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.
Conclusions
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.
