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Back to Dermatology Diseases
Acne
Acne is a pustular infection of the skin, caused by changes in the
sebaceous glands. Excessive secretion of oils from the glands combine
with naturally occurring dead skin cells to block the hair follicles.
Oil secretions build up beneath the blocked pore, providing a perfect
environment for the skin bacteria Propionibacterium acnes to multiply
uncontrolled. In response, the skin inflames, producing the visible
lesion. The face, chest, back and upper arms are especially exposed.
The infection is common in puberty as a result of an abnormal response
to normal levels of the male hormone testosterone. The response for
most people diminishes over time and acne thus tends to disappear, or
at least decrease, after one reaches early adulthood. There is,
however, no way to predict how long it will take for it to disappear
entirely, and some individuals will continue to suffer from acne
decades later, into their thirties and forties and even beyond.
Acne affects a large percentage of humans at some stage in life. Aside
from scarring its main effects are psychological, such as reduced
self-esteem and depression. Acne usually appears during adolescence,
when people already tend to be at their most socially-insecure. For
this reason acne should be treated if severe.
Causes for acne
Exactly why some people get acne and some do not is not fully known.
It is known to be partly hereditary. Several factors are known to
cause acne:
- Hormonal activity
- Hyperactive sebaceous glands
- Accumulation of dead skin cells
- Bacteria in the pores
- Skin irritation or scratching of any sort
- Anabolic steroids
- Birth control pills, however many women have reported reduced acne
while on the pill
Those exposed to high levels of chlorine compounds, particularly
chlorinated dioxins, often develop severe, long-lasting acne, known as
Chloracne.
Not causes for acne
Since the medical knowledge about acne is still relatively small, many
misconceptions and rumours about what causes acne exits:
- Diet. It is not impossible that a changed diet can help clear acne for
a certain individual. But no general correlation has been found.
Chocolate, chips, sugar, milk and seafood among others have not been
shown to effect acne.
- Deficient personal hygiene. Acne is not caused by dirt. This
misconception probably comes from the fact that blackheads by their
nature are black and the acne infected skin, therefore, looks dirty.
- Sex. Rumours have had it that both celibacy and masturbation are
causes for acne. This is not the case.
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Treatments
There is a myriad of products sold for the treatment of acne, many of
them without any scientifically proven effects. However, a combination
of treatments can usually prevent acne in all but the most severe
cases. Generally there are three types of treatments that have been
proven effective:
Killing the bacteria that are caused by the blocked follicles. This is
done either by the intake of antibiotics like tetracyclines, or by
treating the affected areas externally with bactericidal substances
like benzoyl peroxide. However, reducing the p.acnes bacteria will
not, in itself, do anything to reduce the oil secretion that is the
initial cause of the blocked follicles. Therefore, acne will generally
reappear quite soon after the end of treatment — days later in the
case of topical applications, and weeks later in the case of oral
antibiotics.
Reducing the secretion of oils from the glands. This is done by a
great daily intake of Vitamin A derivates like isotretinoin over a
period of a few months. The product is sold by Roche under the names
Accutane in USA and Roaccutane in Europe. Isotretinoin has been shown
to be very effective in treating severe acne and is effective in up to
80% of the patients. The drug has a much longer effect than
anti-bacterial treatments and will often cure acne for good. The
treatment requires close medical examination by a dermatologist since
the drug has many known side effects. The most common are dry skin and
nosebleed. It can also permanently damage the liver and cause
depression. The drug also causes birth defects if women become
pregnant while taking it.
Exfoliating the skin. The topical treatment salicylic acid for example
encourages the peeling of the top layer of skin to prevent a build-up
of dead skin cells which combine with skin oil to block pores. It also
helps to unblock clogged pores.
Popping a pimple or any physical acne treatment should not be
attempted by anyone but a qualified dermatologist. Pimple popping
irritates skin, can spread the infection deeper into the skin and can
cause permanent scarring.
Acne scars
Severe acne often leaves nasty scars where the skin gets a "volcanic"
shape. Acne scars are very hard (and expensive) to treat and it is
unusual for the scars to be successfully removed completely. In those
cases, scar treatment may be appropriate. The most commonly used forms
of scar treatments are:
Dermabrasion. The top layer of the skin is removed to make the scar
look less pitted. It makes the scar less visible but does not remove
it completely. Multiple treatments may be necessary to get the desired
results.
Laser resurfacing. A laser is used to burn off the top layer of the
skin.
Punch excision. The scar is excised with a punch tool and the edges
are sutured together.
Chemical peels. Different types of acid are applied to the skin so
that a smoother layer can surface.
Subcision. The scar is detached from deeper tissue, allowing a pool of
blood to form under the scar which helps form a connective tissue
under the scar, leveling it with the surface.
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