Acne is a skin disease caused by obstruction and inflammation of the pilosebaceous gland. The pathogenesis is complex but, in general, we can say that several factors influence its appearance, such as excess sebum production, androgen stimulation, overgrowth of the bacterium Propionibacterium acnes, local inflammation and follicular plugging.
When is it most common to develop acne?
Acne is more common in adolescents (coinciding with the onset of puberty and hormonal change) and young adults.
It usually occurs in the form of outbreaks, with the appearance of inflammatory and non-inflammatory lesions, especially on the face, but can also affect the décolleté, back and shoulders. These outbreaks can be triggered by hormonal and emotional variations, and even by food. There is also a certain family predisposition to acne, often affecting several members of the same family (parents and children, siblings, etc.).
How to assess whether acne is severe or mild?
Several degrees of acne are differentiated according to the type of predominant lesion: comedones, papules, pustules and nodule-cysts:
- Mild acne: comedones
- Moderate acne: papules-pustules
- Severe acne: nodule-cysts
- Residual acne: scars (most important sequelae of acne).
Within severe acne there is an acute form, fortunately rare, which is acne fulminans. It is associated with fever, general malaise and very inflamed and painful lesions.
Differentiating the degree of acne is fundamental for the treatment, since based on the predominant type of lesion, one drug or another will be indicated. It is therefore essential to be evaluated by a dermatologist who is an expert in acne, since depending on the measures and therapy adopted, the patient’s skin may or may not have lifelong sequelae. It is especially important to treat lesions early, especially inflammatory lesions, and not to let them evolve spontaneously until they are resolved, in order to avoid the dreaded scars in the future. However, any degree of acne should be treated correctly and as soon as possible to prevent the degree of acne from becoming serious.
Do all cases of acne require treatment and which one should be used?
In all patients with acne, cosmetic care is recommended to be carried out at home on a daily basis. In general, a degreasing soap is recommended to clean the skin in the morning and then the application of a specific moisturizing cream for oily skin (if possible with sun protection).
At night, before going to bed, it is advisable to clean the skin again, especially if make-up (which must be oil-free) has been applied, followed by the application of topical medications (antibiotics: erythromycin, clindamycin; retinoids: adapalene, tretinoin) or other active ingredients prescribed at the consultation (exfoliants: glycolic acid, salicylic acid; anti-inflammatories: benzoyl peroxide…).
In mild acne these topical measures are sufficient, but as soon as inflammatory lesions appear (papulo-pustules) it is advisable to associate oral antibiotics, such as tetracyclines (doxycycline), in batches of several months. In women associated with a clear hormonal influence, contraceptives and antiandrogens can be tried directly. Often the response is spectacular.
When the acne is more severe and deeper, or when it recurs continuously with the above mentioned treatments, it is proposed to start oral therapy with isotretinoin (better known as Roacutan®). Those of us who are dedicated to Dermatology say that it is the “strong” drug that cures acne definitively (in +/- 80% of patients it does). To avoid recurrences, we usually give it in batches of 8 months, although nowadays we personalize the treatments according to the type of acne and age of the patient, and we can vary the doses, using lower doses or shorter treatment times.
This drug leaves the skin fantastic but is not without some annoying inconveniences (dry lips, eyes, skin, occasional transient elevation of cholesterol and transaminases, “stiffness”…). It also requires contraception and periodic analysis.
In patients who cannot use oral medication, or do not want to take medication, we have a new and painless technique, which is photodynamic therapy. It achieves in several sessions a considerable reduction of acne without the use of pills. Maintenance sessions are required.
Can acne leave sequelae or marks and how can they be treated?
Regarding the after-effects of acne, we have different very effective therapies that will largely resolve the residual scars. Chemical peels, dermabrasion, fractional laser, hyaluronic acid fillers, mesotherapy, minor surgery, among others. They usually require several sessions but are worth trying once the inflammatory acne has resolved.