At least three-quarters of all young adults experience acne at some time. The majority of cases involve isolated pimple outbreaks, but acne takes various forms, some with the potential to cause permanent scarring. Whether mild or extreme, acne can lead to inhibition and withdrawal from social activities, and as acne is a medical condition, early intervention will result in the best outcome.

Skin diseases are a challenge to eradicate entirely, although dermatologists provide treatment paths that include topical skincare products, oral medications and in more extreme acne cases medical procedures are available. The biological factors that cause the frequency and severity of acne outbreaks are addressed by dermatology and optimum outcomes are attainable with clinical assistance.

Types of Acne

Our skin contains pores which are connected to glands via small canals called follicles. Sebum produced by the glands travels through follicles to the skin’s surface. When follicles get blocked sebum accumulates under the skin causing pimples and with further build-up of bacteria and inflammation, more severe acne occurs.

The majority of follicles are situated on the face, shoulders, upper back, and chest. Many acne outbreaks are attributed to hormones affecting the skin’s oil glands, and extreme outbreaks caused by hormonal action may require treatment by an experienced dermatologist.

There are a number of major types of acne that are distinguished by appearance.

  • Closed comedones (Whiteheads): noticed as a small bump under the skin
  • Open comedones (Blackheads): these are visible on the skin’s surface; the black colour is the result of the sebum coming into contact with air.
  • Papules: appear as small pink bumps on the skin’s surface.
  • Pustules: a commonly occurring pimple that releases pus from the lesion
  • Nobules: large in appearance with a solid feel, these pimples can be deeply embedded and can cause pain.
  • Cysts: large, painful and filled with pus; cysts are very visible and can cause scars.

 What causes acne?

The precise reasons that acne is most severe during the teenage years are being studied. There are several theories.

There are higher levels of sex hormones after puberty than in younger children.

  • Sex hormones are converted in the skin to dihydrotestosterone (DHT), which stimulates sebaceous (oil) glands at the base of hair follicles to enlarge.
  • The sebaceous glands produce sebum. Changes in sebum composition may lead to acne lesions.
  • The activated sebaceous gland cells (sebocytes) also produce pro-inflammatory factors, including lipid peroxides, cytokines, peptidases, and neuropeptides.
  • Hair follicles are tiny canals that open into skin pores (tiny holes) on the skin surface. The follicles normally carry sebum and keratin (scale) from dead skin cells to the surface. Inflammation and debris lead to blockage of the skin pores – forming comedones.
  • The wall of the follicle may then rupture, increasing an inflammatory response.
  • Bacteria within the hair follicle may enhance inflammatory lesions.
  • While acne is most common in adolescents, acne can affect people of all ages and all races. It usually becomes less of a problem after the age of 25 years, although about 15 of women and 5 of men continue to have acne as adults. It may also start in adult life.

Who gets bad acne?

Some people have particularly severe acne. This may be because of:

  • Genetic factors (family members have bad acne)
  • Hormonal factors (higher levels of male/androgenic hormones) due to:
  • Polycystic ovaries (common). Hyperinsulinaemia and insulin resistance are characteristically found in women with polycystic ovarian syndrome, who are prone to acne among other problems
  • Psychological stress and depression
  • Excessive corticosteroids eg Cushing disease (rare)
  • Enzyme deficiency eg sterol hydroxylase deficiency (very rare)
  • Environmental factors such as:
  • High humidity
  • Cosmetics especially certain moisturisers, foundation and sunscreen. Beware of products that contain lanolin, petrolatum, vegetable oils, butyl stearate, lauryl alcohol and oleic acid.
  • Pressure from headbands and chin straps (eg “fiddler’s neck”, a condition seen in violin or viola players, where continual pressure from the violin against the neck causes skin irritation)
  • Excessive dairy products, meat protein and sugars in the diet. Diets low in zinc or high in iodine can worsen pustular acne.
  • Certain medications may provoke acne.

Treating acne

Mild acne is usually treated with over-the-counter medications. These are often topical applications (applied to the skin) containing ingredients known to heal and reduce pimple outbreaks. In more extreme or resistant cases, a dermatologist will diagnose the underlying problem and suggest the most suitable medication.

Depending on the severity of acne, you will be provided with creams, lotions or gels to apply after using a recommended facial cleanser. If necessary, antibiotic tablets or oral retinoids are added for acne removal & elimination.

Acne is resilient, but when diagnosed and treated promptly it can be eradicated. A dermatologist can diagnose and treat all acne types from mild to severe, which not only diminishes the chance of scarring but can also re-establish emotional well-being.

Consult your doctor early. The aim is to minimize the appearance of acne as it can be distressing to the patient, especially teenagers and young adults. Another important consideration is to minimize and prevent scarring.