Definition & Clinical Appearance
Acne is characterized by minor, though occasionally severe, skin eruptions due to inflammation around the sebaceous glands. Most prominent on the face, upper chest, and back, the sebaceous glands secrete sebum, a thick, oily substance that lubricates the skin. Acne develops when the sebum flow is blocked by skin cells, dried sebum, or bacteria. A complete blockage produces a light-coloured bump (white head), an incomplete blockage leads to a dark-coloured spot (black head). Bacteria normally found on the surface of the skin may then infect the whitehead or blackhead, produce pus, and cause an eruption (pimple). In severe cases, known as cystic acne, painful purple lumps develop.
Signs and Symptoms
• Pimples or skin eruptions (blackheads and whiteheads).
• Clusters of red, inflamed pustules and cysts in more severe cases (cystic acne).
• Pockmarks and scarring from chronic acne.
Aetiology
• Hormonal changes during puberty, resulting in increased sebum production.
• Hereditary factors.
• In adults, underlying medical conditions, including ovary or adrenal gland dysfunction, such as polycystic ovarian disease and Cushing’s syndrome.
Contributing Factors
• Certain drugs or compounds, including corticosteroids, illegal anabolic steroids, iodides, bromides and lithium.
• Grease, tar, heavy oils, cosmetics, tight clothing, or anything else that can physically block the pores.
• Other factors including climate changes, stress, and exposure to dioxin.
Start of Pathology / Onset
It is most common during adolescence. Eruptions tend to wane by one’s 20s, but they may persist. In women, acne may first appear in the 20s or 30s. Unexplained outbreaks of acne in older adults may be a sign of a more serious underlying problem.
Location
Usually on the face, but also found on the neck, shoulders, back, chest, buttocks, and rarely, upper arms and thighs.
Complications
Picking or squeezing acne lesions may increase the danger or infection and scarring.
Prophylaxis / Prevention
There is no evidence that dietary modifications (such as avoiding chocolate or greasy foods) will reduce the incidence of acne in those so predisposed, although good hygiene may reduce severity.
Prognosis
Except in cases that cause widespread skin pustules, cysts, or scarring, acne is generally harmless and responsive to treatment.
Medical Treatment
Regular washing of the face with unscented soap to remove excessive oil is recommended. However, overwashing can irritate skin, making acne worse. Topical solutions that dry the skin, promote peeling, and kill bacteria usually improve acne. Over-the-counter preparations most commonly contain salicylic acid or benzoyl peroxide. Serveral different prescription forms of synthetic vitamin A (Retin A, Differin, and Tazorac) can be administered topically. In more severe cases, topical or oral antibiotics like tetracycline and erythromycin may be prescribed. For severe cases resistant to antibiotics, an oral vitamin A derivative drug, Accutane, may be used. This drug can damage a fetus so extreme caution must be used to ensure that pregnancy does not occur during treatment. Accutane has other potential side effects, people taking it must be closely monitored by a physician, usually with monthly visits and blood tests. After acne has been fully controlled, scars can be treated with standard or laser surgery, or a resurfacing procedure called dermabrasion.