as a whitehead.
Comedones may be a symptom of early stage acne. However, clogged pores can occur in anyone from time to time. (5)
Papules, also known as pimples are solid, raised bumps which are usually small. They can be pink, red, purple or brown in color. (6)
These little bumps can feel sore to the touch. Papules can be a sign of early stage acne. (7)
Pustules are similar to papules, except they have a head. These pimples are filled with pus, a thick fluid that can be white or yellow. (8)
Pustules can occur occasionally in the average person. However, if you notice an increase of pus-filled pimples that don’t go away, it could be a symptom of acne. (9)
Nodules are a common symptom of moderate to severe acne. They are large lesions which are solid and found deep underneath the skin. These lumps can also be tender or painful to the touch. (10,11)
Cystic lesions are the most serious category of skin eruption caused by acne. They resemble large boils and usually filled with pus.
Usually painful, cystic lesions are the most likely acne symptom to result in permanent scars. (12)
Acne is graded according to several factors; the types of lesions you have, their prevalence and location on the body.
Higher grade acne is associated with more severe lesion types and acne may also affect several areas, such as the face, back and chest.
The progression of acne is as follows: (13)
You may have the occasional pimple or two, but in general your skin is acne-free.
This grade of acne is mild. It presents as whiteheads or blackheads, or a combination of both.
Pustules and papules can occur at this level, but not in large numbers.
The acne is now classified as moderate and the number of blackheads, whiteheads, or both has increased.
You might find numerous pustules and papules occuring. However, lesions are still primarily confined to your face.
Grade 3 acne is moderately severe. In this stage the amount of pustules and papules will have significantly increased.
Acne has also begun to spread to other areas, such as the chest and back and you may begin to experience inflamed nodules.
Grade 4 acne is categorized as severe.
Nodules will form in large quantities and will be painful and or inflamed.
Pustules are also larger and more aggressive plus existing types of lesions may also have multiplied and spread.
Acne is generally diagnosed by a simple physical examination by your doctor. The treatment strategy will depend on how far your acne has progressed.
Your doctor will also take your needs into consideration, this is because certain treatments may have undesirable side effects.
Also, most acne treatments require a diligent follow through because they do not work instantly.
You should also check with your doctor to establish whether the cosmetics or skincare products you use could be causing more irritation. (15)
The typical treatments of acne can be described as:
Topical treatments are usually the first choice for mild to moderate acne. These ointments, gels and creams are used to prevent new lesions from appearing.
These substances must be applied regularly to the acne-prone areas of your body. However, effects are not immediate, so it is important you commit to using them long term.
There are four topical agents used to treat acne: retinoids, benzoyl peroxide, antibiotics and azelaic acid. (16)
Topical retinoids are a type of exfoliant, meaning they clear dead skin cells from your skin’s surface. This prevents any dead cells from plugging up hair follicles and causing new lesions.
If you are using topical retinoids, you should be careful to avoid sunlight. These substances should also not be used by pregnant women as they cause a risk of birth defects.
Topical retinoid use may cause side effects, for example you may feel a stinging sensation accompanied by skin irritation.
Benzoyl peroxide cream or gel lowers the amount of bacteria on your skin because it has antiseptic and anti-inflammatory properties.
It can also reduce blackheads and whiteheads. However, as with retinoids, it can cause your skin to be sensitive to sunlight.
Benzoyl peroxide can cause peeling, dry skin and a burning sensation in some individuals.
Azelaic acid is a more forgiving alternative to topical retinoids and benzoyl peroxide. This antibacterial exfoliant is ideal for patients with very sensitive skin.
It does not cause sunlight sensitivity and has milder side effects.
Topical antibiotics are used to reduce the chances of blocked hair follicles becoming infected. The gel or lotion destroys bacteria living on the surface of your skin.
Other topical salves may be prescribed again after initial treatment, however, topical antibiotics are usually the exception to this rule. Treatment is halted entirely after 6 to 8 weeks.
This is because skin bacteria can develop antibiotic resistance and worsen the acne. Although rare, topical antibiotics may also provoke skin peeling and irritation in some people. (17)
If your acne is advanced, your doctor may prescribe oral antibiotics. These tablets are usually taken alongside a topical treatment for maximum effect.
As with most acne treatments, antibiotics for acne take time to work. Improvements in your skin could take up to six weeks or more to show.
If you do not suffer any negative reactions and respond well, you may receive a four to six month course of antibiotics. (18)
Isotretinoin is a drug available as either a gel or a tablet. It helps to lower sebum production and reduces the bacteria on your skin’s surface.
Additionally, isotretinoin can help reduce inflammation of existing lesions. It can also work to prevent your hair follicles from becoming blocked.
Isotretinoin is a prescription-only drug intended to be taken for a minimum of four months. Your acne symptoms may initially get worse when you begin treatment.
This drug can cause unpleasant side effects, including bloody urine, skin inflammation or dryness and eye irritation.
In certain individuals, isotretinoin can inflame the liver or pancreas or in some cases it can lead to kidney disease. (19)
What is acne? Acne is a chronic skin condition that can cause inflammation of the hair follicles and oil glands.
What are the signs of acne? Acne manifests as pimples on the skin spanning from mild to severe. These can range from surface whiteheads to large, painful lesions under the skin.
How do you develop acne? Acne develops when your skin’s oil glands produce excess oil (sebum). They then become blocked, which can lead to inflammation and infection on your skin.
How are you diagnosed for acne? Acne is diagnosed through a physical examination of your skin by a doctor.
What is the best treatment for acne? Treatment depends on the type and severity of acne. You may receive topical gels, creams and ointments. Other options also include: oral antibiotics and isotretinoin.
What are the long term complications of acne? Severe acne can result in scarring and it’s also linked to a lowered self-esteem and depression. (20)
Is acne considered a disability? No, acne is not considered a disability. Although it can be painful, it does not impact your ability to work. (21)
Is there any cure for acne? No, there is no existing cure for acne. However, there are various treatment plans to manage the condition. (22)
Is acne life threatening? Acne is not life threatening, although it can be unpleasant to live with. (23)
Acne can be debilitating because of the effects it has on the skin’s appearance. Severe acne which causes cystic lesions can also result in permanent scars.
However, acne is a condition that can be treated and managed. Although it is important to avoid habits which can worsen your acne, like picking at spots and pimples.
Just remember, if you have acne, treat your skin gently. Avoid aggressive scrubbing or spending too much time in the sun. (24)