About Acne (Pimples)

Overview

Acne is a common skin condition that occurs when pores in the skin become blocked and inflamed. It typically occurs on the face, chest, and back but can occur in other areas as well. Acne is caused by a combination of factors, including hormonal changes that cause overactivity of oil-producing glands in the skin. These glands normally release oil onto the surface of the skin through pores, but when the pores become blocked by a protein called keratin and dead skin cells, bacteria can become trapped and cause inflammation. This results in the formation of various types of acne lesions, such as whiteheads, blackheads, papules, pustules, nodules, and cysts. Acne can occur at any age but is most common during adolescence. While it is not a serious health threat, severe acne can lead to scarring. Dermatologists can provide treatments to help reduce acne symptoms and improve the appearance of the skin.

Causes and Risk Factors

The causes of acne include:

• Excess or high production of oil in the pore
• Buildup of dead skin cells in the pore
• Growth of bacteria in the pore

Non-modifiable risk factors are risk factors that cannot be changed. Non modifiable risk factors for acne are:

• Hormones: An increase in androgens, which are male sex hormones, during puberty can lead to acne. Hormonal changes related to pregnancy can also cause acne.
• Family history: If your parents had acne, you may be more likely to develop it.

Modifiable risk factors are risk factors that can be changed or influenced. Modifiable risk factors for acne are:

• Medications: Certain medications containing hormones, corticosteroids, and lithium can cause acne.
• Diet: Some studies suggest that certain foods may worsen acne, although researchers are still studying the role of diet as a cause.
• Stress: While stress does not directly cause acne, it can aggravate existing acne.

It's important to note that these risk factors may vary from person to person. If you have concerns about your acne or want to explore treatment options, it's best to consult with a healthcare professional. They can provide personalized advice based on your individual situation.

Symptoms

The most common early symptoms of acne include:

• Whiteheads: Small, raised bumps with a white or yellowish head
• Blackheads: Small, dark spots on the skin's surface caused by clogged hair follicles
• Papules: Small, red bumps that may be tender to touch
• Pimples: Red, swollen bumps filled with pus
• Cysts: Large, painful lumps under the skin that may contain pus

As acne progresses or becomes more severe, additional symptoms may occur:

• Nodules: Large, solid bumps beneath the skin that are painful and can cause scarring
• Inflammation: Redness and swelling around acne lesions
• Skin Discoloration: Dark patches or spots called hyperpigmentation
• Scarring: Acne lesions that leave permanent marks on the skin
• Depression and low self-esteem: Acne can negatively impact emotional well-being

It's important to note that everyone's experience with acne is different, and symptoms can vary in severity and location on the body. If you have concerns about your acne symptoms, it's best to consult with a dermatologist for an accurate diagnosis and appropriate treatment options.

Diagnosis

To diagnose acne, healthcare providers typically perform the following examinations, tests, and procedures:

• Physical examination: A doctor examines the skin to assess the presence of acne lesions, such as comedones (blackheads and whiteheads), papules, pustules, and nodules.
• Medical history: The doctor may ask questions about your menstrual cycles, medical or family history, and medications you are currently taking. This helps identify potential causes or contributing factors to your acne.

In addition to the above, there are additional examinations, tests, and procedures used to determine the stage or severity of acne:

• Global Acne Grading System (GAGS): This system assesses the severity of acne by evaluating the types of lesions and their location on the face. Each lesion type is assigned a value based on its severity. The total score indicates the overall severity of acne.
• Cardiff Acne Disability Index (CADI): This questionnaire measures the impact of acne on a person's quality of life by assessing physical, emotional, and social aspects.
• Coopersmith self-esteem scale: This scale evaluates self-esteem levels related to acne.
• Blood tests: In some cases, a doctor may recommend blood tests to assess hormone levels or identify any hormonal imbalances that could be contributing to acne.

It's important to consult with a healthcare professional for an accurate diagnosis and to determine the appropriate stage or severity of your acne.

Treatment Options

The goals of acne treatment are to:

• Help heal existing lesions
• Stop new lesions from forming
• Prevent scarring

To achieve these goals, various medications, therapies, and health behavior changes may be recommended:

• Medications: Medication to treat acne often aim to reduce oil production and swelling or treat bacterial infections of the skin.
  • Over-the-counter products: Products include topical medication applied directly to the skin in the form of gels, lotions, creams, soaps, or pads. Benzoyl peroxide is an example of a topical cream or gel that kills bacteria and may decrease sebum production.
  • Antibiotics: Usually used with other topical medications to reduce inflammation and fight bacteria. Antibiotics for acne are usually taken orally (by mouth). Sometimes, topical antibiotics are prescribed.
  • Topical retinoids: Derived from vitamin A, they treat lesions, reduce inflammation, prevent acne formation, and help with scarring. Topical retinoids come as creams, gels, or lotions. They are applied to the skin, usually at bedtime.
  • Salicylic acid or azelaic acid: These helps break down blackheads and whiteheads and reduces shedding of cells lining the hair follicles.
  • Sulfur: Also helps break down blackheads and whiteheads.
  • Oral contraceptives: Combination oral contraceptives containing an estrogen and a progestin may be prescribed for some people.
  • Anti-androgen medications: Spironolactone is a medication that may be used if other therapies do not work. These help block androgen hormones that may cause too much oil production.
  • Isotretinoin: This is an oral retinoid medication derived from Vitamin A. It is usually used for moderate to severe acne that hasn’t responded to other treatments. It has side effects such as inflammatory bowel disease and can severe birth defects. People receiving isotretinoin must be enrolled in a program to monitor for side effects.
• Therapies:
  • Light therapy: A skin specialist doctor may use light therapy to help treat acne. This involves regular visits to the doctor for treatment.
  • Chemical peel: A skin specialist doctor may apply a chemical solution to help improve the appearance of acne.
  • Drainage and extraction: A skin specialist doctor may use tools to remove whiteheads, blackheads, or cysts that do not respond to other treatment.
  • Surgical procedures: Used for severe acne cases to remove lesions or cysts.
  • Injections: Corticosteroid injections can reduce inflammation in large acne cysts or nodules.
  • Treatment of scars: Various procedures can help improve the appearance of acne scars.
• Health behavior changes:
  • Sunscreen use: Important to prevent dark spots and protect the skin while undergoing treatment.
  • Information and support: Patients should be offered information and support to address psychosocial morbidity associated with acne.

It's important to consult with a dermatologist who can tailor the treatment approach based on individual factors like age, medical history, severity of acne, and other considerations. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.