Acne is also known as pimples or teenage breakouts. It is the most common skin condition in children and adolescents, affecting up to 70-87 percent of teenagers. Acne is driven by a rise in sex-hormone activity during puberty, though some adults continue to experience it into their thirties and forties. In most cases acne appears on the face (99% of cases), the back (60%), and the chest (15%).
Since the early 2000s, acne has come to be recognised as a chronic condition - bringing a shift in the approach to antibiotics, to managing the condition, and to the factors that influence how well patients respond to treatment. The rise in hormonal activity leads to overactivity of the sebaceous glands, concentrated mainly in the skin of the face, chest, and back.
Four Main Factors Behind Breakouts
- Increased sebum production in the sebaceous glands
- Proliferation of the acne bacteria Propionibacterium acnes (P. acnes)
- Changes in the keratinisation process of skin cells
- Inflammatory processes - the release of inflammatory mediators into the skin
Comedonal Acne
Comedonal acne presents as non-inflammatory lesions (comedones). It begins with micro-comedones - internal blemishes invisible to the eye, which form the basis for comedones to develop. Comedones take two forms: whiteheads and blackheads. Whiteheads appear first, indicating closed lesions not yet exposed to oxygen; the comedones then open, oxidise on contact with air, and darken into blackheads.
Inflammatory Acne (Papules and Pustules)
Most people with acne experience a combination of non-inflammatory and inflammatory acne. Inflammatory lesions develop from micro-comedones or comedones and may be superficial or deep. Superficial inflammatory lesions are papules or pustules (5 millimetres or less); in more severe acne they can develop into nodules.
Nodular Acne
Nodules are inflammatory lesions larger than 5 mm that are painful to the touch, and they frequently leave secondary scarring.
Acne spans a wide range of presentations - from mild comedonal acne, with or without inflammatory lesions, through severe disease with deep inflammatory lesions, nodules, and in some cases systemic symptoms. Severe breakouts can leave lasting scars on the skin.
Because acne affects facial appearance during such a formative period of life, adolescents with severe acne may develop anxiety or depression over the inflamed or pitted look of their skin.
Treatment Paths for Acne
Medical Treatment Through a Physician
Oral medication: retinoids or antibiotics. Worth knowing: bacterial resistance to antibiotics is a central public-health issue shared by every country, caused by selective pressure on bacteria from both appropriate and inappropriate antibiotic use. Antibiotics were the first effective acne treatment, yet published guidelines now recommend limiting their use - in both frequency and duration. Resistance of P. acnes to antibiotics reduces treatment effectiveness and can affect the skin's natural flora.
Non-Medicinal Treatment
A professional facial to clear accumulated sebum, combined with a home-care routine.
Hygiene and Facial Cleansing
Poor hygiene can aggravate acne, so it is advisable to wash the face with gentle products. Wash the face once a day and no more - over-washing can dry the skin out.
Phototherapy - Blue and Red Light
A treatment method based on blue light at specific wavelengths. The light targets the acne-causing bacteria (P. acnes) and reduces inflammatory lesions in the skin. It suits those who, for various reasons, cannot take systemic medication.
Combining a Topical Retinoid with an Antimicrobial
Combining a topical retinoid with an antimicrobial preparation is the preferred approach for most acne patients. The combination addresses three of the four pathogenic factors: abnormal keratinisation, P. acnes proliferation, and inflammation.
Retinoids are anti-comedogenic (treating micro-comedones), comedolytic, and anti-inflammatory. Benzoyl peroxide is an antimicrobial with keratolytic action, while antibiotics offer antimicrobial and anti-inflammatory activity. The high effectiveness of the combination has been demonstrated in clinical studies encompassing more than 16,000 patients.
Combination preparations add convenience for patients and improve adherence to treatment. Antibiotic-free combinations may reduce the development of bacterial resistance; in theory, preparations pairing a retinoid with benzoyl peroxide are the most advantageous.