Acne is an inflammatory condition of the pilosebaceous units, commonly known as clogged pores or comedones. It is a prevalent skin condition, particularly affecting individuals aged 16-18, with an occurrence rate of 85%. These terms are interchangeable and refer to the same skin condition. Pores are the openings of hair follicles connected to sebaceous glands that produce sebum. Collectively, these structures form pilosebaceous units. Acne goes beyond just facial blemishes. It can significantly impact the quality of life, causing feelings of despair similar to those experienced by chronic pain or substance abuse sufferers. Many with severe acne feel less attractive, less worthy of friendship, and less likely to be hired for jobs. Despite effective treatments being available, many people do not seek help.

The Science

Acne is a skin disorder in the pilosebaceous units. Acne formation involves six key factors, each requiring attention for effective treatment:

  • Hormonal Imbalances: Excess androgens (male hormones) and stress hormone (cortisol) contribute to acne development. 
  • Overproduction of Sebum (oil): The pilosebaceous units, under the influence of androgens, produce excessive amounts of oil.
  • Abnormality in Pore Structure: Irregular or excessive shedding of dead skin cells inside the pore can clog pores, forming comedones.
  • Bacterial Buildup: The presence of Cutibacterium acnes bacteria inside the pilosebaceous units leads to inflammation and irritation through TLR-2 (Toll-like receptor 2) activation.
  • Impaired Microbiome and Skin Barrier: Over-exfoliation can impair the skin barrier and contribute to acne formation.
  • Dietary Factors: Dairy, sugar, and saturated fats can impact acne.
  • Oral Supplement: Vitamin D

Several types of acne exist at the same time. They may be:

  • Inflammatory: papules (small, tender red bumps), pustules (white or yellow spots with pus), and nodules (large, painful red lumps), pseudo cysts (cyst-like fluctuant swellings)
  • Non-inflamed comedones: blackheads and whiteheads.
 

Acne is also graded as mild, moderate, or severe, and the treatment for different grades differs.

  • Mild acne:  <20 comedones, <15 inflammatory lesions. Total lesion count <30
  • Moderate acne: 20-100 comedones, 15-20 inflammatory lesions. Total lesion count between 30-125
  • Severe acne: 5 pseudocysts, total comedone count >100, total inflammatory count >50. Total lesion count >125

It’s one of the most common skin disorders affecting 85% of people aged 12-24. Acne goes beyond just facial blemishes. Acne can significantly impact the quality of life, causing feelings of despair similar to those experienced by chronic pain or substance abuse sufferers. Many with severe acne feel less attractive, less worthy of friendship, and less likely to be hired for jobs. Despite effective treatments being available, many people do not seek help. Early recognition and treatment are crucial to minimize scarring and improve outcomes. So let’s raise awareness and support those dealing with acne as one of the most common mistakes is to delay seeking help and treatment because the severity of acne and its effects are not fully understood.

Solutions

There are several treatments that can help clear acne in addition to skincare and oral medications:

Other Treatments and Strategies

Treatment involves targeting the root causes and is dependent on the severity and the sex of the patient:

Hormonal Imbalance: In females, anti-androgen agents may be used to reduce excess androgen levels.

Targeting Oily Pilosebaceous Units: Use of BHA exfoliating agents, which are lipophilic and can penetrate oil to clear out the pores and reduce inflammation.

Decreasing Acne Bacteria: using Oral antibiotics, Topical antibiotics and Benzoyl peroxide (BP)

Improving Skin Barrier: Use a gentle cleanser. Use anti-inflammatory skincare like Vitamin B2 to neutralize free radicals and calm inflammation in the pilosebaceous units. Protect skin with sunscreen in the morning and moisturize with a light moisturizer at night.

Normalizing Pilosebaceous Units: Retinoids is one of the most effective acne treatments, normalizing the function of the pilosebaceous units. Retinoids also inhibit TLR-2, activate retinoic acid receptors, and normalize the desquamation of skin cells.

Dietary Adjustments: Reducing high glycemic index foods, dairy, saturated fats, and meat may help acne.

Others: Mild acne usually responds to OTC topical treatments and retinoids. Moderate acne requires the use of prescription topical retinoids, and severe acne requires an oral form of Vitamin A under dermatologist supervision. Generally, it takes 2-3 months to see improvement in acne on treatment. Early recognition and treatment are important to reduce the risk of scarring

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