common, acne is the name given to pimples and blackheads that arise due to an inflammatory process in the sebaceous glands and hair follicles. Very common in adolescence, but it is also common in adults, especially women. In addition to the discomfort of injuries, as appearance in adolescence is an important factor, the aesthetic compromise determined by skin changes can reach the psychological side and make the adolescent insecure, shy, depressed, unhappy, with a lower self-esteem and with serious consequences that may persist for life.
Sex hormones, which begin to be produced at puberty, are primarily responsible for changes in skin characteristics, as well as the appearance of acne. Lesions appear more frequently on the face, but can also occur on the back, shoulders and chest. These hormones, called androgens and estrogens, are produced both by the ovaries (woman) and testicles (man) and by the adrenal glands (two small glands located over the kidneys) in both sexes. The production of androgens is greater in men and that of estrogens is greater in women. Androgens are responsible for initiating the functioning of the so-called sebaceous glands that are most active on the face, chest, back and scalp. These glands are present since birth, but they are more active at puberty, a time when, in people with a genetic predisposition, it triggers changes related to the fat content (sebaceous secretion) of the skin and scalp. Thus, the main symptoms are: comedones (blackheads); papules (solid, rounded, hardened and erythematous lesions); pustules (lesions with pus); nodules (lesions characterized by inflammation, which expand through deeper layers of the skin and can lead to tissue destruction, causing scarring) and cysts (larger than the pustules, inflamed, expand through deeper layers of the skin, can be very painful and leave scars). There may be worsening related to stressful situations or menstrual periods. Certain medications such as corticosteroids, B vitamins, excessive exposure to the sun, contact with oils, greases or fatty products, time of year (especially winter) and, mainly, the habit of touching the lesions (“squeezing blackheads and pimples”) worsens the condition. Acne is not contagious and is not related to the “dirt” of the skin or blood.
Ideally, acne should be treated as early as possible. The idea that it should not be treated is outdated because it is considered “typical of age”, “spontaneously disappearing with time” or “not being a disease”. Its control is recommended not only for aesthetic reasons, but also to preserve the health of the skin and mental health, in addition to preventing scars (acne marks) so difficult to correct in adulthood. And the best way to avoid them is to start proper treatment as early as possible. That is, acne is treated and can be cured or controlled, however, this can take a long time. Important: those who have acne should not, under any circumstances, manipulate (“nudge, squeeze”) the lesions, as this can lead to infection, inflammation and scarring. There are options for both local and oral therapy, or a combination of both. Treatment will vary according to severity and location, and depending on individual characteristics. It is necessary to check for non-inflammatory (“blackheads”) and / or inflammatory (“pimples”, nodules, cysts) and / or scars. In mild forms, the treatment can be only local, with numerous products on the market, isolated or combined: salicylic acid, benzoyl peroxide, retinoids (tretinoin, adapalene), antibiotics (clindamycin and erythromycin, preferably associated – in the same product – retinoids or benzoyl peroxide) and azelaic acid. When the condition does not progress well, oral treatment is combined, using specific antibiotics, of the class of cyclins (tetracycline, doxycycline, minocycline, limecycline) or macrolides (erythromycin) or sulfas (sulfamethoxazole-trimethoprim), always associated with local treatment with retinoids or benzoyl peroxide or azelaic acid. Treatment with an oral antibiotic should be done for a maximum of three months, in one or even three cycles. Hormonal treatment, with oral contraceptives, is always useful for women, as long as there are no contraindications. When there is no good response to treatments and a tendency towards scarring or an important negative impact on quality of life is perceived, oral isotretinoin should be indicated as early as possible and as long as there are no contraindications, even in moderate cases. However, this drug is absolutely contraindicated when there is a possibility of pregnancy, as it can cause serious damage to the fetus. The most common side effects are: dryness of the lips, nose, eyes, body skin; increased cholesterol, triglycerides and liver enzymes. Therefore, blood tests are required before and during treatment. It is mandatory to rule out pregnancy with a test, wait for menstruation to start treatment and be sure about the use of contraceptive methods, started a month before, maintained throughout the treatment and for a period of one month after the drug is stopped. There are no risks for pregnancies in the future. Complementary procedures that help in the control of acne are: extraction of “blackheads”, drainage of abscesses, infiltration with corticosteroids in very inflamed nodular lesions or in high scars, chemical peels, microdermabrasion, some types of laser, lights and chemical exfoliations. Guidance on not handling injuries and sun protection are important supporting actions during treatment. Cleaning the skin, when properly indicated by the dermatologist, and well performed by a trained beautician, it can be a great complement to the treatment of some forms of acne. Note: a skin cleaning done by lay people can never be considered a form of treatment.
Prevention begins with proper hygiene of the skin with a soap or cleaning product indicated especially for acne or oily skin. Excessive cleaning is harmful to the skin as a whole (causing irritation) and can worsen injuries. Cosmetics that increase oiliness should also be avoided. Acne has a strong genetic component, and is not directly related to food. Despite several taboos, no diet or dietary restrictions are necessary for its treatment or prevention. The skin may improve after exposure to the sun, however, this improvement is only temporary and overexposure causes a worsening of the condition. People with acne, like everyone, should be exposed to the sun in a careful, rational and targeted manner.