Acne : what is it? Prevention and medical treatments

Definition of acne

Acne is a skin disease characterized by the eruption of red pimples, blackheads and cysts. It most often affects the face and chest, but also the back, chest and even the scalp.

Acne reflects reactions that take place in the sebaceous glands. These glands are located in the skin and produce sebum, a lubricating substance. If there is not enough sebum, the skin will be dry and easily chapped. If there is too much, the skin will become more oily and acne-prone. Indeed, the excess of sebum obstructs the duct of the sebaceous glands.

This facilitates the proliferation of bacteria normally present in the skin, in particular Propionibacterium acnes bacteria, which are responsible for inflammation (red spots). When the clogged follicle expands too much, it causes retention lesions (blackheads and microcysts).

The symptoms of acne are treated fairly well in adolescents. They are sometimes more difficult to cure in adults.

 Who is affected by acne?

In Western countries, acne is very common among adolescents  : it is estimated that 80% to 90% of them have it at one time or another. Boys are more affected than girls . 10% to 20% of them see a doctor for this reason. In the majority of cases, acne disappears around the age of 20 or 30, but it sometimes persists, we then speak of late acne.

 Causes of acne pimples

The acne is multifactorial. Here are some elements that can contribute to its appearance.

  • The hormonal surge at puberty. During puberty, regardless of gender, sex hormones increase, especially androgen hormones (which cause the appearance of male sexual characteristics). As a result of this increase, the sebaceous glands produce more sebum. This increase in sebum production creates a breeding ground for Propionibacterium acnes bacteria that feed on it;
  • Hormonal fluctuations in women. Some women see acne pimples appear 2 to 7 days before having their period. Contraception can also have a positive or negative role: women who start taking certain contraceptive pills containing potentially acneogenic progestogens such as gestodene, desogestrel, norgestrel, levonorgestrel, norgestrienone, norethisterone, lynestrenol… can see their acne worsen or, on the contrary, stopping contraception (for a desire to get pregnant for example) can also cause acne. Pregnancy and menopause can also be responsible;
  • A disorder in the functioning of the ovaries or adrenal glands. Sometimes acne in women can be attributed to a dysfunction of the ovaries or adrenal glands, but this is exceptional. This usually results in signs other than acne (increased hair growth, irregular periods…)

Other factors can cause acne or make it worse. To find out what these are, see the Risk Factors section.

Myths
  • Contrary to some popular ideas, acne is not caused by poor skin hygiene, nor by high sexual activity;
  • Diet is not considered a cause of acne. However, in some cases, acne can be aggravated by one or more specific foods. The association between acne breakouts and milk consumption is weak, according to studies.

Possible complications


Deeper lesions (cysts) may leave scars. Piercing of lesions should be avoided at all costs, as this can maintain the acne and is more likely to cause scarring.

The prolonged presence of numerous pimples or lesions on the face and body can affect self-image and self-esteem, especially in adolescents. It can increase stress in social relationships. It is often possible to improve the appearance of the skin with daily skin care until the acne subsides or disappears.

Symptoms of acne

The face, neck and chest are the areas with the most sebaceous glands. This is why acne is concentrated there.

  • Open comedones or blackheads: a black head appears because the mixture of sebum and skin cells changes color when it comes into contact with the air;
  • Closed comedones: appear as white pimples. They are caused by the congestion and dilation of hair follicles due to excess sebum;
  • Papules: these are red pimples. The redness indicates inflammation. They can be sensitive to the touch;
  • Pustules: these are lesions containing pus. They may be red at the base and tender to the touch. They form when the obstruction of the follicle leads to an accumulation of bacteria;
  • Nodules: These lesions are larger, deeper and more painful to the touch than pustules. They are hard to the touch;
  • Cysts: like nodules, they form balls, but are located deeper under the skin. Sometimes they are painful and redden, a sign of infection.
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People and risk factors for acne

People at risk for acne

  • Teenagers. Boys are more affected than girls;
  • People whose parents have suffered from acne;
  • People who must take certain medications, such as cortisone, lithium, isoniazid (an anti-tuberculosis drug);
  • Workers exposed to certain chemicals that clog the pores of the skin: for example, petroleum and tar products and by-products and halogenated aromatic compounds such as chloronaphthalenes and polychlorinated biphenyls;
  • Employees who work in kitchens where there are vats filled with frying oil.

Risk factors for acne breakouts

  • Anything that can irritate the skin, such as rubbing against tight clothing or sports equipment (e.g. helmet or backpack);
  • Direct and repeated exposure of the skin to greasy or oily products that block pores, such as certain greasy or non-comedogenic cosmetics;
  • Although not all sources agree on this point, many consider that stress can be an aggravating factor;
  • Profuse sweating;
  • Taking certain medications or anabolic steroids (substances that increase muscle mass and decrease fat mass);
  • Exposure to chemicals at work, such as chlorine compounds, industrial machinery oil and tar.

Acne prevention

Measures to prevent aggravation

Skin hygiene

  • Gently clean the affected areas 1-2 times a day with a mild, unscented soap or cleanser. Washing too often or rubbing too hard can irritate the skin and cause tiny lesions in which bacteria can lodge;
  • The sun aggravates acne (it improves it temporarily and then the acne reappears after a few weeks). In addition, many products used to treat acne can make the skin more sensitive to sunburn. In this case, you should not expose yourself to the sun. If you have no choice, you should use a non-comedogenic sunscreen, i.e. one that does not contribute to the formation of comedones;
  • Do not touch, scratch, pinch or pierce the lesions. Do not touch, scratch, pinch or pierce the lesions. These manipulations can lead to the appearance of scars or brown spots on the skin.

Shaving

  • Shave only when necessary;
  • Test hand-held and electric razors to see which one is less irritating to the skin;
  • If you use a hand razor, change the blades often to prevent a dull blade from irritating the skin;
  • Soften your beard with water and mild soap before applying shaving cream;
  • Do not use after-shave lotion containing alcohol.


Make-up

  • Avoid heavy foundations and oil-based cosmetics. Choose non-comedogenic, water-based cosmetics;
  • Remove makeup before going to bed;
  • Throw away expired beauty product containers;
  • Regularly clean cosmetic brushes and applicators.


Body hygiene


Take a shower after heavy physical effort, as the mixture of sweat and sebum can trap bacteria in the skin’s pores;
If you have oily hair, wash it often;
Wear loose clothing to reduce sweating, which can irritate the skin.


Miscellaneous

  • Avoid tight-fitting sports equipment, such as helmets and backpacks, which can irritate the skin;
  • Be careful with anything that is in prolonged contact with the skin of the face: avoid pressing your face against your hands for long periods of time. Also avoid haircuts that make the hair fall on the face;
  • If you tend to have acne, avoid work environments that expose your skin to pollutants or industrial oils.

Medical treatments for acne

In general, juvenile acne is very treatable. Unfortunately, adult acne can be more difficult to treat. That said, all treatments require perseverance, as it can take several weeks or even months to see results. Part of the reason acne lesions are so slow to heal is that they also take time to form: at least 8 weeks.

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Very mild acne (rare blackheads and/or papules)

Treatments applied to the skin

They come in different forms: gels, lotions, creams, soaps, etc. Creams are moisturizing and are a good choice if you have dry or sensitive skin. Alcohol-based solutions or gels are more appropriate for people with very oily skin or who live in a hot, humid environment.

  • Benzoyl peroxide . It fights the multiplication of Propionibacterium acnes bacteria and dries up the skin, which decreases inflammation in the follicles. In France, mention may be made of Cutacnyl ® Eclaran ® Effacne ® Pannogel ® Panoxyl ® …;
  • Retinoids (derived from vitamin A). 0.025% or 0.05% tretinoin (Effederm ® Ketrel ® Locacid ® Retacnyl ® …), or adapalene (Differine ®) act more on the retention component of acne (blackheads, microcysts) and promote renewal of skin cells. They unclog the hair follicles, allowing topical antibiotic treatment to enter them and fight the bacteria that have accumulated there;

Note. To ensure the effectiveness of the treatment, these products should be used regularly for several weeks. At first, skin irritation may appear; it can lead to limiting the number of applications per week.

Mild acne (comedones and / or papules on less than half of the surface of the face)

Treatments applied to the skin

  • Benzoyl peroxide .

and

  • Retinoids  (derived from vitamin A).

In the event of failure after 3 months of well-conducted treatment:

  • Either an intensification of the previous treatment (change of molecule and / or increase in dosage and / or more frequent applications)
  • Either an association
    • local retinoids (0.025% or 0.05% tretinoin or 0.1% adapalene) or azelaic acid (Skinoren ® 20% cream)

and

  • topical antibiotics: they stop or slow down the proliferation of bacteria, especially Propionibacterium acnes,  and reduce inflammation. They are in the form of lotion, cream or gel. The most common are based on clindamycin (Dalacin T Topic ®, Zindacline ® …) or erythromycin (Eryacne ® Eryfluid ® Erythrogel ® …). Your doctor may prescribe a product that contains both benzoyl peroxide and an antibiotic, such as erythromycin.
  • Either an association
    • local retinoids (0.025% or 0.05% tretinoin or 0.1% adapalene) or azelaic acid (Skinoren ® 20% cream)

                        and

  • oral antibiotics: the most commonly used are lymecycline and doxycycline (Doxy ® Granudoxy ® Spanor ® Tolexine ® Tetralysal ® Vibramycin ® …);

Medium acne (more than half of the facial surface has comedones and / or papules)

First-line treatment:

Treatments applied to the skin: Benzoyl peroxide and Retinoids.

And

Oral antibiotic treatment

Very severe acne (very inflammatory acne, affecting the whole face, with nodules)

  • Isotretinoin (Contracne ®, Curacne ®, Procuta ®…) in first intention. This derivative of vitamin A is prescribed only in the most rebellious cases of inflammatory acne with nodules. It works by markedly reducing the size of the sebaceous glands, which decreases the production of sebum. It should be taken under close medical supervision because of its numerous and dangerous side effects.
  • Skin cleansing (removal of retentional lesions by microsurgery consisting of incising comedones and lesions to empty them) may be proposed before the initiation of isotretinoin in order to reduce the risk of severe inflammatory outbreaks sometimes occurring at the start of treatment.
  • For forms with a high retention component, isotretinoin should be started at a lower dose (0.2 to 0.3 mg / kg / day) in order to reduce the risks of acute and severe exacerbation (acne fulminans).

 Contraception

Contraceptive treatment is often needed to treat acne in women. 1st and 2nd generation pills are recommended as a first-line treatment, especially those based on levonorgestrel.

 Scars

The treatment of scars comes under medical supervision . Different techniques are used: dermabrasion, microdermabrasion, laser rays, pulsed light rays and local surgery.

Our doctor’s opinion on acne

If you are a teenager and suffer from acne, don’t put up with it thinking it’s inevitable. In almost all cases, even if the acne is not completely cured, it can be greatly reduced.

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If your acne is mild, you may well find appropriate over-the-counter treatments at the pharmacy. Be patient and persistent, as results may take time to come. Above all, leave your pimples alone and avoid fiddling with them, which will prevent scarring.

For those who suffer from more severe acne with inflammation, I strongly recommend consulting a doctor. He or she will certainly be able to prescribe a suitable and effective treatment. You will feel better in every way.

Complementary approaches to acne

Zinc. Several studies conducted in the 1970s and 1980s indicate that taking dietary supplements of zinc can improve the appearance of acne. More recently, in a double-blind, placebo-controlled study of 332 subjects, zinc gluconate (a dose equivalent to 30 mg of elemental zinc per day) taken for 3 months reduced the number of lesions by 75% in 31% of subjects.3 3 However, the oral antibiotic (minocycline in this case) was significantly more effective in reducing the number of lesions in 63.4% of participants.
Dosage: Take 30 mg of elemental zinc daily as a gluconate.

Essential oil of melaleuca (Melaleuca alternifolia). Tea tree oil has an antibacterial effect in vitro. Two clinical trials suggest that it helps reduce the number of acne lesions4,5. 4,5 In one of these trials, a gel containing 5% melaleuca essential oil was comparable in efficacy to a lotion containing 5% benzoyl peroxide. The effects of melaleuca took longer to develop, but the essential oil caused fewer adverse effects than the peroxide treatment.

Recognized use Oats (straw) (Avena sativa). Commission E recognizes oatmeal (psn) baths in the treatment of skin diseases caused by excessive sebaceous gland activity7. These baths may be useful for acne on the back, chest or forearms. The straw, i.e. the dried aerial parts of the plant, is used.
Dosage
Prepare an infusion of 100 g of oat straw in 1 liter of boiling water and pour into the bath water.

Recognized use Brewer’s yeast. Brewer’s yeast is a microscopic fungus of the Saccharomyces type. Commission E approves the use of inactive brewer’s yeast supplements in the treatment of chronic forms of acne8. The supplements naturally contain high amounts of B-complex vitamins.
Dosage
Take 2 g, 3 times daily, with food.

Recognized use Probiotics. The German Commission E has also approved the use of active brewer’s yeast (also called “live” yeast) Saccharomyces boulardii as an adjuvant treatment for certain chronic forms of acne.
Dosage
See our Probiotics fact sheet.

Traditional use Burdock. Based on traditional use, several authors recommend the use of depurative plants, such as burdock, to treat acne. These plants, generally bitter, stimulate the liver and facilitate the elimination of toxins and waste by the body. The depurative effects of burdock are well known.
Dosage
Take 1 g to 2 g of dried root powder, in capsule, 3 times a day. You can also boil 1 g to 2 g of dried powder per 250 ml of water. Drink one cup 3 times a day and apply as compresses on the affected areas.

Approaches to consider Chinese Pharmacopoeia. Dr. Andrew Weil recommends consulting a practitioner of Traditional Chinese Medicine, as there are several traditional herbal remedies for acne. They come in the form of preparations that can be applied to the skin or taken by mouth.9 One of them is the herbal remedy for acne. One of these is Fang Feng Tong Shen.

Approaches to consider Dietary approaches. The role of diet in the development of acne is highly controversial10. Naturopaths and nutritionists sometimes suggest dietary changes in the hopes of alleviating symptoms. For example, they may recommend reducing the consumption of foods high in salt, fat or trans fats, which are often fast food. At the same time, they may suggest eating more foods rich in omega-3s (fatty fish, flaxseed, walnuts, etc.), which are fats that can reduce inflammation.