Written by Timothy Okooboh
Acne popularly called pimples is a common skin problem among teenagers and adults. It affects both males and females. The presence of acne especially on the face can cause a feeling of embarrassment, low self esteem, anxiety and social isolation. The objective of this article is to improve your understanding of acne and how to get rid of them as well as to prevent them from developing on your skin.
NB: Strictly speaking, pimples is a form of acne in which the lesions on the skin are mainly papules and pustules. But no one should be crucified for using acne and pimples interchangeably.
By the end of this article you will have a clear understanding of how acne develops and what causes it to form on the skin. You will also understand the six different acne lesions; whiteheads, blackheads, pustules, papules, nodules and cysts and most importantly, how to get rid of acne. So consider this your ultimate guide to acne resolution!
What is Acne?
Acne is a skin condition in which there is excess production of an oily substance called sebum which together with dead skin cells and bacteria accumulate under the skin and clog (block) the skin pores causing a raise in the skin. Therefore, acne usually occur in areas of the skin that are oily such as the face, back, neck and chest.
You may already be wondering what sebum is, how it is produced by the skin and how it combines with dead skin cells and bacteria to block the skin pores, and how all these leads to acne. But do not worry, all these questions will be answered.
How acne develops on the skin
Stage 1: Presence of risk factors.
Several factors lead to the development of acne. They include, genetics (presence of acne in parents), hormones (especially androgens such as testosterone), puberty (hormonal changes oocur) bacteria (especially Cutibacterium acnes, formerly called Propionibacterium acnes), oil-based cosmetics, some medications (such as steroids) and too much washing of the face.
Stage 2: Enlargement of the sebaceous gland.
The above risk factors cause hypertrophy (enlargement) of the sebaceous gland. The sebaceous gland produces an oily substance called sebum. Sebum helps to lubricate the skin and hairs as it moves upward through the skin pores to the surface. Also as this oily substance moves to the skin surface, it carries with it dead skin cells to be washed away.
Stage 3: Over production and accumulation of sebum, dead skin cells and bacteria.
Enlargement of the sebaceous gland will lead to over production of sebum and after sometime, sebum and the dead skin cells they carry will accumulate under the skin. A type of bacteria called Cutibacterium acnes formerly Propioni-bacterim acnes will also accumulate under the skin because this bacteria feed on triglycerides contained in sebum and with the help of lipase enzyme that this bacteria possess, it is able to breakdown triglycerides in sebum into fatty acids.
Stage 4: Clogging (blockade) of skin pores.
The accumulation of sebum, dead skin cells and bacteria will lead to the clogging (blockade) of skin pores, especially as they try to move upwards to the skin surface.
Stage 5: Formation of Acne
The clogging of skin pores leads to a raise on the surface of the skin. This is acne! The raise on the skin appear as various skin lesions such as blackheads, whiteheads, papules, pustules, nodules and cysts. An understanding of these different acne lesions is very important as this will to a large extent, determine the choice of treatment agent that will help to get rid of acne.
NB: Too much production of keratin (a kind of protein) by the skin (hyperkeratinization) causes dead skin cells to stick together which can also lead to clogging of skin pores.
Understanding Acne Lesions
- Whiteheads and Blackheads (comedones). Whiteheads and blackheads are usually the first kind of acne lesions formed on the skin. If the raise on the skin is open and exposed to air, oxygen reacts with melanin inside the content of the acne and darkens it to form blackheads. But if the raise on the skin is closed then there will not be entry of oxygen into the acne and it will appear white or pale (but not filled with pus), hence the name whiteheads.
NB: Whiteheads and blackheads are collectively called comedones. They are non-inflammatory acne lesions.
- Inflammatory acne lesions. Inflammation is the body’s response to infection or injury. The accumulation of bacteria under the skin will cause the immune system to respond and the interraction between bacteria and the immune system can lead to the transformation of blackheads and whiteheads (non-inflammatory acne lesions) into inflammatory acne lesions such as papules, pustules, nodules and cysts. Inflammation can produce swelling, redness, pain and even formation of pus.
Papule acne lesions are characterized by round hardened elevations on the skin without the presence of pus. Because of the inflammation that has occurred, papules may appear red and painful.
Pustule acne lesions are characterized by pus-filled round elevations on the skin.
Nodule acne lesions are severe forms of acne characterized by nodules on the skin. Nodules are very large papules. Like papules, they are hard and do not contain fluid.
Cysts acne lesions are severe forms of acne characterized by cysts on the skin which are deeper and bigger lesions filled with fluid and may be red in colour.
Treatment of Acne
Now I believe you are familiar with the various acne lesions. Let us move on to something very important; how to get rid of acne. The choice of treatment should depend on the acne lesions present on the skin.
- Treat blackheads and whiteheads (comedones) with topical retinoids e.g tretinoin cream, gel or ointment (Retin-A). Tretinoin is comedolytic that is, it breaks down comedones and also helps to prevent their formation. It also has anti-inflammatory property therefore can help to prevent generation of inflammatory acne lesions such as papules and pustules.
NB: Avoid exposure to sun or UV light when topical tretinoin is applied as this may result to an inflammatory reaction on the skin. Also tretinoin may produce severe irritation in people with eczematous skin.
- Treat papule and pustule acne lesions with a combination of topical or oral antibiotics and either Retin-A, Benzoyl peroxide or Azelaic acid . Papules and pustules are inflammatory acne lesions best treated with topical agents such as benzoyl peroxide, erythromycin, clindamycin and dapsone. Oral antibiotics such as doxycycline, minocycline and tetracycline can also be used especially when the acne is resistant to the topical agents. Benzoyl peroxide can be used for 5-7 days between topical antibiotics use. Individuals such as pregnant and breastfeeding women who cannot use tetracycline class of drugs should use erythromycin or azithromycin.
NB: As a general rule, avoid topical antibiotics as the only treatment for acne. Avoid oral antibiotics as the only treatment for acne. Also, avoid concurrent use of topical and oral antibiotics. This is important to avoid development of resistance by Cutibacterium acnes according to the American Academy of Dermatology. Addition of oral or topical antibiotics with either Retin-A or benzoyl peroxide is essential for greater clearing of lesions and prevention of resistance. Also, Avoid concurrent use of Retin-A and Benzoyl peroxide as this can be associated with severe irritation on the skin.
- Severe acne lesions such as cysts and nodules are best treated with an oral medication called isotretinoin especially if treatment failure occured with the topical agents and oral antibiotics.
NB: Pregnant women and women getting ready to be pregnant must avoid isotretinoin as it is associated with severe birth defects.
- For women whose acne is due mainly to androgens, treatment is done successfully with oral contraceptives such as Ortho Tri-Cyclen and Estrostep. However, this must be initiated by qualified dermatologists.
- Avoid squeezing pimples. It can lead to scars and release of pus-filled bacteria which can cause the spread of acne.
- Avoid oil based cosmetics.
- Avoid too much washing of the face. This can increase friction on the face and cause a local irritation.
- For ladies, wash your make-up brushes at least once a week.
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