Acne is the most common skin disease with negative psychosocial consequences. Affected individuals have an increased likelihood of decreased self-consciousness, social isolation, depression, and even suicidal ideation.
Acne vulgaris (or common Acne without using fancy medical terms) affects approximately 40–50 million individuals each year in the US alone.
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Knowing The Skin
Skin is composed of multiple layers of cells with various shapes and functions.
The skin has microscopic exocrine glands called Sebaceous glands, and these glands secrete sebum. Sebum is a yellow thick viscous liquid. It is composed of fatty materials like triglycerides, free fatty acids, wax and cholesterol compounds.
Sebum helps in immunity, producing substances that help in the protection of the body, but these substances also play a role in the formation of acne.
Sebum production increases at the time of puberty and is a critical factor in the formation of acne at that time.
Sebaceous Glands are well developed on the scalp, face, upper back and chest, and these areas tend to be oilier than the rest of the body, and so these areas are prone to acne.
In general, people with acne have larger oil glands and produce more sebum than people with healthy skin.
Early Stages Of Formation Of Acne
Sebum in oily glands and within the ducts is clear and sterile and contains no free fatty acids, but the environment of the hair follicle is good for and favours the growth of the bacteria like P. Acnes (Propionibacterium Acnes) and even fungi/yeast.
In patients with acne, the resident bacteria (especially P. Acnes) are increased in number in oily follicles. They produce substances that destroy the surrounding area and other substances that divide the fats into other substances that affect the growth of the cells at the top of the base of the hair follicle increasing the number of cells there abnormally.
These skin cells are blocked at the entrance of the hair follicle and substances accumulate. These cells stick together and lead to the formation of microcomedones. These microcomedones are also commonly known as whiteheads.
With expansion of the microcomedo, the contents become closely packed, and as the forces increase, the comedo wall ruptures with expulsion of the irritative cell products and sebum (i.e. all the loosely packed contents spell out into the surrounds), these materials are irritative and cause inflammation, at this point, this is what is called an open comedo or a blackhead.
It appears black because of Melanin deposition (which is a dark pigment) and it’s also due to lipid oxidation within the debris that is responsible for the black colouration.
When the cell products and sebum get spilt into the surrounding, the WBC accumulate to help control the bacteria but it does more harm than good.
Different Types Of Acne
There are six different types of acne depending upon the size, shape and content.
It is like a continuous scenario of subsequent stages. Now that we have a little insight into how the acne forms, we will discuss the different approaches on how to get rid of acne and the scars.
How To Get Rid Of Acne: Acne Treatments
Hormones play a major role in the secretion of sebum and on the development of acne.
The rise in serum levels of dehydroepiandrosterone, a male hormone (androgen) that is made in the adrenal glands, and is the most present circulating steroid in the human body is converted into other hormones. The rise in serum levels of this hormone in early puberty is associated with an increase in sebum production and the initial development of comedonal acne (1).
Studies are suggesting that consuming milk on a regular basis can actually worsen the conditions of acne (2). Milk is somehow capable of influencing hormonal levels resulting in breakouts in teenagers (3).
Step 1: Visit a Dermatologist
When it comes to visiting a dermatologist, many people try and avoid the situation. Maybe it is the physical examinations one has to go through or the temptation to squeeze the pustules all by themselves.
But besides the overwhelming desire to treat the acne at home, it is best to pay a visit to a dermatologist. They study and treat people having skin problems for a living.
Physical examinations are done to get a better understanding of the shape and size of the pustules and to detect the severity of the condition for treating it more effectively.
Step 2: Topical Treatments
Topical Treatment 1: Topical Retinoids
Topical Retinoids can normalize the follicular cell growth and can thus reduce existing visible lesions and inhibit the formation of new ones.
Retinoids have anti-inflammatory properties which can help reduce the irritation caused by the acne. It can also lighten hyperpigmentation caused by acne (4).
Side Effects: Retinoids can cause irritation, peeling and dryness in some cases but these mild side effects are only observed in the first few weeks (5).
Topical Treatment 2: Topical Antibiotics
Benzoyl peroxide is a potent bacterial killing agent that reduces P. Acnes within the follicle. It also has mild comedo dissolving properties and is particularly effective when used in combination with other therapies.
Many preparations for all skin types are available in both over-the-counter and prescription formulations. These include bar soaps, gels, lotions, creams, foams and pads.
Other antibiotics include Clindamycin and erythromycin.
Side Effects: Benzoyl Peroxide can leave the skin sensitive to the sunlight, so it is recommended to use sunscreen.
Topical Treatment 3: Isotretinoin
Isotretinoin is available in many brand names like Accutane, Claravis, Absorica and Zenatane.
The introduction of isotretinoin was a key advance in dermatologic therapy. Isotretinoin is still the only treatment that has been shown to induce long-term remissions and even “cure” acne because it is the only medication that affects all the causative factors involved in acne including sebum production, comedo formation, and Propionibacterium Acnes bacteria.
Studies were done to find the efficacy of isotretinoin and it proved to reduce acne vulgaris satisfactorily (6).
Side Effects: The most common adverse effects of isotretinoin involve the skin and mucous membranes.
These include mouth and lips inflammation, dryness of the oral and nasal mucosa, generalized skin fragility and skin infections (in particular with Staphylococcus aureus).
Such infections can be avoided by the use of antibiotic ointment applied twice daily during isotretinoin therapy.
Step 3: Natural Remedies
Some people might want to try the natural remedies to cure acne due to the mild side effects associated with topical treatments.
Natural remedies can also be used alongside with medicines prescribed by the dermatologist as they do not usually interfere with the efficacy of the latter.
Natural Remedies: Lemon Juice
Lemon juice is rich in citric acid which can control the production of sebum in the skin due to its drying effects.
The antiseptic properties of lemon can also help in killing bacteria that cause breakouts.
Lemon juice is very effective in lightening the scars left over by acne.
It can be applied to the skin in combination with honey or water. Mix two tbsp of honey with one tbsp of lemon juice. Apply it on the affected area and leave it for almost three hours. Then rinse it with cold water.
The effects are best seen after 6-8 weeks of regular use.
Natural Remedies: Aloe Vera
Aloe Vera is a plant with a viscous gel inside its leaves. The gel found in its leaves is used in creams and lotion to moisturize the skin.
The gel is rich in many active constituents including vitamins like vitamin A, C and E.
Hormones like auxins, gibberellins found in aloe vera gel have wound healing and anti-inflammatory properties.
Aloe vera can be used to treat acne because of its wound healing properties. It can be combined with tretinoin for better results (7).
To apply aloe vera gel, scrape the gel out with a spoon and apply it on the affected area directly. Keep it on for 4-5 hours and then rinse with cold water.
The results are best seen after regular application for 6-8 weeks.
Natural remedies: Tea Tree Oil
Tea tree oil is extracted from Melaleuca alternifolia. It can help in reducing the swelling caused by acne.
It has antimicrobial properties and hence can be effective against acne.
A study was done on 60 people where it was found that a 5% tea tree oil can effectively reduce mild acne (8).
To apply tea tree oil on the skin it should be first diluted with some other oil like coconut oil, jojoba oil or almond oil. Try and do a patch test on the skin to determine the level of dilution required to be made before you apply it on the affected area.
Side Effects: Undiluted tea tree oil can cause redness, irritation on the skin. It is, however, safe for most people if diluted before using.
Natural Remedies: Diet
Diet and its relationship with acne have been very controversial throughout the decade. There are many studies which suggest that diet can play a major role in acne breakouts.
It has been found that food with a high glycemic index can increase sebum production which will eventually lead to acne breakouts. A diet rich in food with a low glycemic index can be beneficial for patients with acne.
Diet rich in antioxidants can definitely help in fighting acne because of their property of removing reactive oxygen species from the body. These reactive oxygen species can otherwise increase the progression of acne (9).
Zinc is another micronutrient that should be present in the diet. It is essential because it can reduce the production of pro-inflammatory cytokine.
Step 3: Surgical Treatments
The keratin contents of open comedones may be expressed using a comedo extractor.
Extraction is especially beneficial for deep and persistent comedones. This procedure should be used in conjunction with a topical retinoid or other comedo dissolving treatments for maximum benefit.
Comedo extraction should not be performed on inflamed comedones or pustules because of the risk of scarring.
Intralesional injection of corticosteroid can quickly improve the appearance and tenderness of deep, inflamed nodules and cysts. Larger cysts may require incision and drainage prior to injection.
Side Effects: The risks of corticosteroid injections include hypopigmentation (particularly in dark skin), skin thinning, dilation of surface blood vessels, and needle tract scarring.
Other options used in selected cases include
- Photodynamic therapy
- Skin mini-grafting
Bottom line: Fighting acne can be very tricky and can definitely leave scars on the patient dealing with it, but the right treatment at the right time can cure acne permanently. It might take several months to cure the acne depending on the severity of it, so anybody dealing with it should have patience and visit a dermatologist before trying any of the above-mentioned treatments.