Acne Vulgaris, more commonly known as acne results from hair follicles being clogged with oil, dirt and dead skin. Though acne is common in adolescents, it can affect people of all ages equally.

The problem gives rise to many skin manifestations which include: seborrhea (increased oil-sebum secretion). Comedones (follicles distended by incompletely desquamated keratinocytes and sebum) may be open (blackheads) or closed (whiteheads). Inflammation leads to papules (pinheads), pustules (pimples), and nodules (large papules). Less frequently deep pustules or pseudocysts and scarring in a few may appear on the skin.

Acne Vulgaris

Signs And Symptoms For Acne

It is a multi-factorial chronic inflammatory disease caused due to blockage of sebaceous follicles. This blockage is a result of oil, dirt or dead skin clogging the hair follicles. The appearance of acne varies with skin color and affects skin area with profuse sebaceous follicles such as face, back, and chest etc. The major signs and symptoms include:

1. Skin Outbreaks – The very prominent signs of acne are seborrhea, comedones, papules, pustules, nodules, and possible scarring as discussed above.

2. Pigmentation – Scar marks due to pigmentation are usually the result of the painful bumps lying under the skin. These give rise to inflamed red marks on the skin. If these nodules are not aggravated or left untouched the scar marks can be evaded.

3. Scars –These include Ice pick scars (deep pits), Box car scars (Angular scars that usually occur on the temple and cheeks), Rolling scars (wave like appearance), and Hypertrophic (thickened) scars. These scars are created when skin is inflamed by the action of acne and while trying to heal itself the skin collects a bulk of collagen at one place. The face is affected in 99% of cases, the back in 60% and the chest in 15%.


What Causes Acne?

There are numerous factors that can lead to Acne Vulgaris or simply acne. These factors can range from genetically inherited to ones caused by unhealthy lifestyle. They can also be caused by:-

  • Infectious agents like Propionibacterium acnes (P. acnes, an anaerobic bacterium) and Staphylococcus epidermidis (fungi) are most commonly cited causative agents of this disease.
  • Hormones play a pivotal role in fostering the disease. Acne tends to occur in adolescence (in both sexes), when hormones are in a state of flux. Similar is the case when hormones vary due to menstrual cycle, pregnancy, menopause or disorders such as polycystic ovary syndrome and Cushing’s syndrome.  
  • Genetic factors have also been studied and linked to the vulnerability of people getting acne.
  • Psychological factors responsible for acne have also been proved by various scientific researches. The studies show a strong link between acne manifestation and elevated stress levels.
  • Certain diets and food also give rise to Acne Vulgaris in a person. For instance diets with increased amounts of Glycemic acid, milk, chocolate, salt etc. and oily or greasy food.
  • Medications with iodine and some prescription drugs like lithium, isoniazid, phenytoin, corticosteroids, anabolic steroids, and oral contraceptives with high androgenic activity can also aggravate acne.


Risks Factors Associated With Acne

In most cases this disease is generally ignored and left untreated. The severity of this condition varies for different individuals. But if it gets worse it can cause irreversible marks on the skin.

The likelihood of disease occurring in adolescence is very high. This is when a person is most conscious about looks and personality and social life carries hefty importance. The unsightly blemishes and pimples can lead to mood swings, social and family isolation, depression, and in worst cases to suicidal tendencies.


How Is The Disease Diagnosed?

Doctors usually diagnose this disease by simply analyzing the spots and outbreaks. But there are various medical methods like Cook’s acne grading scale, Pillsbury scale, Leeds acne grading technique etc. Differential diagnoses for the different types of manifestations include:

  • Tuberous sclerosis: Tuberous sclerosis or tuberous sclerosis complex (TSC) is a rare multi-system genetic disease that causes non-malignant tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. A combination of symptoms may include seizures, developmental delay, behavioral problems, skin abnormalities, and lung and kidney disease.
  • Perioral dermatitis: It’s a rash that mostly affects women. The rash is seen to inflict the area around mouth.
  • Acne rosacea: Affects adults or middle aged people mostly.
  • Pityrosporum folliculitis: This acne type manifests itself predominantly on the trunk.
  • Folliculitis and boils: This is the infection of the hair follicles and may be present with pustular lesions similar to those seen in acne.
  • Acne Conglobata: Highly inflammatory disease presenting with comedones, nodules, abscesses, and draining sinus tracts. This condition presents with blackheads appearing around the face, neck, chest, upper arms and buttocks in groups of two or three.
  • Milia: These are small keratin cysts which are whiter than acne whiteheads and are most commonly seen around the eyes.
  • Skin lesion culture may be required in patients who do not respond to treatment.


What Are The Preventive Measures?

  • Hygiene and cleanliness should be the foremost focus when battling with acne.
  • Use a mild antibacterial/antifungal soap/body wash to wash your face or body regularly.
  • Take wash immediately after sports and outdoor activities to prevent any infection on skin.
  • Make a point to wash your pillowcases frequently as infections can travel from head via pillowcases onto your face.
  • Moisturize after each face wash. For oily skin use a gel-based moisturizer and for dry skin use an oil-based moisturizer.
  • Drink at least 10-12 glasses of water to keep your skin hydrated.
  • Use makeup that is not oil based or greasy; make sure you remove makeup before going to bed.
  • Exfoliate skin mildly once a week, to slough off the dead and contaminated skin cells.
  • Avoid rubbing, touching, and squeezing the acne blemishes as this can aggravate the condition.
  • Apply non greasy, high SPF (at least 20, PA+++) sunscreen when going out.
  • Wear loose fitting cotton clothes in summers.
  • Take care of the scalp and hair. Wash the scalp regularly and keep it clean and healthy.
  • Go for over-the-counter acne cream or gel to tackle the acne condition as and when it arises.
  • Include vitamin A, omega 3 fatty acids, and zinc in your diet and make it a habit to eat healthy minerals and nutrients rich food.
  • Exercise is very helpful for avoiding acne because it alleviates the stress levels.


Treating Acne

Multitude of treatments available today can assist you in treating acne. There are topical drugs as well as medications taken orally and some effective therapies which help in treating acne. This includes:-

1. Prescribed Topical Treatments – Doctors can advice you drugs and medicine that can abate the grave acne situation. Some antibiotics that are normally prescribed help in killing the harmful bacteria. Tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage) are examples of topical prescription products derived from vitamin A. These medications boost cell turnover and aid in preventing follicle blockages. It is always recommended to take doctor supervision before taking any tropical or oral medicines.

2. Over-The-Counter Topical Treatments – Over-the-counter (OTC) creams and drugs are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or sulfur as active ingredients. These are very helpful in mild acne condition.

3. Medications

Medications include treatments with-

  • Benzoyl peroxide and its derivatives
  • Antiseptics (like potassium hydroxyquinoline sulphate)
  • Antibiotics ( like  erythromycin, clindamycin, and tetracyclines)
  • Hormones(like estrogen/progestogen, drospirenone, spironolactone)
  • Topical retinoids(like  tretinoin, adapalene, and tazaroten)
  • Oral retinoids(like  isotretinoin)
  • Anti-inflammatories( like Nicotinamide, vitamin B3, Ibuprofen,  tetracycline, Mandelic acid, etc)

4. Therapies And Procedures

  1. Laser Treatment – Laser surgery is used to remove the scars left behind by acne. It can also help in prevention of the acne by burning away the hair growing follicle sac, the sebaceous glands producing the oil and by promoting formation of oxygen in the bacteria and killing them.
  2. Comedo Extraction – This treatment may help in extracting stubborn comedones. This is a resort if the normal treatments fail to uproot the comedones.
  3. Blue and Red light Phototherapy – Light exposure is used for a temporary treatment for acne. The processes like phototherapy or deep penetrating light therapy utilize visible light effectively to treat mild to moderate acne. When treated with light therapy twice a week, the number of acne lesions reduce by 64%; proves more effective when treated daily.
  4. Photodynamic Therapy – Though the treatment is surrounded by controversies but some scientists speak strongly in its favor. Some studies have shown that intense blue/violet light can reduce the number of inflammatory acne lesion by 60–70% in four weeks of therapy. This is more effective when the P. acnes are pretreated with delta-aminolevulinic acid (ALA), which fosters the production of porphyrins.
  5. Surgical Lancing – Cystic acne boils can be extracted through surgical lancing. A minor surgical procedure cuts out individual acne scars. The hole or cavity is then filled with skin grafts or repaired by stitches.
  6. Soft Tissue Fillers – In this treatment collagen or fat is infused under the skin, into scars to fill out the skin. The stretched skin makes the scars less conspicuous. The treatment should be repeated over time owing to its temporary results.
  7. Chemical Peels – The treatment uses a high-potency acid to be applied over the affected skin. This is done to burn away the top layer and to minimize deep scars.
  8. Dermabrasion – For people suffering from more severe scarring, Dermabrasion is apt. The technique removes the top layer of skin with a rapidly rotating wire brush removing the surface scars completely.  Moreover, the technique renders the deeper acne scars less noticeable.
  9. Microdermabrasion – This is relatively new technique and utilizes a hand-held device that blows crystals onto the skin. These crystals are considered to gently polish the skin’s surface. Following this, a vacuum tube clears off the crystals and skin cells. The results are moderate with some scars still visible after sessions of treatments.


10 Home Treatments For Acne

1. Garlic, Turmeric, and Honey – Crush the garlic seeds well, add Manuka honey and a pinch of turmeric powder to it and mix well. Apply the paste onto your acne prone skin. The blemishes lighten by regular application. Garlic and turmeric together are antibacterial, antifungal, antiviral and anti-inflammatory, so perfect for battling out pimples. Manuka Honey improves blemished skin and helps prevent breakouts.

2. Tea Tree Oil – Tea tree oil is an effective natural antiseptic plus has strong antibacterial qualities. Use it as it is on the skin and spread it evenly on the affected part. It will help fight off infection and improve complexion.

3. Kaolin Clay – Kaolin clay has always been considered as a boon for the oily skin. It helps get rid of excess oil and surface impurities. It tightens pores and imparts skin an even complexion.

4. Yogurt And Oatmeal – Yogurt has antibacterial properties and contains pro-biotic elements, both proven to improve the skin condition and complexion. Oatmeal on the other hand helps in exfoliating the skin and tightening skin pores.

5. Lemon Juice And Rose Water – Owing to its acidic properties, lemon cleans dirt accumulated in the pores and hardens the sebum. Rub a slice of lemon on the affected area and leave it for some time and rinse off with water. You can alternatively mix lemon juice with rose water in equal proportions and apply it on the affected area. Rose water being a good astringent and toner will add to the benefits.

6. Aloe Vera – Aloe Vera has got very effective medicinal properties. This factor lends it a reputation of being a very efficient acne remedy. Apply the juice of Aloe Vera on the affected area twice daily. It also improves the complexion and heals the scars caused by acne.

7. Neem Or Indian Lilac – Neem or Indian Lilac is a multipurpose skin remedy. It contains fungicidal properties; very beneficial in the acne treatment. Use it with turmeric and water to enhance the benefitting properties. This is probably one of the easiest ways to cure acne at home.

8. Orange Peel – Orange has been bestowed with benefitting acidic property and high Vitamin C elements.  Both orange juice and orange peel (preferred powder) are equally efficient when it comes to acne treatment.

9. Cucumber – Cucumber has a cooling and soothing effect on the skin. It will relax and benefit inflamed skin. Simply apply cucumber slices or paste on the affected area and enjoy the relieving effects.

10. Fenugreek – The herb fenugreek helps in healing the acne blemishes and sores. Make a fine paste of Fenugreek leaves with water and apply the herbal paste on the affected areas. Leave it for about fifteen minutes and rinse off with lukewarm water.

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