August 06 2021
Acne vulgaris is the medical term for common acne which is characterized by the presence of blackheads, whiteheads, and other types of pimples on the skin. Various factors are found to either aggravate or alleviate acne. The symptoms of acne are generally found to be aggravated around the time of the menstrual cycle, hormonal factors such as the presence of conditions like polycystic ovarian syndrome (PCOS) and other endocrinological disorders also increase acne. Stress worsens acne whereas exposure to ultraviolet light can alleviate acne.
Consumption of a low glycemic diet which includes higher amounts of whole grains, fresh fruits and vegetables, garlic, fish, and olive oil and reducing the intake of high glycemic index foods like biscuits, cakes, aerated drinks, and ice creams have a beneficial effect in decreasing the manifestation of acne in some individuals. Oil-based cosmetics further aggravate acne, especially on the forehead and temples. Intake of prescription medications like oral corticosteroids, anabolic steroids, lithium, ciclosporin, iodides may also increase acne.
The clinical findings in acne vulgaris include seborrhoea or greasy skin, comedones which are non-inflamed lesions such as blackheads and whiteheads, the presence of inflamed lesions like papules and nodules, scarring which may occur as a result of the loss of tissue and pigmentation which is more prominent in dark-skinned individuals. Some patients with acne vulgaris may require additional investigations especially those suffering from polycystic ovarian syndrome associated with oligomenorrhea and hirsutism. Those individuals with late-onset congenital adrenal hyperplasia manifesting with precocious puberty, menstrual irregularity, infertility, hyperandrogenism, and patients suspected to have underlying endocrinopathy should be sent for further investigations and referred to an endocrinologist.
Treatment of acne vulgaris
The primary aim of treatment of acne is to minimize scar tissue as once scarred, the affected area can never be brought back to normal. Patients with nodular scarring which occurs in severe acne as well as papular-pustular scarring which is associated with non-response to treatment should be treated with six weeks of scar formation to prevent further worsening. In patients with mild to moderate acne, topical medications such as benzoyl peroxide are recommended even though they may cause dryness of the skin and irritation. Monitoring by photography during acne treatment is of great use in determining the efficacy of the line of treatment followed.
Treatment of comedonal acne
The first line of treatment in such conditions is a topical retinoid like adapalene, isotretinoin, or adapalene in combination with benzoyl peroxide which helps in reducing comedonal activity. The second line of treatment is azelaic acid.
Treatment of pustular acne
This involves the use of combination doses of benzoyl peroxide which helps in decreasing bacterial resistance along with a topical retinoid or topical antibiotic such which is the first line of treatment and duac which is the second line of treatment and other medications such as treclin and erythromycin are also used in the treatment of pustular acne. When the above medications are found to be ineffective, systemic antibiotics can be introduced along with a topical agent such as BPO which prevents the further onset of bacterial resistance.
Some of the choice antibiotics include
Tetracycline - Lymecycline is the first-line antibiotic with a lower threshold of bacterial resistance which on being ineffective can be replaced with doxycycline. The preferred first-line antibiotics in pregnant women and children below the age of 12 years are macrolides which include erythromycin or clarithromycin. In young children with a proven allergic reaction to macrolides, trimethoprim is prescribed.
The use of these prescribed antibiotics should be ceased after three months as its prolonged usage may increase the bacterial resistance and only the use of topical agents should be continued. For the treatment of moderate to severe acne, in addition to the above medications, dianette is added specifically in patients suffering from the polycystic ovarian syndrome.
Acne in pigmented skin
In pigmented skin, post-inflammatory hyperpigmentation takes place which often prolongs for many months to even years. In such cases, more aggressive treatment modalities are prescribed including the use of isotretinoin. Secondary acne can be occurring as a result of the use of various compounds like hair oil which can lead to pomade acne prevailing on the forehead and steroid-induced acne is caused by the use of skin-lightening creams that contain steroids.
Acne in pregnancy
Benzoyl peroxide preparations and 2% topical erythromycin are considered to be safe for administration in pregnant women if the need arises. If the acne is not treatable by these topical applications, oral erythromycin is prescribed.
Scarring caused as a result of acne is usually cured if mind within the period of 6 to 12 months. Established scars are more difficult to manage and may or may not be treatable and such patients can take the help of dermatologists or plastic surgeons if the scarring is extensive. The types of scars include:
Atrophic scars - These types of scars are generally treated with the use of ablative lasers and also the application of appropriate surgical procedures. Small atrophic scars are usually treated by the process of punch excision. Scar revision is the method employed in treating deeper scars. Other treatment modalities include intradermal collagen injections which lead to the stimulation of collagen synthesis thereby causing healing of the scar tissue.
Hypertrophic scars - These are also known as keloid scars and are usually treated with the application of silicone gels. Local steroids are used for a couple of months and the occurrence of adverse reactions such as skin thinning and telangiectasia should be closely monitored. For the reduction of scars, a procedure known as pulsed dye laser can also be used.
Home remedies for acne
In addition to the standard clinical treatment of acne, some home remedies are also known to decrease acne. Apple cider vinegar on the topical application is beneficial in reducing acne by suppressing inflammation and decreases scarring. Intake of zinc supplements helps treat acne as these patients have been found to have lower levels of zinc in the body. Applying a mask made of honey and cinnamon is effective in reducing acne because of its anti-inflammatory and anti-bacterial properties. The use of tea tree oil as a topical agent reduces skin inflammation in those with acne. Intake of Alvizia fish oil supplements rich in omega -3 fatty acids decreases inflammatory factors which in turn reduces acne.