Introduction: Acne is the most common skin disorder in Indian society. 60% of 16 – 20 year-olds are affected. In people older than 25, women are more prone than men to suffer from acne. Acne is characterized by either non– inflammatory (open or closed comedones, so – called “blackheads“ and “whiteheads “ respectively) or inflammatory papules, pustules and nodules. The most affected areas are the face followed by the back, chest, neck and arms.
What factors trigger acne?
The risk factors associated with the prognosis and severity of acne are unknown. A genetic predisposition would be related with the development of more important scarring forms. On the other hand, the four major mechanisms involved in its pathogenesis have been already described: follicular hyperkeratosis, excess sebum production, inflammation, and presence and activity of propionibacterium acnes within the follicle.
Grading of acne:
Doctors grade Acne according to severity in order to consider different treatment options according to the staging and also for follow up assessment.
- Grade 1: Comedones also called blackheads/ open comedones and white heads / closed comedones, occasional papules (raised lesions)
- Grade 2: Papules, comedones, few pustules (pus filled)
- Grade 3: Predominant pustules, nodules, abscesses (large pus filled boils)
- Grade 4: Mainly cysts (large fluid/ pus filled), abscesses, widespread scarring (early and red/ late ).
Many types of scars are present. They may be flat with redness or pigmentation or They may be depressed or elevated. Depressed scars may be shallow or deep, rolling or boxcar or pits.
The most typical form of acne appears in adolescence, when sebum production is increased. If it begins before the age of 12,it is known as early onset acne and is usually a non – inflammatory form of the disease.
- It begins earlier in women, though it is more prevalent in males during adolescence.
- It affects the face and to a lesser extent the chest, the back, and the shoulders
- Lesions are varied, inflammatory and non – inflammatory.
- A large number of lesions is seen.
Acne in adult women
Also known as post-adolescent acne, it is the one that appears after the age of 25;it may be a continuation of adolescent acne or develops de novo in adulthood (late onset acne)
- Prevalent on the face.
- Mainly inflammatory lesions (papules, pustules and nodules).
- Lower number of lesions.
- Prevalence of lesions in the U zone of the face: the chin.
Acne in Males
- Generally more severe
- Later in onset in adolescence, but more severe
- Involvement of back, chest more common
- Keloidal acne more common
- Scarring more frequently seen probably because of delay in treatment
- More chances of Hyperpigmentation due to more frequent sun exposures
Other than the above commoner acne types other types of acne like neonatal acne which occurs in newborns due to maternal hormones, drug induced acne due to medications etc may also occur. Nowadays many people take supplements for building muscle mass and thes can also give rise to acne followed by scarring. People are also using various steroid preparations knowingly or unknowingly in various over the counter (OTC) preparations and fairness creams which can cause acne on face .
- Wash your face thoroughly with clear water, if necessary use a gentle non – abrasive cleanser.
- Use non – comedogenic and oil – free skin care products.
- Do not over wash your face. Limit washing to twice a day and after perspiring.
- Dry your skin with fresh towel. Never scrub your skin.
Do not squeeze or scratch your acne spots! Doing any of this can irritate the skin and make acne worse. It also increases the risk of getting acne scars
- If your skin feels dry, use an oil free moisturizer.
- Use non – comedogenic and oil – free make-up.
Apply acne medication first. Then you can apply moisturizer/sunscreen and make up.
- Tanning damages the skin.
- Some acne medications make the skin very sensitive to the sun.
To avoid aggravation of acne, it is recommended to use special sun screen fluids for acne skin
- Omega 3 Fatty acids ( fish, flax seeds)reduce breakouts
- Fresh naturally colored fruits(papaya, beet, carrots,pumpkin) beta carotene which is the precursor for Vit.A
- Antioxidants- Green tea
- Probiotics( curds)- reduce gut inflammation
- Zinc rich foods (pumpkin, watermelon seeds, oysters)
Dietary fads are however discouraged and a consultation with a nutritionist may be desirable for some
Applications of antibacterial or non antibacterial anti acne agents.
Oral Antibacterial, Retinoids, Hormone based agents, anti androgenic agents and supportive treatments.
WHEN- Can be added at any time
WHY-Faster treatment outcomes, adjunctive to orals, acne excorie, associated pigmentation, boost morale, prevent scarring, for acne scars
CHEMICAL , LASER, CRYO
- TYPES: Alpha hydroxy acids , beta hydroxy acids, phenol, combination
- EFFECTS: Reduce sebum secretion and dry up sebaceous gland, cause peeling of skin and open up blocked pores, reduce pigmentation, anti-inflammatory, rejuvenation- glow, remodels skin by dermal stimulation
- USE: As per skin type
- Once in 15 to 20 days depending on depth of peel
- Post treatment care: Sun protection, moisturizer
- Side effects: Hyperpigmentation, crusting, need for repetition, financial drain
- LOW LIGHT THERAPY – Inhibits P. acnes growth
- IPL, ALEXANDRITE, RUBY
Macular acne scars to reduce erythema and hasten scar maturation and thereby reduce scarring
Superficial Carbon peel
ACNE SCAR THERAPY
- Medium to deep peels
- TCA cross, Phenol
- Microneedling- Dermaroller, Dermapen
- Microneeding RF
- Fractional resurfacing- RF, CO2, Erbium glass, Erbium YAG
- Scar revision surgeries- scar excision, levelling (RF, CO2),
Punch grafting, filler- dermal, hyaluronic, fat graft
Full face dermabrasion.
Acne / pimples is an inflammatory conidition of the oil or sebaceous glands of the skin.
Acne occurs mainly on the face but it can also occur on back, neck and chest.
Acne can occur after puberty in males and females.
Almost 90 percent of the population gets acne some time in their life. I t is more common in those who have a family history, oily skin,dandruff, Polycystic ovarian syndrome, hormaonal issues, on certain medications like steroids and antitubercular drugs, etc.
Routine cleansing of skin atleast 2-3 times a day with a gentle / anti acne cleanser/ face wash.This will prevent build up of sebum and overgrowth of bacteria. Avoid scrubbing of acne or using very harsh products. This can be followed up with toner and moisturiser meant for acne prone skin which specifically prevents blockage of pores.
One should avoid excessive dairy foods, chocolates and caffeinated products. Avoid picking on the acne. avoid aggressive scrubbing, avoid oily creams and products which will block the pores.
Few acne in teenage which do not become pustular or leave unsightly scars can be managed by above means, however recurrent acne with many white heads and blackheads, red painful large acne, pustular acne, nodules and scars need to be addressed by a skin specialist.
A SKin specialist also called a dermatologist with an M.D, DVD or DNB degree in skin diseases is the only right person to treat acne as they have the expertise to diagnose, differentiate it from other causes and treat it in the right way.
Skin N Sculpt
Shop No 7, Gopal Bhuvan,
Next to Hotel Pallavi, Azad Road,
Andheri East, Mumbai,
Maharashtra – 400069
For Appointment Clinic: 9769 1125 73