Acne

Acne vulgaris appears in two primary forms: inflammatory and non-inflammatory. Inflammatory acne consists of papules and pustules (what are commonly called pimples), deeper nodules, and cystic lesions, all accompanied by inflammation. Non-inflammatory acne, on the other hand, includes common whiteheads and blackheads (comedones). Acne is most commonly found on the face but can also occur on the chest and back. Although it often begins during adolescence, it can commonly continue into adulthood or even begin as adult acne.

Multiple factors contribute to acne development, including clogged pores and hormonal changes. During puberty, an increase in hormones stimulates the production of more oil (sebum) in the skin. This excess oil, combined with sticky dead skin cells, clogs the pores. Normal bacteria present on the skin become trapped in these clogged pores, leading to an inflammatory response. Clogged pores without significant bacterial involvement result in whiteheads and blackheads, while greater bacterial activity leads to inflammatory lesions like pustules, papules (small bumps), cysts, and nodules (solid, hard lesions).

While these are the primary contributors to acne, other factors can exacerbate the condition. For example, a diet high in sugary, processed foods (high-glycemic index) can increase inflammation and sebum production, worsening acne. Hormonal imbalances, such as those seen in polycystic ovarian syndrome (PCOS), can also lead to increased sebum production. Therefore, acne can be a sign of underlying physiological processes.

• Increased hormones lead to higher sebum production
• Sticky dead skin cells clog the pores
• Increased bacterial flora on the skin
• Elevated levels of skin inflammation

• High-glycemic index diet
• Insulin resistance
• Hormonal imbalances, such as in PCOS
• Certain medications, including steroids and anticonvulsants
• Occlusive cosmetics or moisturizers
• Direct, prolonged pressure on the skin, such as with sports helmets
• High environmental humidity

Fortunately, a variety of effective treatments are available to manage acne. Because different factors can cause acne, a personalized approach is essential for successful treatment. A one-size-fits-all solution is rarely effective. It is important to note that acne treatments take time, often showing results over four to eight weeks.

The primary goals of acne treatment are to unclog pores, reduce acne-causing bacteria, decrease sebum production, and minimize inflammation. Preventing scarring is also a critical aspect of treatment. Combination therapy is generally the most effective approach. For example, topical retinoids can help unclog pores by promoting the shedding of dead skin cells. Chemical peels containing glycolic and salicylic acid can enhance exfoliation and reduce oil production. Topical and oral antibiotics are commonly prescribed to decrease bacterial counts and inflammation. Phototherapy can also be employed to target bacteria and inflammation.

For women with hormonally driven acne or PCOS, oral contraceptives or other hormonal treatments may be appropriate. In severe nodular or cystic acne cases or those resistant to other treatments, isotretinoin (commonly referred to as Accutane) is often an effective treatment.

As acne severity increases, so does the likelihood of scarring. It is crucial to begin treatment early to prevent scarring. However, if scarring does occur, several cosmetic treatments are available, including microneedling, chemical peels, and laser therapy.