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Over 70% of the adolescent and young adult population in the Western world is affected by acne, a chronic but not life-threatening skin disease. It has the potential to cause scars and significant disfigurement. This condition also leaves visible scars behind that can lead to psychological issues for a young individual, aggravating the common psychosocial problems in these times of a person’s life. The number of studies made on acne has been inadequate, resulting in myths and home-spun remedies that are often fraught with danger. Acne, therefore, demands serious attention.

Acne shows up mainly as lesions on the face, neck, back, and shoulder. Comedones are the primary lesions in acne, which are non-inflammatory. When comedones burst the follicular walls, however, they become inflammatory lesions called papules and pustules. These inflammatory lesions have the potential to leave behind scars.

Types of Acne

To arrive at appropriate treatment, acne must first be classified to mild, moderate and severe based on the number and distribution of various types of acne spots. Mild acne would consist of mostly non-inflammatory comedones, while moderate acne would have comedones, pustules, and papules. Sever acne on the other hand would consist entirely of inflamed lesions.

Causes of Acne

Although the exact causes of acne are not well known, at least two agents playing the leading roles in its development are certain. These are the sebum, a fluid secreted by sebaceous glands in the skin, and the body hormone androgen.

Excess sebum secretion resulting from excess androgen stimulation is thought to be the cause of acne - this has been shown in several studies. The treatment of acne, therefore, should aim to reduce the influence of androgen in various ways. Although there is no dispute over the role of androgen in the formation of acne, not much is known about factors leading to its excess production. Acne treatment today remains rather underdeveloped.

Treatment of Acne

Retinoids, antibiotics, antimicrobials and sulfur or its compounds, in oral as well as topical forms, are the most common acne treatments today.

Retinoids: Mild acne is commonly treated with retinoid. With its anti-inflammatory action, it can also be used for inflamed lesions. Tretinoin, adapalene, and isotretinoin are the common drugs used which come in both cream and gel form. The more severe types of acne is treated with oral isotretionoin, the most effective for these types of acne.

Antibiotics: To effectively reduce inflamed acne, topical antibiotics like clindamycin and erythromycin is applied. In cases in which scarring or hyperpigmentation is expected, oral antibiotics tetracycline, doxycyline, and minocycline are prescribed as systemic treatments. However, with the significant increase in bacterial resistance, the efficiency of antibiotics is restricted. Antibiotics are not used with antimicrobials to combat bacteria, and are withdrawn once the inflammation is cleared.

Antimicrobials: The most commonly utilized antimicrobials are benzoyl and azelaic acid. Their anti inflammatory and anti-comedogenic actions are useful against mild and moderate acne. They are more effective and better tolerated when combined with antibiotics. Mild side effects are limited to skin irritation and erythema.

Sulfur: The use of sulfur as acne treatment has declined due to the emergence of other formulations, although this has been the premier traditional treatment in the past. It has few mild and short-lived side effects and is well absorbed. Sulfur today remains a viable option for acne treatment.


Although much is known about acne now, much still remains to be understood, particularly regarding its pathogenesis. However, acne scars and disfigurement are easily rectified with available treatments today. The future of effective acne therapy is more targeted because of the level of knowledge now available.