What is acne?

Acne is a chronic, inflammatory skin condition marked by whiteheads, blackheads, pimples, cysts, and nodules. It can appear on the face, shoulders, back, neck, chest, and upper arms. Acne is one of the most common skin conditions; More than 90 percent of the world population is affected by acne at some point in their lives. Acne commonly occurs during puberty when the sebaceous glands activate, but it can occur at any age. Although acne is not dangerous, it can affect people’s self-esteem and, over time, may cause permanent physical scarring.

Causes of Acne
  • Excess oil production as a result of increased androgen production
  • Abnormal keratinization within the follicle resulting in clogged pores
  • The proliferation of P. acnes bacteria
  • Inflammation
Common Presentations
  • Hormonal acne: Androgens are hormones that increase in adolescence during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal acne may present itself at any stage of life when hormones fluctuate (e.g. pregnancy, oral contraceptives, menopause).
  • Acne cosmetica: comedogenic or irritating ingredients in everyday products can trigger acne. Certain makeup, hair care products, and laundry detergents may clog the pores and lead to breakouts.
  • Asphyxiated acne: is caused by extreme skin dryness and reduced cell turnover. The skin isn’t properly sloughing away dead skin and pores become clogged. It is common in dry climates and may be the result of using skincare products with drying ingredients, such as alcohol, without the use of a daily hydrator. It is also common among those who smoke cigarettes.
  • Inflammatory acne: is amongst the most painful types of acne. It is often a combination of bacteria growth and intense inflammatory response.
  • Bacterial acne: is the over-production of P. acnes bacteria that causes acne. P. acnes bacteria flourish in warm, humid environments but cannot live in the presence of oxygen. Topical oxygen sources, such as benzoyl peroxide, help to control bacteria distribution and growth.
  • Cystic acne: is the large, painful nodule beneath the surface of the skin, which can remain for weeks or months. The depth and inflammation associated with cystic acne can destroy the follicle, resulting in scarring.
  • Systemic acne: when acne appears on other areas of the body such as arms, back, chest and shoulders. Systemic acne may be brought on by disease, illness, medication, or diet-related issues.
Controlling acne
  • Increasing cell turnover by gentle exfoliation- the initial trigger in the production of acne is the increased adherence of the dead cells to the follicle wall and increased sebum production, resulting in a clogged pore. A buildup of dead cells on the surface of the skin traps oil and bacteria, allowing the bacteria to grow. Using proper peeling agents that control bacteria and oil production, opens the pores and allows treatment products to penetrate more effectively. Salicylic acid, alpha hydroxy acid, azealia acid, resorcinol, sulfur, retinoids, and benzoyl peroxide are all ingredients that act as keratolytics ( peel agents).
  • Controlling sebum production – in acne-prone skin, increased P. acnes bacteria and sebum build up can trigger an inflammatory response. It is essential to understand that over-drying the skin, even if it is oily, will cause the skin to compensate by producing more sebum. This will cause even more breakouts. Some examples of the ingredients that help control sebum production are salicylic acid, ginger root, green burnet route, licorice root, cucumber extract and cinnamon bark.
  • Decreasing P. acnes proliferation – using antibacterial and antimicrobial topical agents and oral or topical antibiotics (when applicable) are ways to control the bacteria. Topical oxygen sources, such as benzoyl peroxide and hydrogen peroxide, deliver oxygen to the follicle, killing the bacteria. In-office treatments that increase circulation and blood flow will deliver oxygen, leading to a decrease in P. acnes, and assist in the clearing of active lesions.

Protect from UV rays and other inflammatory stimulants – inflammation is both a cause and result of acne. When the number of P. acnes bacteria increases, sebum is broken down into irritating free fatty acids, which stimulates an immune response. White blood cells weaken the follicular wall, resulting in rupture and increased inflammation. Utilizing topical anti-inflammatory ingredients will soothe current irritation and help to avoid future inflammation. Aloe vera, salicylic acid, bisabolol, panthenol, licorice extract, resveratrol, and EGCG from green tea are all extremely useful in helping to control inflammation. Over-drying and over-stimulation will lead to further breakouts. With inflammatory acne, over-treating and overusing the daily use of irritating ingredients should be avoided. Many of the products that help treat acne make the skin more sun-sensitive, thereby increasing the risk of damage and post-inflammatory hyperpigmentation(PIH). A broad-spectrum SPF of 30 or higher should be used every day on any exposed skin. Exposure to UV rays daily will cause more significant inflammation, slowing the process of treating acne.

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