Acne

Acne is one of the most common skin diseases. It generally starts during adolescence and affects both men and women equally, varying in severity. It usually disappears spontaneously at around 20 years of age, but it can persist for considerably longer.

It is estimated that acne affects 85% of the adolescent population, mainly on the face, and sometimes also on the chest, back and shoulders; these are areas where there are a high number of sebaceous glands. The typical acne lesions take place in the pilosebaceous follicle, the initial ones are the comedones (closed or open: “pimples") that can evolve into papules and pustules ("spots"), nodules and cysts (the latter in the most severe cases).

What are the causes of acne?

The processes that have to occur for the formation of the "spot" and which are the causes of acne are as follows:

• Sebaceous glands produce a greater amount of sebum, which builds up in the pore or pilosebaceous follicle.
• The skin cells forming the follicle canal present a disorder in their growth and they become more rigid and also build up in the pore. The accumulation of sebum and cells blocking the pore causes it to dilate and become blocked (comedogenesis). The result of this stage are the so-called comedones, which may be open (“blackheads or pimples”) or closed (“whiteheads”).
• The microorganisms forming part of the normal skin flora in the bottom of the follicle or pore get trapped in the comedone together with the dead skin cells and sebum. This provides the ideal microenvironment for bacterial growth, particularly for Propionibacterium acnes, which causes the body to produce an inflammatory reaction (reddening, swelling and pain). The results are the so-called papules and pustules (“pus-filled spots”) which may form deeper lesions such as cysts and nodules that can leave hypertrophic scars and even keloids.

Factors related to the appearance of acne

As it is a multifactorial disease, it can be enhanced or triggered for several reasons, such as:

• Genetic predisposition.
• Hormonal imbalances (puberty, menstruation, pregnancy, polycystic ovarian syndrome, etc.).
• The use of inappropriate products in the area (occlusive creams and/or cosmetics, some medications such as corticosteroids).
• Emotional state (environmental changes or stress).
• Although it has been commonly believed that diet (chocolate, fats, etc.) contributes to the formation of acne, there is no scientific evidence to support this causal relationship.

Acne: Treatment

Acne treatments are not always the same and will depend on different factors.

Depending on the severity of the disease, which is assessed according to the presence of scars, the possible psychological effects it may produce and the failure of previous treatments, the patient can opt for topical therapy, oral treatment or surgical therapy.

• For mild acne, topical treatments with different medications such as antibiotics (erythromycin or clindamycin), benzoyl peroxide, azelaic acid, retinoids, adapalene or a combination of the above are recommended. Face masks with zinc oxide, sulphur and camphor are also useful.
• For moderate acne, oral treatments such as antibiotics (erythromycin and tetracyclines) or retinoids (derived from vitamin A such as isotretinoin) are used in conjunction with topical products. Oral retinoids cause a complete remission of the lesions, thanks to their comedolytic effect and the decrease in sebaceous secretion. These should be used under medical supervision, as they can produce adverse effects such as cheilitis (dry lips), conjunctivitis, epistaxis (nosebleeds) or headaches. As they are teratogenic, they should not be administered to pregnant women. Lastly, oral contraceptives (hormonal therapy) are also used to treat moderate acne, as they reduce sebum production and are an alternative to antibiotic failure.
• Oral isotretinoin is administered for severe acne, since it is considered that in this condition, the benefit/risk ratio is usually very positive.
• The use of cryotherapy with liquid nitrogen or lasers is reserved for severe cases when all other treatments have not been successful.