Acne is a disease characterized by the appearance of skin lesions as a consequence of folliculitis, inflammation and subsequent infection of the follicular pore (hair exit hole). These lesions are usually pimples, black pimples, and red, inflamed patches, such as cysts.
This disorder can have psychological and social implications, especially among adolescents and people who work facing the public, who sometimes have problems in their work environment because they do not reach the required degree of physical presence.
However, acne appears in most cases during adolescence, affecting approximately 80 percent of this population group. It arises due to the interaction between hormones , sebum and bacteria that live on or within the skin and also in the hair. During puberty , the activity of the sebaceous glands increases, and often dry sebum, peeling skin, and bacteria accumulate in the pores of the skin, forming a comedone, which prevents sebum from flowing from the hair follicles through the pores. If the block is incomplete, black dots form; if complete, white dots appear.
There are also some special forms of acne that can affect newborns or adults exposed to certain industrial products (occupational acne) or people who take certain medications such as oral corticosteroids (drug-induced acne), these clinical forms being less frequent than acne. classic youth.
The main cause of acne is clogging of the skin pores . Clogging can be triggered by several factors:
- The glands secrete excess sebum.
- The hormonal changes that are associated with puberty, pregnancy, menstruation , stress or the consumption of oral contraceptive methods , such as the pill.
- The use of some cosmetics and products for oily hair .
- Some drugs that contain steroids, estrogens, testosterone, or phenytoin.
- Excessive sweating
Acne manifests clinically with various types of lesions. In fact, in some patients several of them may appear. Acne lesions are located mainly on the face (forehead, cheeks and chin), back, shoulders and presternal region, which are the seborrheic areas of the body.
During winter acne tends to get worse and better in summer, probably due to the beneficial effect of the sun . The diet has little or no influence ; however, some people are sensitive to certain foods. Eliminating them from the diet for several weeks and re-including them months later can help determine their true influence.
Acne can also appear with each menstrual cycle in young women and can disappear or worsen markedly during pregnancy.
The main symptoms that appear on the skin are:
- Scabs with rashes on the skin.
- Scars on the skin.
- Redness around the skin rashes.
- Small, red bumps.
- Black pimples.
Although there is no effective way to prevent acne , patients with acne can consider a series of recommendations that will help reduce the impact of acne and the severity of injuries.
The Spanish Academy of Dermatology and Venereology recommends:
- Clean the face twice a day . In this way you can remove excess oil from the surface and dead skin cells that can block the pores. However, keep in mind that excessive cleansing can cause damage, such as over-drying the skin or irritating persistent acne.
- Apply the recommended products to treat the condition topically after washing.
- Dry the skin without rubbing it.
- Play sports outdoors and wash your face after doing it to prevent sweating from clogging the pores .
- Reduce hair contact with facial skin. In fact, experts do not recommend wearing bangs or long hair.
- Try not to abuse foods such as pork, pastries, seafood, alcohol, nuts, strong cheeses and foods that contain chocolate.
- Choose cosmetics that do not contain oils or fats in their composition.
- Select sunscreen that is not greasy.
- Do not touch the beans .
- Be patient: acne takes at least three months to heal.
- Avoid stress.
- Do not share treatments with other people who have or have had acne.
- Do not treat scars while lesions are active.
Acne can be classified according to the type of lesions, distinguishing between inflammatory and non-inflammatory.
Within noninflammatory open and closed comedones and blackheads are included among inflammatory are reddish papules, pustules, nodules and cysts . These last two are the most important because, in their evolution, they can leave residual scars , which are the most important sequelae of acne.
Some patients may present more severe symptoms that associate fever and poor general condition and that require early systemic treatment.
If we look at the type of injuries and the severity of them, acne can be classified into several degrees:
- Mild acne.
- Moderate acne.
- Severe acne
- Very severe acne .
The diagnosis is made clinically in the presence of one or more elemental lesions.
In some patients in whom acne is associated with other disorders , such as menstrual disorders, hair loss, seborrhea or increased hair, it is necessary to carry out a complementary hormonal analysis that will rule out the presence of hormonal changes and better guide treatment.
Acne treatment is based on two modalities: topical and systemic . The choice of one modality or another will depend on the severity of the acne. The treatment guidelines are as follows:
In this type, the recommended therapy is topical treatment that includes exfoliants (elemental sulfur, salicylic acid, glycolic acid), benzoyl peroxides 4, 5 and 10 percent, azelaic acid and retinoids (tretinoin, isotretinoin and adapalene). .
In the moderate, treatment will also be topical with benzoyl peroxide, retinoids, and antibiotics (clindamycin phosphate and hydrochloride, tetracycline hydrochloride, and erythromycin base).
In this type, specialists recommend starting a systemic treatment that includes systemic antibiotics (tetracyclines, erythromycin, minocycline, and clindamycin) for 3 to 6 months. Systemic retinoids ( isotretinoin ) administered at doses of 0.5 to 1 mg / Kg / day for five months allow a complete cure in almost all patients. In some patients it is necessary to administer more than one cycle of treatment.
Very severe acne
Patients can follow two types of therapies, as determined by the expert:
- Surgical treatment: In some patients it is necessary to perform cyst drainage or mechanical removal of comedones as complementary treatments.
- Systemic treatment: Isotretinoin associated with systemic or intralesional corticosteroids.
In patients with secondary acne scars , it is possible to carry out corrective treatments as long as there are no active lesions. Among other options, we have chemical peels with glycolic acid or other somewhat more aggressive methods such as dermabrasion or the CO 2 laser , which allow us to improve the appearance of patients.
Patients with demonstrated hormonal abnormalities may benefit from antiandrogenic treatments or by means of estrogens associated with progesterone .
It is important that patients avoid manipulation of lesions and are consistent in carrying out treatment