What is Acne?
Importance of Effective Treatment for Acne
Acne is one of the commonest inflammatory skin disorders and a cause of much distress to many of us – just when we care most about our appearance. Acne is a chronic disease, lasting in many cases until the mid-20s. In 7% of subjects clinical acne persists until 40 - 50 years of age – and this is more common in women. The mildest form involves a few perceivable blackheads and occasional red spots; most of the adolescent population will suffer from this form at some time. The more severe forms can be disfiguring: 2-7% of sufferers develop life-long scars, emphasising the importance of effective treatment.
Can Acne be Treated?
Of the 70-87% of adolescents who develop acne, 15 - 30% will seek medical advice. Many subjects seek advice from the pharmacist, but some will not seek help at all because of embarrassment or the misconception that no treatment is available.
Acne and the possible scarring that can ensue may cause significant psycho-social disability. The severity of the acne does not necessarily correlate with the psycho-social morbidity.
Acne can be treated, and sufferers should consult their GP or pharmacist if their condition is not tolerable.
Pre-Menstrual Flare Acne
Acne represents a disease of the hair and sebaceous follicles [the pilosebaceous units] present on the face and upper chest, upper back and shoulders. These follicles are under the influence of hormones called androgens. As a consequence of the hormonal drive, acne typically begins at puberty or in early adolescence, reaching peak incidence and severity in both sexes between the ages of 16 and 20 years.
Although the production of sebum (grease) is dependent on hormones, most acne sufferers have normal hormone levels.
Girls and women will know that a premenstrual flare is common in around 70% of women.
There are four main factors involved in the development of acne:
- Sebum - Increased production of the oily product sebum. This is under the control of androgen hormones which result in increased sebum production known as “seborrhea”.
- Blackheads & Whiteheads - Increased cell turnover in the duct of the pilosebaceous unit results in the formation of blackheads and whiteheads.
- Bacteria - The build-up of acne bacteria called Propionibacterium acnes (P. acnes) in the duct.
- Inflammation - this is as a result of P.acnes colonizing the duct which results in inflammation and the red spots recognized in acne.
Treatment should be aimed at reducing the main causative factors - therefore a combination of therapies is usually required. Acne sufferers need to remember that:
- acne is a chronic disease
- a treatment strategy is needed and this will probably be a long-term therapy
- acne is a slow-responding disorder with little improvement in the first 3 - 5 weeks
- there is a need for strict compliance with the treatment programme
Treatments for acne should be aimed at reducing or clearing the skin of the tiny precursors to both the red inflamed spots we recognize in acne, and the non inflamed blackheads and whiteheads, even before they are visible to the naked eye. If this can be done they will be prevented from developing into the typical acne spots.
Topical retinoids are regarded as the treatment of choice by dermatologists and should be applied to all areas of skin affected by acne, even in the normal looking areas, in an attempt to clear the skin before the visible acne lesions emerge.
What Can Make Acne Worse?
- Stress may make acne worse
- Diet - studies have recently indicated there may be a link between milk and acne. As a result of these reports there is currently renewed interest in the link between diet and acne.
- Studies have indicated that there may be a link between genetics and acne and also possibly a relationship between the susceptibility to scar and family history.
- Some reports suggest that smoking can make acne worse.
- A premenstrual flare is seen in 70% of pre-menopausal women
- Sunshine often helps acne - but only temporarily
- Humidity can trigger acne
- Certain cosmetics can encourage the development of blackheads and whiteheads. Be careful of what you use!
- General principles - acne is a chronic, slow-responding disorder requiring disciplined self care by the sufferer
- The dermatologists’s topical therapy of choice is a retinoid cream
- Topical therapy is required by most acne sufferers, either alone or in combination with oral antibiotics or oral contraceptives [for women]
- Many topical agents produce redness and dryness and should be combined with non oil based moisturisers
- Systemic therapies include oral antibiotics.