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Acne vulgaris also known as acne or pimple is one of the most common skin disorders faced by people. It can lead to self-esteem and self-confidence issues. Acne may have recurring occurrence all through your life, but it can be controlled with proper treatment. Based on their severity, acne is categorized as blackheads and whiteheads, papules, pustules, and nodules. Let us understand the details of acne and the treatments options available.
What Is Acne Vulgaris?
Acne vulgaris is a disorder of the pilosebaceous unit of skin (which consists of hair follicle, hair shaft and the sebaceous gland from where sebum is secreted). There are different morphological varieties of acne consisting of comedones and skin outbreaks. It causes inflammation and blockage of hair follicles due to oil and dead skin cells clogging the skin pores. It usually is prone in areas of the body with dense sebaceous follicles like face, neck, chest and back.
There are four key elements for acne; abnormal follicle keratinization, excess sebum secretion, inflammation and the proliferation of a bacteria (p. bacterium). There must be holistic treatment given by an expert dermatologist to prevent and treat this condition which includes medicines to contain the root cause and the aesthetic treatments to reduce the appearance of these breakouts.
Types And Classifications
How Is Acne Classified?
Grading the acne is always helpful in determining the appropriate treatment option. Based on factors like type, severity, extent, and quality of life acne can be classified into:
- Grade 1 – Proliferation of whiteheads, blackheads, and mildly inflamed pimples.
- Grade 2 – More aggravated whiteheads, blackheads and inflamed pimples with pus formation.
- Grade 3 – Larger inflammatory pimples, pus-filled pimples, and a few cysts.
- Grade 4 – Large cysts
What Are The Common Types Of Acne?
- Comedones – These are the basic acne lesions which arise due to clogging of skin pores as a result of excess sebum and dead skin cells. They may take form of blackheads and whiteheads bumps on skin.
- Papules – These are inflamed acne which are red or pink coloured bumps on skin. They are sensitive and may scar if popped or left untreated.
- Pustules – Another kind of inflamed acne comprising a yellowish to white bump surrounded by a red ring around. This is filled with pus. Picking can cause pigmentation and scarring on skin.
- Nodules – These are large, hard and inflamed bumps on the skin and deep within the skin. They are painful and severe form of acne. They must be treated by a dermatologist in time, as these can leave permanent scars behind
- Cysts – Large and pus filled, cysts look almost like a boil. These are painful and severe form of acne.
- Nodulocystic acne – These comprise multiple inflamed cysts and nodules which are red and purple in colour. They leave scars behind and need a prompt and dedicated treatment.
Causes, Signs And Symptoms
What Causes Acne Vulgaris?
Intrinsic Factors – When the causes for acne vulgaris are within the body which include
- Hormones – Any fluctuation in the hormones can alter the activity of sebaceous glands thus triggering them to secrete more sebum. Some of these conditions include PCOS, cushings syndrome, acromegaly, hormonal imbalance, thyroid, etc.
- Genes – Heredity plays an important role in causing acne too. If it prevails in your family, then you have more chances of these outbreaks.
Extrinsic Factors – The factors which are outside the body, but add up to acne outbreak include
- Stress – As such mild stress may not cause acne but if you have prolonged condition, it can severe the acne.
- Medications – Certain medications may also cause acne outbreak. These drugs include corticosteroids, lithium, barbiturates, androgenic steroids, DHEA, medicines containing bromides or iodides, etc.
- Using harsh chemical based products – certain skincare products can trigger the secretion of sebum also destroy the outer epidermal layer of skin and thus resulting in acne vulgaris.
- Diet – Some studies suggest that eating certain kinds of foods with high glycemic index can cause acne.
What Are The Common Signs And Symptoms?
Some of the symptoms of acne include –
- Clogged pores forming blackheads, whiteheads and pustules
- Dark spots on skin
- Redness and inflammation around the outbreak
- Cysts and abscesses may also form in severe condition
Who’s At Risk?
Over 10 million cases of acne is reported in India every year. This condition affects to both men and women in all age groups starting from 20s and can be with them till their 40s. Generally, people with hereditary tendencies, anxiety, stress, hormonal imbalance (pregnancy, puberty, menopause) and improper lifestyle are more prone to getting acne.
Also Read: What Causes Adult Acne And How To Get Rid Of It?
Acne Vulgaris Treatments
Depending upon the strength of acne vulgaris there are 3 lines of treatments available. The acne can be divided into mild, moderate and severe.
The effective treatment of acne is governed by four principles;
- Correct the faltered pattern of follicular keratinization
- Decrease sebaceous gland activity
- Decrease the follicular bacterial population
- Cause an anti-inflammatory effect
The treatment therapy comprises cleansing the acne affected area with mild and prescribed agents along with certain other treatments including
- Azelaic Acid – It is a dicarboxylic acid with antimicrobial and comedolytic properties. It also helps in decreasing hyperpigmentation.
- Benzoyl Peroxide – They are the most common topical medicine prescribed by a dermatologist as they are a very power antimicrobial agent. Also they are an ideal agent for combination therapy.
- Retenoids – Topical retinoid assists in destroying the acne vulgaris infection in a few days, although these need to be continued further for maintenance. By doing so, future acne will be inhibited
- Antibiotics – Broad spectrum antibiotics should be taken orally or applied topically after seeking professional medical advice only. These work by targeting the root cause of the acne, the bacterial infection, and trying to resolve it
- Hormonal Therapy – Using agents that reduce the androgen/testosterone activity can assist in bringing down their effects on sebaceous glands
- Salicylic Acid – Salicylic acid is available in the form of creams or chemical peels. Both of these help in rejuvenating the skin and clearing it from the acne vulgaris infection
- Isotretinoin – It is an oral retinoid and is used for treating cases of severe acne
- Acne surgery – It is done to remove superficial comedones and acne pustules for cases which do not respond to comedolytic agents
- Phototherapy – These include UVB light, porphyrins, photodynamic therapy, etc. to treat acne vulgaris
- Laser – A beam of laser light can help in reducing the appearance of acne greatly. Various types of lasers are used for different kinds of acne outbreaks.
Also Read: How To Remove Acne Scars?
Acne Vulgaris Treatment Algorithm
|Comedonal||Papular/ pustular||Papular/ pustular||Nodular||Conglobata/ fulminas|
|First-line||Topical retinoid||Topical retinoid + topical antimicrobial||Oral antibiotic + topical retinoid + BPO||Oral antibiotic + topical retinoid + BPO||Oral isotretoin + oral corticosteroids|
|Second-line||Azelaic acid or salicylic acid||Azelaic acid or salicylic acid||Oral antibiotic + topical retinoid + BPO||Oral isotretinoin or oral antibiotic + topical retinoid + -BPO/ azelaic acid||High dose oral antibiotic + BPO|
|Female||–||–||+ Oral contraceptive/ anti androgen||+ Oral contraceptive/ Anti androgen||+ Oral contraceptive/ anti androgen|
|Invasive options||Comedone extraction||Comedone extraction||Comedone extraction; intralesional corticosteroid||Intralesional corticosteroid|
|Refractory to treatment||Check compliance||Check compliance||Check compliance|
|Maintenance||Topical retinoid + BPO|
** BPO: benzoyl peroxide
* From Fitzpatrick’s Dermatology in General Medicine (Table 78-1)
How To Prevent This Condition?
While there is no factual evidence suggesting any of the methods could prevent the occurrence of acne but they may help in controlling the acne from spreading further and taking a severe course. Some of these tips include –
- Keep your skin clean and wash it every day with a mild soap (dermatologic recommended)
- Skin care routine must be followed which includes cleansing exfoliating and moisturizing to remove dead skin cells along with dirt and grime, thus reducing the acne
- Avoid sweating heavily and wash your face soon after workouts
- Keep your hair clean and wash it regularly also tie it away from the face as hair tends to get oily and cause acne on forehead
- Limit smoking and alcohol intake
- Do not touch your face especially if your hands are not clean
- Avoid harsh chemicals, oily cosmetics and home based products without understanding their impact on your skin
- Drink plenty of water and fresh produce as this will enable proper circulation in the body and prevent infection
- Keep your skin protected from harsh UV rays of the sun by applying sunscreen, covering the face and using hat/ shades and other appropriate attire
- Do not pick or squeeze the pimples as they may get worse with scarring
Acne Vulgaris Vs. Acne Rosacea
- Acne vulgaris and rosacea are both a disorder of pilosebaceous unit. Rosacea is chronic facial inflammatory dermatosis with peculiar flushing as a major characteristic. And people with rosacea have overabundance of demodex (mites that are a part of human biome)
- Acne vulgaris mechanisms include increased sebum, inflammation, heightened keratinocyte proliferation and bacterial infection, while rosacea mechanisms include vasoactive and affecting the nerve and skin (neurocutaneous) which include flushing, facial erythema, inflammatory papules, etc.
- In acne the areas affected include the face primarily but is also seen in chest, back and neck. Rosacea usually occurs at the central area of the face including cheeks and nose and sometimes chin and forehead
- The symptoms of acne include lesions like comedones (backheads, whiteheads) papule, pustule, nodule etc. While rosacea begins with redness of dilated blood vessels and bumps may appear with inflammation.
What are acne vulgaris nodules?
Nodular acne vulgaris is a severe form of acne that causes large inflamed and painful skin deformities in the form of breakouts which are larger in size than the normal acne. It also consists of a bacteria called the p. acne. It may turn into a severe infection when it gets clogged by sebum and dead skin cells.
How long will I have acne vulgaris?
Usually acne vulgaris last for about 3-5 years but it may vary depending upon several factors. Most people get rid of their teenage acne by the age 21 but in some adults the condition prevails for long, which needs dermatologic consultation and treatment.