Acne is a disorder of the skin commonly seen in teenagers and young adults. Acne does occur in adults also due to various causes. 10-20% of adults experience some form of acne in later life. In the teenage years, the factor responsible for acne is the increased sebum production by the sebaceous glands. Sebaceous glands are glands present in the skin which produce an oily secretion called sebum. These glands are found attached to hair follicles and are found mostly on the face, neck, back and chest.
The commonest form of acne is the formation of comedones. They are formed due to blockage of the follicular orifice by the retained sebum and keratinous material. These comedones are initially white in color and later, on exposure to air turn black which are the blackheads that all of us have experienced at some point of our life. Bacteria like the Proprionobacterium acnes lodge in these comedones and release free fatty acids from the sebum and cause inflammation. This results in the formation of pus which is contained in a cyst. This cyst ultimately ruptures and an anti-inflammatory foreign body reaction develops due to extrusion of oily and keratinous material from the cyst. Erythema (redness) is seen and the area is painful and exhibits all the features of inflammation.
The various forms of acne are congested pores, whiteheads, blackheads, papules, pustules, cysts and nodules. When inflammation occurs near to the surface of the skin you get a pustule, if it's deeper, you get a papule, deeper still and you get a cyst. When this cyst breaks, a whitehead is formed plugging the pore and this on exposure to air gets oxidized to form a blackhead. A short description of the lesions is given below.
- Papule - It is a small lesion which is less than 5mm in diameter slightly elevated above the surface of the skin. When they appear in groups, they may not be visible but have a sandpapery feel to touch.
- Pustule - It is a dome shaped lesion which contains pus and looks like a dome with pus pointing in the center and is surrounded by an area which is erythematous (reddish). It forms over a sebaceous follicle. When these pustules heal, they usually do not leave a scar.
- Macule - They are erythematous red colored spots which are seen shortly after acne heal. They disappear in a few days to a few weeks.
- Cysts - They are lesions which are sac-like and contain semi-liquid debris consisting of leukocytes (WBC's), dead cells and bacteria. It is larger than a pustule, is inflamed and extends deeper into the skin. They are painful and leave scars when they heal.
- Nodule - It is a solid dome shaped or irregular lesion. It has inflammation extending to the deeper layers of the skin causing some destruction of the layers of the skin. It is the most severe form of acne and when it heals, leaves a scar.
Lesions of acne are limited to those parts where the sebaceous glands are naturally present and are large and these are the areas of the face, mainly the forehead, nose and chin, the ears, the chest, back and occasionally the upper arms. Most acne remain mild but a small number of people develop large inflammatory cysts and nodules which lead to scarring.
Some Myths About Acne:
Factors which do not cause acne are a) heredity- it plays a role in very severe acne, b) food- it does not directly influence acne but oily food is not good for health in general, c) diet or dust- a blackhead is an oxidized white head and not an accumulation of dirt/grime, d) Stress- it does not have a direct influence on acne, e) Hormonal cyclical influence-there is no cyclical breakout of acne in women or men based on hormonal release though hormones do play a role in their causation.
Apart from the causes of acne as described above, glucocorticoids as medications i.e. oral or topical steroids cause acne. Other medications like Lithium, Isoniazid, Phenytoin, and Phenobarbital are few examples of drugs which cause acne.
Treatment
Treatment for Acne has to undertaken only under the supervision of a Doctor preferably a dermatologist if you are to escape the ugly scars that remain for life. You have to follow the doctor's advice in letter and spirit. The doctor would usually prescribe some ointments and creams to be applied over the affected regions usually the cheeks and might also prescribe some oral medications(antibiotics like Tetracycline etc) to be taken internally by mouth. He will also advise about diet, sleep, exercise,. washing of face with water etc. etc Teenagers and others can get over this traumatic phase of their lives by following a healthy lifestyle(avoiding oily foods), not applying cosmetics and other medications on the face without doctors prescription,etc.
Avoid stress and Stop worrying, remember its part of growing up.
