Acne

Definition

Considered the most common skin disease during adolescence, acne vulgaris begins at puberty and can extend into the third decade of life. However, it may also start later, sometimes associated with hormonal issues such as polycystic ovary syndrome.

It usually appears as blackheads and pimples, but in some cases, larger—and sometimes more severe—lesions may develop, potentially causing psychological and social problems for the adolescent. The lack of proper treatment can result in unaesthetic and difficult-to-treat scars.
 

Characteristics

Due to hormonal influence during adolescence, there is an increase in the activity and size of the sebaceous glands. As a result, skin oiliness also increases. In addition, there may be a thickening of the outermost layer of the skin.

This leads to the formation of small masses of keratin (a hard, water-impermeable protein substance found in nails, hair, and skin) and sebum, which clog the pores. Comedones (or blackheads) then appear.

Due to the action of bacteria from the skin’s normal flora on the sebum (bacteria that naturally inhabit the skin), free fatty acids are released (substances present in our body, derived from the chemical breakdown of fat). This irritates the skin and causes the appearance of small reddish lesions. In contact with keratin and sebum, these lesions form yellowish pimples with purulent discharge—or, when deeper, cysts and abscesses.
 

Incidence

Both men and women produce androgen hormones, which are involved in the development of acne. In most cases, women affected by acne do not have hormonal disorders. However, it has been shown that the skin of individuals with acne has the ability to metabolize (transform) male hormones at above-normal rates, resulting in an altered hormonal response of the sebaceous gland (the gland that produces sebum or oil). Female hormones, on the other hand, reduce the production of sebaceous secretion.

Cause

Acne results from hormonal activity but can be triggered or worsened by certain medications. There is also a genetic factor involved.

The use of ointments, creams, injections, or pills containing corticosteroids, as well as medications used to treat tuberculosis and epilepsy, can worsen an existing condition or promote the onset of acne. The same applies to iodine, chlorine, and bromine. Vitamin B12 also has the potential to aggravate or trigger acne.

Emotional state and, in women, the proximity of menstruation contribute to the occurrence of the condition.

Creams, ointments, and greasy cosmetics definitely worsen acne. Manipulating lesions—either by the patient or an unqualified professional—is another aggravating factor. The act of “squeezing” pimples or blackheads can leave residual marks and even scars on the skin.
 

Symptoms

Acne is characterized by the appearance of blackheads, pimples, cysts, and even abscesses on the skin, depending on the severity of the case. These signs usually appear on the face, chest, shoulders, or back, along with increased skin oiliness. Blackheads are black (if closed) or light (if open). In more severe cases, cysts may drain pus, sometimes leaving raised or depressed scars.

According to the predominance of one or more types of lesions, acne is classified into four ascending grades:

• grade I: only blackheads are present
• grades II and III: characterized by the progression of the first, with papular lesions (small elevations of the skin) and pustular lesions (pus accumulated beneath the epidermis)
• grade IV: all previously described lesions coexist, along with cysts and scars. Grade IV acne, the most severe form, occurs more frequently in men and affects the face, trunk, and neck
  
   

Prevention

First and foremost, it is important not to “squeeze” the lesion in order to avoid scar formation. If treatment has already begun, it is advisable to maintain regular follow-ups until, over time, the symptoms naturally disappear.

Treatment

• topical treatment: hygiene with soap appropriate for the skin type, exfoliants, gels, antibiotics, etc. It will depend on the case and must follow medical prescription
• skin cleansing with a qualified professional
• oral treatments (including antiandrogens and antibiotics) for more extensive cases, also under medical guidance
• treatment of marks and scars can be done with chemical peels, laser, etc. Always with medical recommendation

By Einstein Editorial Board