Everyone wants an acne-free face: cheeks as smooth as that of a baby! Unfortunately, those annoying bumps begin to appear at adolescence, and up to 12% of women and 5% of men aged 25 years, will continue to have various degrees of acne on the face (sometimes extending to the chest and back). Severe acne shouldn’t be taken lightly as it may result in serious psycho-social problems, like depression and suicidal ideation.
Genetics plays a major role in the development and severity of acne. However, several causative or risk factors have been identified.
*Cosmetic products – such as pomades
*Certain drugs – eg, steroids, lithium, antiepileptics
*Hormonal imbalance – as in pregnancy
*Hormonal disorders – eg. Polycystic ovary disease (PCOS)
*Excessive exposure to sunlight
*High-fat, high-carb diet – fries, sugary drinks etc
The process of formation of acne is as follows:
1. Excess sebum production.
Sebum is an oil-based fluid produced in the sebaceous glands within the skin. It’s promoted by androgens (testosterone); which explains the preponderance in adolescent boys and adult ladies with abnormally high testosterone level.
2. Colonization by bacteria.
Excessive accumulation of sebum enhances the growth of Propionibacterium acnes, which causes inflammation and pustules.
3. The release of inflammatory substances into the skin.
This causes redness, pain, swelling and warmth. It’s advisable to avoid “popping” the pimples at this stage as it may worsen the inflammation.
4. Excessive thickening of the skin (hyperkeratinization).
This manifests in different grades(grades I – IV) as:
*Comedones- whiteheads and blackheads.
*Papules- reddish bumps of varying sizes
*Pustules – bumps containing pus
*Combination of the 3 above with scarring and darkening
**Darkening is worse in dark-skinned individuals, especially when the pimples are popped prematurely.
*It’s important to be sure that what you have is simple acne and not some other acne-like diseases or infections. Don’t feel shy to talk to a physician or skin specialist. AVOID SELF MEDICATION.
*Do not take drugs without knowing the correct dosage and possible side effects to expect. In pregnancy, oral and injectable drugs are best avoided.
*Topical agents are preferred. Oral and injections are reserved for moderate to severe cases. Topicals come as soaps, creams, lotions and gels.
*A combination of two or more classes should be used for optimum results.
*Medications include: retinoids (eg. Tretinoin), antibiotics (eg. Clindamycin), anti-inflammatory (eg benzoyl peroxide), spironolactone (in cases of high androgen levels)
*Psychotherapy might be helpful for chronic sufferers.
*Surgical intervention, such as laser surgery can be offered in selected cases.
*Herbal remedies and natural therapies can be used as adjuncts. Excellent examples are aloe vera, cucumber and lemon juices, honey and vinegar.
To prevent recurrence and worsening…
*Practice excellent personal hygiene. Wash the affected areas twice daily using simple soaps (avoid harsh soaps), lukewarm water (not hot) and dab with clean towel (avoid vigorous scrubbing)
*Traumatic procedures such as shaving, piercing and tattooing should be avoided as much as possible.
*Modify your lifestyle by eating a healthy diet, exercising daily and stress management.