Acne is undoubtedly the most common skin disease that affects us. Usually occurring in our teenage or early adult years, acne can affect people of every races and age.
The term acne comes from early English word “acme” which is originated from the Greek word “akme” meaning “the highest point”.
Medically known as Acne Vulgaris, acne usually develops on the face but sometimes acne can be found on the skin of the neck, back and even on the chest.
Although acne is not particularly harmful at all, it can leave scar marks on the affected skin.
Some of the symptoms associated with acne are whiteheads, blackheads, pustules, papules, nodules, cysts, and pimples or zits on the skin of face, neck, back and shoulder.
Pimples, whiteheads, and blackheads are extremely common while nodules and cysts are only caused in severe forms of acne.
Whiteheads usually stay hidden under the skin but blackheads are clearly visible. Large and pus-filled pimples that go deep within your skin are called cysts and they can leave behind scar marks if left untreated.
Before we can talk about how acne is caused, you need to know the basic structure of our skin. The upper layer of the skin is scaly which gradually flakes off and there is another layer under it. The layer under the top skin layer is called basal layer and it is responsible for creating new skin cells which eventually replaces the dead skin cells of the top layer.
There are also millions of pores on our skin, some of them are tinier than the others. The tinier pores are connected to the sweat glands which secrete sweat to keep our body cool and these pores let them out on the skin. The other slightly bigger pores house sebaceous glands under them. These glands are responsible for secreting sebum or oil which nourishes our skin and keeps it moisturized and smooth.
Apart from letting out the sebum on the skin surface, hairs also grow through these pores. During puberty, these sebaceous glands grow bigger as hormone level rises during this period. Studies have shown that male hormones or androgens are responsible for the growth of the sebaceous glands. These enlarged sebum secreting glands produce more oil than before and because of this skin becomes extremely greasy.
The greasier the skin becomes the worse acne is likely to be. As androgen levels are higher in males than in females, teenage boys and young men are usually prone to be affected by acne outbreaks.
Now as the skin becomes thick it can block off the pores along with dead skin cells that accumulate on the skin surface. These blockages can be also be seen with naked eyes as black or white spots on the skin. The white spots are called whiteheads and the black ones are called blackheads.
Despite popular belief that the blackheads are black due to the accumulation of dirt, the black color is actually because of the skin pigments. As the pores get blocked, some sebum may get trapped under the blackheads or whiteheads. These sebum filled spots are called pimples or papules.
Most of the times the condition does not progress beyond this mild stage of acne. But in some cases, if the acne is left unattended, the condition may progress further. A bacterium called Propionibacterium acnes live under the skin in these pores in small numbers at all time. Inside the blocked pores, this bacterium may develop in large numbers in the trapped sebum.
When a large number of this bacterium develops it triggers our immunity system which in turn cause inflammation of that particular area. Because of the reaction of the immunity system, the surrounding skin areas become red and swollen, and the small pimples get bigger and get filled with pus. These pus filled big pimples are called pustules and in some individuals, these may grow even bigger and develop into cysts or nodules. The cysts or nodules are usually painful but the pain goes away as soon as the inflamed spots heal.
The healing of the inflamed spots can take anywhere between a few days to a whole month. As the cysts go deeper into the skin than normal pimples small pit marks are left on the skin even after healing. In people with darker skin tones the area of the skin that was once affected by acne may remain discolored for several months.
But the above-stated condition is not the sole reason responsible for causing acne. Researchers have shown that acne can be hereditary, if someone’s parents have experienced acne at some point in their lives then the children might experience them too.
Even excessive exposure to some chemicals like halogenated hydrocarbons can cause acne in most people. Some medical conditions like polycystic ovary syndrome can cause acne in women. It is a condition where the ovary and the adrenal gland produce excessive male hormones or androgens.
Apart from acne some of the symptoms associated with this condition are an excessive growth of facial and body hair or hirsutism, thinning of scalp hair, irregular menstrual cycle etc. Studies have also shown that although medicines that contain lithium or androgens, progesterone only contraceptive pills, phenytoins, steroid creams and anabolic steroids may not cause acne, they can make acne worse.
There are no proven particularly useful ways to prevent acne. But avoiding extremely greasy and oil based cosmetic products can prove beneficial for acne prone people.
There is a common myth that acne is caused by poor hygiene. Although it is partially true since a less oily skin means a lesser chance of getting acne, excessive washing can make it worse. It is advised to wash your skin twice a day with mild soap or face wash and lukewarm water.
Shaving can also cause acne, so always use a sharp blade while shaving.
For treating mild acne there are many over-the-counter medicines and ointments that one can buy without a prescription from a doctor.
Ointments containing benzoyl peroxide is particularly helpful in treating acne problems as benzoyl peroxide kills bacteria, slows down the sebum production of the sebaceous glands, clears pores and accelerates skin turnover.
Resorcinol, retinoids like tretinoin, and azelaic acid can help in clearing the pores, breaking down blackheads and whiteheads etc. Most of the OTC ointments actually use benzoyl peroxide and any other antibiotic to treat acne. Benzoyl peroxide may work wonders in treating mild acne but it often makes the skin extra sensitive to sunlight, reddens and dries the skin.
Women who are experiencing flares of acne as a result of hormonal changes in their body may find relief in using the combined contraceptive pill.
Acne treatments take anywhere between 4 to 6 weeks to show results and some kind of maintenance treatment should be continued to prevent flares for someone who is extremely prone to acne.
Scars associated with acne can only be treated by specialists using various methods such as laser resurfacing of the skin, collagen filler injection, chemical peeling of the skin etc.
If you are experiencing severe acne outbreak or are pregnant then it is always advised to visit a doctor for proper diagnosis and treatment.