Acne: Various Types, Causes and Treatment Available

Acne, medically known as Acne Vulgaris, is a skin disease that involves the oil glands at the base of hair follicles. It commonly occurs during puberty when the sebaceous (oil) glands come to life – the glands are stimulated by male hormones produced by the adrenal glands of both males and females.

Acne is not dangerous, but can leave skin scars. Human skin has pores (tiny holes) which connect to oil glands located under the skin. The glands are connected to the pores via follicles – small canals. These glands produce Sebum, an oily liquid. The sebum carries dead skin cells through the follicles to the surface of the skin. A small hair grows through the follicle out of the skin. Pimples grow when these follicles get blocked, resulting in an accumulation of oil under the skin.

The word acne comes from the word acme meaning “the highest point”, which comes from the Greek akme meaning “point” or “spot” – it was originally mispelt, with an ‘n’ rather than an ‘m’ in 1835.

In humans, pimples tend to appear on the face, back, chest, shoulders and neck.

Simply put skin cells, sebum and hair can clump together into a plug, this plug gets infected with bacteria, resulting in a swelling. A pimple starts to develop when the plug begins to break down.

Scientists from the Washington University School of Medicine found that there are good and bad strains of bacteria which determine the severity and frequency of developing acne. They explained in the Journal of Investigative Dermatology (March 2013 issue) that not all acne bacteria trigger pimples – in fact, one strain they identified can actually help keep the skin pimple-free. There are various types of pimples-free.

There are various types of pimples

• Whiteheads – remain under the skin and are very small.
• Blackheads – clearly visible, they are black and appear on the surface of the skin. Remember that a blackhead is not caused by dirt. Scrubbing your face vigorously when you see blackheads will not help.
• Papules – visible on the surface of the skin. They are small bumps, usually pink.
• Pustules – clearly visible on the surface of the skin. They are red at their base and have pus at the top.
• Nobules – clearly visible on the surface of the skin. They are large, solid pimples. They are painful and are embedded deep in the skin.
• Cysts – clearly visible on the surface of the skin. They are painful, and are filled with pus. Cysts can easily cause scars.

How common is acne?

Dermatologists (skin specialists) say that approximately three-quarters of 11 to 30 year-olds will get acne at some time. Acne can affect people of all races and all ages. It most commonly affects adolescents and young adults, although there are people in their fifties who still get acne. According to Brown University, USA, approximately 17 million Americans are estimated to have acne at any one time.

Although acne affects both men and women, young men suffer from acne for longer – probably because testosterone, which is present in higher quantities in young men, can make acne worse.

What causes acne?

Nobody is completely sure what causes acne. Experts believe the primary cause is a rise in androgen levels – androgen is a type of hormone. Androgen levels rise when a human becomes an adolescent. Rising androgen levels make the oil glands under your skin grow; the enlarged gland produces more oil. Excessive sebum can break down cellular walls in your pores, causing bacteria to grow.

Some studies indicate that susceptibility to acne could also be genetic. Some medications which contain androgen and lithium may cause acne. Greasy cosmetics may cause acne in some susceptible people. Hormone changes during pregnancy may cause acne to either develop for the first time, or to recur.

Treatment of acne

How your acne is treated may depend on how severe and persistent it is.

Treating mild acne

The majority of people who get acne will develop mild acne. This can usually be treated with OTC (over-the-counter) medications. OTC medications can be bought at a pharmacy without a doctor’s prescription. They are usually applied to the skin – topical medicines.

Most acne OTC products may contain the following active ingredients:

• Resorcinol – helps break down blackheads and whiteheads. It is a crystalline phenol and comes from various resins. Resorcinol is also used for treating dandruff, eczema and psoriasis.
•  Benzoyl Peroxide – kills bacteria and slows down your glands’ production of oil. Benzoyl peroxide is a white crystalline peroxide used in bleaching (flour or oils or fats) and as a catalyst for free radical reactions. It works as a peeling agent, accelerating skin turnover and clearing pores, which in turn reduces the bacterial count in the affected area.
•  Salicylic Acid – helps break down blackheads and whiteheads, also reduces shedding of cells which line the follicles of the oil glands, effective in treating inflammation and swelling. Salicylic acid is a white crystalline substance which is also used as a fungicide, or in making aspirin or dyes or perfumes. It causes the epidermis to shed skin more easily, prevents pores from becoming blocked while at the same time allowing room for new cells to grow. It is commonly added to shampoos used for treating dandruff.
•  Sulfur – helps break down blackheads and whiteheads. Sulfur, in its native form, is a yellow crystalline solid. Sulfur has been used for centuries for treating acne, psoriasis and eczema. Scientists are not sure how sulfur works to help skin diseases. We do know that elemental sulfur does oxidize slowly to sulfurous acid which is a mild reducing and antibacterial agent.
•  Retin-A – helps unplug blocked pores. Retin-A contains Tretinoin, an acid from of vitamin A, also known as all-trans retinoic acid (ATRA). Tretinoin is also used for the treatment of acute promyelocytic leukemia. Retin-A has been used widely to combat aging of the skin, it also acts as a chemical peel.
•  Azelaic Acid – strengthens cells that line the follicles, stops oil eruptions, reduces bacteria growth. It is a saturated dicarboxylic acid found naturally in wheat, rye, and barley. Azelaic acid also mops up free radicals, which reduces inflammation. It is useful for patients with darker skin who have dark patches on their face (melasma), or whose acne spots leave persistent brown marks.

You can buy acne medications in the forms of gels, soaps, pads, creams and lotions. If your skin is sensitive you may prefer a cream or lotion. Gels, which are usually alcohol based and tend to dry the skin, are better for people with oily skin. OTC medications will have these ingredients in different concentrations. It is advisable to start with the lowest strengths. You may experience skin irritation, redness, and/or burning when you first try them. These side effects usually go away after continued use. If they don’t you should see your doctor.

• Virus may be possible acne cure – researchers from the University of Pittsburgh believe that a virus that lives on our skin might one day be used to effectively treat acne.

Treating more severe cases of acne

If your acne is more severe you should consider seeing a dermatologist – a skin specialist. The specialist may prescribe a treatment that contains some of the active ingredients mentioned above, such as benzoyl peroxide, azelaic acid, as well as adabalene. Prescription medications for acne are presented in many forms, such as creams, lotions, etc. Your dermatologist will decide what is best for you.

You may be prescribed an oral or topical antibiotic. Antibiotics can combat the growth of bacteria and reduce inflammation. Most commonly Erythromyocin and Tetracycline are prescribed as antibiotics for the treatment of acne.

Treating a cyst with interlesional corticosteroid injection

If an acne cyst becomes severely inflamed there is a high risk of rupturing. A rupturing acne cyst can often result in scarring. The specialist may inject a diluted corticosteroid to treat the inflamed cyst and to prevent scarring. The injection will lower the inflammation and speed up healing. The cyst will “melt” within a few days.

• Isotretinoin- This is a strong oral retinoid, used for the treatment of severe cystic acne, as well as severe acne that has not responded to other medications and treatments.

•  Oral antibiotics- Oral antibiotics are frequently prescribed for patients with severe acne and some patients with moderate acne too. The aim of such oral antibiotics is to lower the population of Propionibacterium acnes (P. acnes), a bacterium commonly found on the skin, which will multiply rapidly in blocked follicles. The dosage will be initially high, and then as the acne reduces so will the dosage. Antibiotics are not taken for more than six months. As time passes the P. acnes can become resistant to the antibiotic and another antibiotic is needed. Some American studies have indicated that it is better to use oral broad-spectrum antibiotics.

• Oral contraceptives- The majority of women with acne find that taking certain oral contraceptives clears it up. Oral contraceptives suppress the overactive gland and are commonly used as long-term treatments for acne in women. If the woman has a blood-clotting disorder, smokes, has a history of migraines, or is over 35, she should not take this medication without checking with a gynecologist first.

• Topical antimicrobials (topical = applied to the skin or mucus membranes)- As with oral antibiotics, the aim of topical antimicrobials for the treatment of acne is to reduce P. acnes populations. Topical antimicrobials are used for patients with moderate to severe acne. Examples may be clindamycin, erythromycin, and sodium sulfacetamide. The dermatologist may prescribe a topical retinoid. Topical retinoids are a derivative of Vitamin A and are very popular for the treatment of acne. They unclog the pores and prevent whiteheads and blackheads from developing. Examples of topical retinoids prescribed in the USA are adapalene, tazarotene, and tretinoin.

 Looking after your skin if you have acne (or are prone to acne)

• Wash your face about twice each day. Do not wash it more often. Use a mild soap made especially for people with acne, and warm water. Do not scrub the skin. Experts advise the use of an OTC lotion which contains benzoyl peroxide.

• Don’t try to burst the pimples. You may push the infection further down, causing more blocking and worse swelling and redness. Popping pimples makes scarring more likely.

• If you have to get rid of a pimple for some event, such as a wedding, or public speaking occasions, ask a specialist to treat it for you.

• Try to refrain from touching your face with your hands. When you are on the phone try not to let the receiver touch your face – there may be sebum and skin residue on it.

• Keep your hands clean, wash them regularly.

• Always wash your hands before touching your face. This includes before applying lotions, creams or makeup.

• Glasses should be cleaned regularly. They will collect sebum and skin residue.

• You skin needs to breathe. If your acne is on your back, shoulders or chest try wearing loose clothing. Tight garments, such as headbands, caps and scarves should be avoided – if you have to wear them make sure they are cleaned regularly.

• Don’t go to sleep with makeup on. Only use makeup that is nonceomedogenic or nonacnegenic – you should be able to read this on the label. If you cannot find it, ask the shopkeeper or pharmacist. You should use makeup which does not have oil and does not clog up the pores.

• Hair collects sebum and skin residue. Keep your hair clean and away from your face.

• Too much sun can cause your skin to produce more sebum. Several acne medications make it more likely that you will be sunburned.

• If you shave your face, do it carefully. Use either an electric shaver or safety razors. If you use a safety razor make sure the blade is sharp. Soften your skin/beard with warm soapy water before applying the shaving cream.

What can make acne worse? 

•  Menstrual cycle – Girls and women with acne tend to get it worse one or two weeks before their menstrual period arrives. This is probably due to hormonal changes that take place. Some people say they eat more chocolate during this time and wonder whether there may be a connection. However, experts believe the worsening acne is not due to chocolate, but rather to hormonal changes.
• Anxiety and stress – mental stress can affect your levels of some hormones, such as cortisol and adrenaline, which in turn can make acne worse. Again, stress can make some people binge-eat. Experts believe the culprits are most likely the hormone levels, rather than the binge-eating.
•  Hot and humid climates – when it is hot and humid we sweat more. This can make the acne worse.
•  Oil based makeups – moisturizing creams, lubricating lotions, and all makeup that contain oil can speed up the blocking of your pores.
•  Greasy hair – some hair products are very greasy and might have the same effect as oil based makeup. Hair products with cocoa butter or coconut butter are examples.
•  Squeezing the pimples – if you try to squeeze pimples your acne is more likely to get worse, plus you risk scarring.