Acne

Acne is a chronic inflammation of the pilosebaceous follicle that affects 80% of the adolescent population, most often between the ages of 10 and 18. Its clinical expression is variable, generally with earlier involvement in the female sex and more serious in the male, preceding or accompanying the first menstruations.

The most severe clinical forms can produce significant aesthetic alterations.

Why is it produced?

Inflammation takes place by several mechanisms:

• Increased sebum secretion.
• Excessive desquamation of the cells that line the hair follicle.
• Growth of microorganisms.
• Hereditary factors.
• Abnormal response of the follicle to androgens.

The initial alteration, which gives rise to the lesion called comedo, occurs in the deepest part of the pilosebaceous follicle and consists of:

• An increase in keratin manufacturing.
• An increase in lipid secretion from the pilosebaceous gland. When the keratin mixes with the lipids, a mass that is difficult to drain through the follicle forms, which ends up becoming clogged.
• There is a greater cellular turnover in comedones influenced by the androgenic stimulus, which produces an increase in keratin.
• Growth of microorganisms: from the first moments of life the pilosebaceous canal is colonized by specific bacteria and yeasts. With puberty these microorganisms increase in number, and are made up of:

– Propionibactrium acnes: it needs low oxygen conditions to live, it is quantitatively related to the amount of sebum in different places on the skin.
– Staphylococcus epidermidis: it is more common in pustular acne lesions.
– Pityrosporum ovale: it is the yeast most frequently found on the skin surface. Of the three species, P. acnes is the one with the greatest influence on the pathogenesis of acne. It releases enzymes that break down sebum into free fatty acids causing inflammation, in addition to releasing other substances that attract inflammation factors to that place.

Acne symptoms

Acne is located in the so-called seborrheic areas: frontal region, cheeks, back of the nose, chin, upper third of the thorax and shoulders. It is located on follicles with hyperfunctioning sebaceous glands.

The elemental lesion is the comedo that can manifest itself in two ways:

1. Closed comedo: it is a small, pale pink and hard elevation.
2. Open comedo: a small hole scratchy to the touch and black in color due to its melanin content, and if it is squeezed it drains its content.

Acne can be constituted only by comedones or evolve towards papules and spontaneously or by its manipulation towards pustules, nodules or cysts, which evolve slowly and that when resolved can leave hyperpigmented scars.

Special clinical forms

Acne neonatorum : due to the passage of maternal androgens to the fetus during pregnancy. It remits spontaneously between four and six months of life.
Excoriated acne : it can affect any age, but mainly affects young female adolescents, due to the manipulation of acne lesions, leaving scars as a consequence. There is often a neurotic basis.
Drug-induced acne : drugs can induce acne-like rashes or aggravate acnes pre-existing. They adopt a more diffuse distribution, which is not focused on the seborrheic areas and with more evolved initial forms. Produced, among others, by: corticosteroids, androgens, oral contraceptives containing progestogens with androgenic action, vitamin B12, phenobarbital …
Cosmetic acne : it occurs in the form of comedones and papulopustules, on the cheeks and chin of adult women, as a result of the use of products cosmetics with a high fat content and whose formula mainly includes sunscreen filters.
Occupational acne : conditioned by the use of industrial products such as chlorinated hydrocarbons, cutting oils, coal tar …, producing a large inflammatory component in the areas of skin contact with these products.
Summer acne : it appears in people who sunbathe in a sudden and sustained way. It most often affects women between the ages of 20 and 30 with papules on the neck, shoulders, arms, and trunk. There are usually no comedones.
Premenstrual acne : appears abruptly a week before the start of menstruation; a worsening of acne, in patients who already suffer from it.
Acne conglobata : it is the most severe form of acne, it affects adolescent males more frequently, lasting until adulthood. It is of the nodule-cystic type appearing on the back, buttocks, neck, shoulders, and sometimes the face, arms and thighs. They usually leave scars in the aftermath.
Acne fulminansIt almost always affects males between the ages of 10 and 20, with a sudden onset such as plaques, nodules, and abscesses that rapidly ooze, ulcerate, and become crusted over. Mainly on the trunk, respecting the neck and face. It is accompanied by fever and joint pain.

How is it diagnosed?

The diagnosis is carried out by visualizing the typical polymorphic lesions with comedones, located in the seborrheic areas of the skin.

Possible triggers or aggravating factors such as drugs, cosmetics, sunlight, etc. must be ruled out, as well as knowing previous treatments.

Acne Treatments

As a general rule, the duration of treatment should not be less than 3 to 6 months. Most failures are due to non-compliance or poor treatment.

Comedones predominate

It is usually started with comedolytics:

• Scrubs: salicylic acid.
• Bacteriostats: 5 and 10% benzoyl peroxide.
• Keratinization reducers: retinoic acid.

With the use of these products, sunlight should be avoided, the skin should be dry, and at first you may notice that it worsens and then begins to improve.

Predominance of inflammation

From the outset, the previous products should not be used, although later we can associate them with these others:

• Topical antibiotics: clindamycin, erythromycin.
• Systemic antibiotics: tetracyclines, minocycline, erythromycin, clindamycin.
• Hormones: estrogens, antiandrogens.
• Isotetrinoin.

Other treatments

Surgery: drainage of cysts, repair of scars.
Ultraviolet rays.

How to avoid acne?

Avoiding factors related to the development of different types of acne, although in many cases it will depend on non-modifiable factors such as genetic predisposition.

No food has been shown to trigger or worsen acne.

Excessive cleaning can aggravate injuries. Neutral soap is recommended. The use of antiseptics is not recommended as they can cause contact dermatitis. Do not manipulate the lesions, as it would facilitate the appearance of complications and scars. Some cosmetics can aggravate it.

Before the appearance of important injuries or that do not evolve in an adequate way with the mentioned hygienic measures, a medical treatment should be started that should be supervised and evaluated individually, since it will be a long treatment.