What is acne?

Acne is a chronic and inflammatory disease that involves the skin sites where the hair originates; hair follicles, and the sebaceous glands. Acne may be a life-long process, and usually starts before puberty, or at the onset of puberty. However, it can begin in adulthood or even in elderly people. The areas that are typically affected are the face, neck, upper chest, back and the shoulders.

Acne affects both males and females. At the age of 18, acne is more frequent in men than women. Beyond the age of 23 it is more common in women. The severe inflammatory form of acne is more often in men at any age. Scars rarely occur in females, except when the lesions are manipulated by the patient.

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What causes acne?

The increased production of the hormone androgen in puberty triggers a higher production of sebum by the sebaceous glands in the skin. The sebum is a natural subtract for bacterial growth, and allows the bacteria to increase dramatically in numbers, especially Propionibacterium acnes (P.acnes). The sebum is transformed by P. acnes in both free fatty acids, and other chemicals that produce the inflammation process.

The combination of increased androgen and pro-inflammatory chemicals causes a higher cohesion of the epidermal cells in the pore areas. This action forms what are commonly known as pimples - the characteristic lesions of acne.

There are closed and open pimples: a closed pimple is a closed pore with a tiny plug. An open pimple, also known as a blackhead, is also a closed pore with a larger follicular plug. Blackheads are not dirty. The dark colour is due to increased skin pigment and the sebum contacting the oxygen present in the air.

The plugged pore can become swollen and inflamed, resulting in a pimple of minor or major proportions. The leakage of the follicles, in the surrounding skin, produces more inflammation, and creates other lesions of acne, such as cysts, pustules, and abscesses.

The hypersensitivity to the inflammatory process caused by P. acnes, is greatest in individuals with genetic predisposition. In other words, the problem is very much one of genetic heritage. The same combination of genes that made you the person that you are: height, hair colour,  etc., also made your skin the type that it is.

In early adulthood the androgen levels decline slowly. This fact may contribute to the resolution of acne in the adulthood period. Some updated studies show a deficiency in the vitamin Pantothenic Acid as the basic cause of acne.

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Symptoms?

There may be minor pain, itching, or mild soreness, and very rarely, fever with inflammation and pain in the joints.

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Diagnostic tests

Hormone tests can be carried out, and also a skin biopsy which is used to differentiate acne from other possible diseases.

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Does acne have complications?

It can have if it goes untreated. The most important complications are Cyst formation: a big, hard and deep closed pimple which can lead to scarring, and the effect it can have on Psycho-social development.

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What about acne treatment?

Topical treatment: In both sexes, acne in the adults respond very well to treatment. Topical treatment can include topical antibiotics, topical retinoids such as tretinoin and iso-tretinoin; benzoyl peroxide, azelaic acid, sulphur, and salicylic acid.

Systemic treatment: Most of the time the systemic treatment, or oral therapy, is reserved for cases of moderate to severe inflammatory acne. In these cases, a combination of topical and oral treatments are indicated. Oral treatment may include isotretinoin and/or antibiotics such as tetracycline, erythromycin, clindamycin, sulphas, etc. Hormonal therapy, such as oral contraceptives, corticoids etc. may also be useful in adult females with hormonal abnormalities, or acne that does not respond well to conventional treatment.

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What about over-the-counter acne treatments?

These type of treatments are for topical use. Most of them contain a low-concentration of benzoyl peroxide. Other such treatments often contain mild drying or keratolytic agents to remove the deposit of dead cells on the skin. These agents can be helpful for mild acne. They are both inexpensive and easily accessible, and they come in creams, gels, lotions or soaps. All of them may cause some skin irritation during the treatment phase.

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Can acne scars be treated?

Yes. However, it requires hands-on clinical training. Most people do not develop scars from their acne. Discoloration almost always disappears with time and avoiding sun exposure. Your dermatologist will select the best treatment for your acne scarring.

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What about Psycho-social impacts?

People with psycho-social problems due to acne may need to be treated by a psychologist or, in some cases, by a psychiatrist. Some of the psycho-social impacts are: 

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Conclusion

Acne is an important disorder to treat, and it should not be dismissed as something trivial or purely cosmetic. There are medical steps that can be taken to alleviate symptoms.

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Case History

E.H - Acne

E.H had suffered from acne for 2 years and in that time had bought all the over-the-counter products that promised to help and even cure her acne. She had even been prescribed antibiotics and other medicated treatments by her G.P - all to no avail.

A friend mentioned AcuMedic, and she came in for a consultation. After only four months of treatment, E.H declared that her skin had been ‘transformed’ and had ‘tremendously benefited.’

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Your Thoughts and Questions

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Our forum is monitored by qualified health professionals and a member of staff will do their best to offer advice. Also our forum allows other users to post comments, sugestions and experiences that may help you.

Click here to participate in the Acne Discussion Thread

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Further Reading and Products for Acne

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Chinalife Remedies

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Always seek health advice from your doctor, or local  Health Outlet. AcuMedic will be very pleased to offer advice regarding difficulties with this condition. Please see our Clinic

Please note that although we are confident that our treatments will help the majority of our patients, we cannot absolutely guarantee a cure as the needs and difficulties of each patient can differ greatly