Acne is a skin condition that, although it does not represent a serious threat to health, has a negative effect on the patient’s quality of life, since the comedones, pustules and secondary scars of this pathology can worsen the patient’s appearance.
Acne is a very common pathology of the hair follicle, occurring mainly in adolescence, with extension in the first decades of adulthood. It is manifested by the appearance of open and closed comedones (“blackheads”), inflammatory lesions such as papules and pustules (“pimples” with and without “head”), deeper lesions such as nodules and the eventual appearance of secondary scars.
There are different degrees of acne, from the exclusive appearance of comedones, without inflammatory lesions, to the presence of nodular and even ulcerated lesions on the face and trunk, accompanied by fever (acne fulminans), passing through moderate-severe inflammatory forms, with association of papules, pustules, nodules and scars in different intensity and extension.
Causes
Acne is not produced by a single cause; it is a multifactorial process in which the obstruction of the hair follicle outflow or the excess of sebum production and the presence of a bacterium called Propionibacterium acnes intervene. The mixture of all these factors produces the rupture of the hair follicle wall and the appearance of inflammation in acne.
Sometimes the use of some oral drugs can favor the appearance of acne, as in the case of steroids.
Prevention
There is no way to prevent acne. Local hygiene with soaps can reduce a little the intensity of the lesions. There is no evidence of the implication of diet in acne and it is not clear that foods such as those rich in fats or chocolates worsen the condition.
Even so, there are patients who report that the ingestion of certain foods causes exacerbation of the lesions, in which case it would be advisable to avoid them. This should not lead to the generalization of restrictive diets in all patients with acne.
Treatment
Treatment depends on the intensity of the lesions and their extension. Hygiene with soaps containing substances that eliminate follicle occlusion may be beneficial, such as benzoyl peroxide, azelaic acid or salicylic acid.
Topical antibiotics such as clindamycin or erythromycin are usually used, often in association with products such as those mentioned above. The use of topical antibiotics alone is not recommended to avoid the appearance of resistance.
Oral antibiotics, such as tetracyclines, on the other hand, can be useful but for periods of 2-3 months and in the case of mild-moderate acne, but after discontinuation, lesions often reappear.
Moreover, in women, the combination of an oral contraceptive and an antiandrogen can keep acne inactive for long periods.
The most effective drug is isotretinoin. In treatments lasting 6-8 months, it is capable of eliminating lesions, even for long periods after discontinuation. In many cases, isotretinoin even achieves total cure of the process.
Finally, techniques such as photodynamic therapy or laser therapy can provide temporary improvements, although they are not very widespread. Photodynamic therapy consists of applying a cream and activating its substances with a special lamp. The laser, on the other hand, is responsible for burning the sebaceous glands that cause oily skin or a thin layer of skin to reduce acne scars.