what is acne? Acne is very common skin disorder which can be treated. Disease progression may require the patient to stick to therapy. In some cases, even when acne becomes asymptomatic, the patient has to adhere to the acne treatment in order to prevent recurrence. Acne has a direct effect on pilosebaceous units in the skin which usually consist of a hair follicle accompanied by a sweat gland. Acne can be non-inflammatory or can be accompanied with inflammation (painful lesions). For the latter, it is necessary to start treatment for acne on a priority basis in order to prevent scars from developing that may lead to the development of permanent marks on the visible regions of the skin.
Acne develops on the skin of most people at one or the other stage of their skin and can vary in degree from person to person. Acne can cause excessive oil secretions on the skin, visible spots in the form of marks and in some advanced cases it can result in a painful sensation when the skin is touched. The most common areas for the occurrence of acne are limited to the face and upper torso (shoulders, back and chest) with the occurrence on the facial skin being the most common in all the acne patients.
The nature of the spots also varies according to the severity of the disease. Some of the spots that usually occur are blackheads and whiteheads (for mild acne), papules and pustules (in the case of moderate acne) and cysts and nodules (less common and only in severe acne).
Types Of Acne
Knowing what signs of acne you’re dealing with is the first step in any successful treatment regimen, which is why we’ve compiled this handy guide. Recognizing particular of is the first step in getting familiar with acne and its outbreak. Early diagnosis followed by an appointment with a dermatologist is essential to start the treatment.
Whiteheads are small white marks which appear on the skin. Whiteheads are mainly attributed to the primary onset of mild acne when the follicles are clogged by cell debris and accumulation of excessive oil. But accumulation of sebum does not always contribute to the buildup of whiteheads.
Deposition Of A Particular Quantity Of Sebum on the skin is essential for the protection of skin against abrasion (damage due to friction) as well as for nourishment against dryness. However, it becomes problematic when the quantity surpasses the required limit, resulting in the formation of pilosebaceous plugs.
Blackheads appear the same as whiteheads but are black in color. In terms of acne, blackheads are often described as comedones. The distinctive black color of the blackheads is because of the oxidation of cellular debris caught up in the pilosebaceous units. Whiteheads primarily retain their white appearance because they are sealed off from the top and the cellular debris does not get oxidized.
A papule is the stage when sebum and cellular debris in pilosebaceous unit becomes infected by P. acnes to such an extent that it elicits an immune response that causes inflammation of the follicular unit.
The inflammation of the pilosebaceous unit is also fairly characterized by the swelling under the skin and apparent redness in most cases. Papules – if compared to other symptoms of acne – are smaller in size and cause irritation and inflammation.
The goal for the treatment of papule at this stage should not be remove it completely but to wait for infection to resolve (using the treatment recommended by a dermatologist). It is also important to note that there is no development of pus at any level in a papule. Both whiteheads and blackheads have the tendency to turn into papules but usually whiteheads serve as the basis for the formation of a papule.
Pustules are also called pimples. They get bigger in size owing to the periodic deposition of the pus which can be of any color ranging from white to yellow. Pus makes the pustules stand out from the crowd of papules. It is actually an advanced stage of a papule in which pus starts to accumulate.
Pustules, because of their obvious appearance, are a target of popping since it is commonly held that removing the pus will help the skin to heal instantly. Popping pustules can leave scars at the end of an acne breakout which can last for a lifetime. Both papules and pustules account for the mild to moderate acne.
Nodules And Cysts
Nodules are comparatively larger in size because of the solidification of deposition in them. Cysts are also deep-rooted but their lesions are not solidified and offer a grave risk of lifelong scarring.
Nodules and cysts are an indication of one of the three forms of severe acne i.e. nodular acne, acne conglobata, and nodular acne. Nodules and cysts have a rather serious tale to tell. These symptoms mark a more serious problem than sebum accumulation and bacterial infection. Both nodules and cysts are deep rooted and painful.
The symptoms of severe acne have a greater risk of leaving behind post acne breakout marks and require urgent attention. In the breakout of nodular, cystic or acne conglobata the first line of defense has always been the widely available OTC treatments but a dermatologist should always be consulted.
Classification Of Acne
Acne was first classified in a consensus conference convened by American Academy of Dermatology in Washington D.C. (1990). The conference concluded with the development of a system that was later to be to classify acne infections (especially acne vulgaris). According to this system, there are three classifications of acne; mild, moderate, and severe.
The characteristic of mild acne include the presence of whiteheads and blackheads in a limited number ranging from very few to several in some cases. Mild acne does not possess cysts or nodules.
Mild acne can turn into moderate acne when inflamed lesions accompany the whiteheads and blackheads. At this stage, there is still no evidence of papules or pustules on the skin.
Severe acne is clearly differentiated from the rest by the extent of inflammation owing to the presence of numerous papules and pustules and deeper-rooted cysts and nodules. Depending on the presence of different symptoms of severity, other names used to describe severe acne are cystic acne, nodular acne, and nodulocystic acne.
Classification On The Basis Of Lesion Type
Another general classification is based on the type and kind of lesions/pimples that appear on the skin of the patient. Some other types of acne, hence, include:
- Inflammatory acne (acne symptoms mainly including pustules and cysts i.e. pus filled non-solidified lesions)
- Comedonal acne (acne characterized by the presence of comedones or clogged pores which can be in the form of blackheads)
- Papulopustular acne (acne comprised of mainly papules and pustules minus the cysts and nodules present in the case of nodulocystic acne)
Under Standing The Pathophysiology: Treatment For Acne
Pilosebaceous units are affected by acne when one or more than one factor – out of the four outlined to be the causative agents for acne -come into play.
- Overproduction of sebum (skin oil).
- Hyperkeratinization of the hair follicle leading to blockage of the follicle.
- Colonization of Propionibacterium acnes.
- Inflammatory response elicited by the immune system.
Blockage Of Pilosebaceous Unit (Plugging)
The usual course of action is increased oil production on the skin which leads to blockages of the excretory canal of the pilosebaceous unit. Once the plugging of the excretory canal of the pilosebaceous unit is complete it leads to the development of the cellular refuse in the follicle as there is no other outlet for it. It deposits in the skin along with other lipids.
Microenvironment Formation (Log Phase Of P. Acnes)
The accumulation of these two factors plays a contributing role towards the formation of a microenvironment which is favorable for the growth and reproduction of Propionibacterium acnes.
The increased production of the natural flora, in turn, triggers the synthesis of mediators of the inflammatory system as an elicited immune response. The advanced stage of the inflammation is observed when the follicular eruption occurs because of the deposition of excessive fatty acids, bacterial flora and lipids.
Treatment For Acne
As research has expanded, therapies and treatments have also increased to cure acne. Best treatment options which are currently available for the management of acne can be divided into four distinct groups:
- Complementary and alternative medications (CAMs).
- Over the counter treatments (OTC).
- Prescription medications
- Light and laser source based treatment.
Complementary And Alternative Medications (CAMs)
Complementary and Alternative Medications (CAMs) are not the first line of therapy against acne but they are increasingly popular amongst acne patients because they are home-based therapies and are relatively easy on the financial budget of the patients.
A research was conducted by P.J Magin published in the Complementary Therapies in Medicine which comprises of an elaborate view of the efficacy and possible effects of the commonly used CAMs for the treatment of acne. A detailed review entailing the mode of action of popular CAMs for the treatment of acne can be read in the E-book or other articles.
Avibilty Of Over The Counter Acne Treatment
Over the counter drugs or ‘OTC’ are widely available commercially as treatments of mild acne and its repeated breakout. The nature of OTCs varies and range from lotions and gels which are to be left on the skin for a while.
Ashley Decker and Emmy M. Grabber carried out research on the most sought after OTCs for acne treatment that was published in The Journal of Clinical and Aesthetic Dermatology. A detailed review of individual OTC treatments for acne can be consulted in the EBook or other articles on acne to get to know these OTCs better.
Prescription Medications For Acne
According to Medline Plus, self-care and at home remedies help a person take care of the acne vulgaris outbreak for a variable time frame. However, there are certain conditions that require immediate attention. Continuous stress, itchiness, and irritation of the skin around the acne lesions and the development of scars are some of the telltale signs of switching over to the prescription drugs.
The research gathered from several studies targeting prescription medications as well as individual drugs give us a brief insight into the management of acne.
Food and Drug Authority of U.S. (FDA) has also been very active in approving some drugs and has expressed its reservations against others. The extensive history of prescription medications formulated to address the menace of acne is also tainted with many controversies and myths. Check out our elaborate E-book or other articles in order to get to know more about prescription medications.
Light And Laser Source: Not The Best Acne Treatment
Light and laser based treatment have surfaced as the latest treatment for acne. Lasers and lights of different wavelengths are being used for the treatment of acne with more patients choosing it as the treatment of choice. This increasing inclination towards this mode of treatment is because of rapid visualization of effects with a slightly higher safety standard in comparison to other therapies.
Recent modifications of this treatment include a combination of laser and light treatments with pharmacologically active agents and other physical enhancements of the process in order to bring about better therapeutic results. A detailed review of the laser and light based treatment options for acne as well the review of these treatment options by Susan Pei and colleagues published in Indian Dermatology Online Journal can be further studied in the E-book or other articles on Acne.
Classification Of Acne Scars
In order to better understand scarring caused by acne, it is of prime importance to get to know different types of scars that might appear during the course of acne progression. Two major types of scars namely,
- Atrophic scars (can be identified by a visible loss of collagen and are generally deeper than the rest of the epidermis) and
- Hypertrophic scars (can be identified by the excessive deposition of collagen and appear raised than the rest of the epidermis) appear in the case of acne.
The incidence of atrophic scars is almost three times greater than that of the keloids and hypertrophic scars. Detailed reviews of acne scars by Gabriella Fabbrocini and her team, published in Dermatology Research and Practice, explains the importance of stopping the scars from emerging in the first place.
Acne scars can be best avoided by preventing the acne from developing aggressively. There is a genetic predisposition of responding to acne that is inherited, secondly, the response of skin in reaction to a trauma (scarring in the case of acne) varies amongst individuals.
Need To Keep the Scarring At A Minimal Level
There is a lack of complete treatment to reduce scars or to completely remove them. But there are a few treatments which can be chosen to make the scars less obvious. The first and foremost direction in terms of combating acne scars is to keep the scarring to a minimum and reduce the duration of inflammation.
Sustained Susceptibility Of P. Acnes Towards Antibiotics
Layton AM highlighted some recommendations in his study on the most important treatments of acne published in Dermatologic Clinics.
Tolerance towards Isotretinoin by the skin and maximum absorption of the drug by the body should be the foremost priority. At the same time, substances such as creams and other topical solutions that may act as irritants should be kept away from the skin as aggravating acne is the least beneficial thing in treating acne scars. Other food products, drugs and supplements which trigger sensitization towards acne should be avoided during the course of treatment.
Intimidating Cost Of Acne Scar Treatments
Studies conducted so far have less credible data with them to claim efficacy in terms of acne scar treatment. Studies are teeming with accumulating shortcomings and limitations and lack a standardized approach to assessing and analyze different acne scar treatments. An intervention of post-acne scar treatment came under the spotlight but the study has failed to discuss and assess the long-term side effects of the treatment.
There is a need to incorporate randomized control studies also keeping the placebo effect in mind. Abdel Hay R carried out a systemic review of the Cochrane Database and reviewed the current treatment options for acne scars across the globe. All the studies lack the cost-effect relationship between the therapies and treatments, making it impossible to evaluate the effectiveness of each treatment over the period of time, considering the results are accurate.
Needless to mention again, the psychological effects of the acne are farfetched but the post-acne scars leave a lifelong negative impact on the personality causing different mental conditions in the patients.
There is a lack of general guidelines which can provide step-by-step direction for managing post-acne scars. Generally, the treatments options are both medical and surgical in nature while the latest advancements include laser techniques in order to get the desired results. There are limitations which still need to be addressed in the case of each treatment, some of the important issues to address while studying these treatments are; trials keeping the sample set randomized along with the control group, observation of long-term effects, evaluating the cost-effect relationship of each treatment and the subsequent improvement in the post-treatment life and mental health of these patients.
Best Treatment For Acne: Can Deep Cleansers Root Out Acne?
- An active debate on abrasive cleaning practices
- Abrasive cleaners effectively clean in depth.
- Overdoing hygienic practices has a toll on acne.
Some dermatologists are also in the favor of abrasive cleansing of the parts of the body with active acne lesions. David D. Fulghum, MD, and co-authors tested various abrasive cleansers (with and without the granules that cause abrasion) in their study published in the JAMA Network. They applied abrasive cleansers to a group of patients by utilizing comparison via the bilaterally paired method.
For both the study groups remarkable decrease in the skin acne lesions was seen while there was no significant difference between the result of the group which used cleansers with abrasive granules and the one using cleansers without abrasive granules.
As mentioned earlier, according to a published review of the face washing products done by Parker Magin in Family Practice, it is better to select acidic and antibacterial cleansing soaps. But, having stressed upon the necessity and importance of cleansing, it is necessary to avoid overdoing the face and skin hygiene practice.
If the face and skin are cleaned excessively then it may lead to loss of essential oils, consequently signaling the skin to produce excessive oil in order to compensate for the dry skin. If the patient is already administering irritating ointments to their body parts with acne vulgaris then no good can come from antibacterial skin cleansing products.
Acne E-book explains some tips and tricks in detail that may help when you are facing difficulty in deciding skin products which can clean as well as treat acne.