What are acnes?
Acne as generally called is actually acne vulgaris. It is an inflammatory skin condition involving the hair follicles and the surrounding sebaceous gland of the face, neck, back, and chest. It is most commonly seen in adolescents and few instances in adults. Acne can result in skin scarring and lesions and facial disfigurement rendering the individual embarrassed, develop low self-esteem, and lose confidence. The hormone androgen is usually produced excessively during puberty and contributes to the development of acne.
Are acnes different from pimples?
Acne vulgaris is the disease condition whilst pimples are just a sign of acne vulgaris.
What causes acne?
Some pathogenic/physiological factors contributing to acne development include;
1. Excess sebum production;
The surge in levels of androgens during puberty results in growth in size of the sebaceous gland and hence increase in levels of sebum production. The excess sebum clog hair follicles and leads to development of acnes.
2. Bacterial growth;
The Propionibacterium acnes is the common bacteria implicated in acne development. It is part of the normal flora of the skin and grows better in sebum deposited and keratinized tissues and hence worsens acne symptoms.
3. Inflammatory processes;
The presence of the bacteria and excess sebum with keratinized tissues triggers an inflammatory process that can result in scarring of the skin tissues, development of papules, pustules, nodules and cyst.
4. Keratinization;
The sloughing of epithelial cells in the hair follicle is also a natural process. In acne, however, hyperkeratinization occurs and causes increased adhesiveness of the sloughed cells. Accumulation of these cells clogs the hair follicle, blocks the flow of sebum, and forms an acne lesion called an open comedo or “blackhead.”
What are the symptoms of acne?
Acnes may present with the following symptoms; pimples, papules, pustules, blackheads or comedones, whiteheads, nodules and or cyst in the face, neck, chest and back.
When do I have to see a doctor about my acne?
One may decide to see a doctor when the acne becomes worse such that it affects the person psychologically or socially and or when it becomes infected.
In some individuals, it becomes so bad that they don’t even want to go out to public places; the person’s self-esteem becomes diminished and the person loses his or her sense of beauty. Some people may even harbor suicidal thoughts, hence, in such instances, one must see a doctor.
What are some of the myths and facts about acne?
Myth 1: Popping pimples will make them go away faster.
Fact: Popping a pimple may make it seem less noticeable temporarily, but popping can cause it to stay around longer. By squeezing pimples and zits, you can actually push bacteria, dead skin cells, and oil further into the skin, causing more swelling and redness — and sometimes causing a red or brown mark or scar to form. Sometimes marks can last for many months and true scars (dents and pits) will last forever.
Myth 2: Eating chocolate and greasy foods makes acne worse.
Fact: there’s no evidence of a link between eating these foods; pizza, potato chips, groundnuts, chocolate, etc, and acne
Myth 3: Acnes is caused by stress.
Fact: May actually get worse with stress
Myth 4: Masturbation causes acne.
Fact: Masturbation does not cause acne, however, it results in Hormonal changes but these hormones disappear after ejaculation.
Myth 5: Acnes is caused by dirt.
Fact: Dirt may result in rapid multiplication of bacteria and hence flare-up acnes
Myth 6: Only adolescents get acne.
Fact: It is most common in this age group but can also be seen in adults 20 and 30 years of age
What kind of complications can acne lead to?
Acnes may result in the development of depression, social withdrawal, anxiety, scarring of the skin with facial disfigurement. Nodules, cysts, and pustules may also form.
What are the risks factors for developing acne?
- Age: acne is most common in adolescents but may occur in all age groups
- Genetic predisposition is also an important factor
- Hormonal changes during puberty and pregnancy is a risk factor as androgen levels may be elevated at these stages.
- Taking certain medications such as prednisolone, lithium, insulin, etc these play a role in stimulating the production of testosterone.
- Eating high glycemic foods contribute to the worsening of acne.
How to prevent acne from developing
- Moisturizing of the skin: many acne products contain ingredients like sulphur that dry the skin, so always use a moisturizer that minimizes dryness and skin peeling. Look for ‘non-comedogenic’ on the label, which means it should not clog pores. There are moisturizers made for oily or dry skin.
- Regularly cleaning the face or skin to remove dead cells and bacteria from the skin
- Reducing intake of high glycemic foods
- Avoiding certain medications that are causing your acne for example : prednisolone
- Drinking lots of fluid to stay hydrated. If you’re dehydrated, your body may signal your skin’s oil glands to produce more oil. Dehydration also gives your skin a dull appearance and promotes inflammation and redness.
- Avoid aggressive skin washing
How can I treat my acne?
Acne treatment is based on acne severity and type of acne lesion. Other factors such as response to previous treatment, patient preference, cost and adherence are also considered.
Mostly topical treatments are used for mild acne whereas topical together with oral medications are used for both moderate and severe acne treatment.
Response to treatment may take weeks (about 6 to 8 weeks) for results to be physically apparent. Treatment is usually continued and maintained after an improvement is observed with a particular treatment.
Some topical agents commonly employed includes;
- Benzoyl peroxide which is easy to use. It is a comedolytic and helps to unblock any blocked pores and has antibacterial effects as well.
- Retinoids: Highly effective for acne treatment. Reduce epithelial turnover and has anti-inflammatory effects. Examples are adapalene, tretinoin, and tazarotene.
- Antibacterial ointments such as clindamycin ointment, azelaic acid, erythromycin ointment, dapsone gel, sulphur ointment, salicylic acid ointment etc. These are applied once or twice daily for at least 3 months
- Oral agents. One should consult a doctor or pharmacist for the right oral drug treatment to be initiated. However, oral treatment alternatives include; tetracycline, doxycycline, minocycline, erythromycin, azithromycin, clindamycin, septrin, spironolactone at higher doses, oral contraceptives (ethinyl estradiol), isotretinoin. Particularly, the retinoids should be initiated by a physician.
What home remedies can I use to treat my acne?
Many home remedies lack scientific backing and further research on their effectiveness is needed. If you are looking for alternative treatments, though, there are still options you can try.
- Apple cider vinegar to apply. It contains citric acid and lactic acid which has anti-inflammatory effects and antibacterial activities against Cutibacterium acnes.
How to use it
- Mix 1 part apple cider vinegar and 3 parts water (use more water for sensitive skin).
- After cleansing, gently apply the mixture to the skin using a cotton ball.
- Let it sit for 5–20 seconds, rinse with water and pat dry.
- Repeat this process 1–2 times per day, as needed.
- Taking zinc supplements. Zinc is an essential nutrient for cell growth, hormone production, metabolism, and immune function. Taking at least 30 to 45 mg per day helps reduce acne development.
- The use of honey and cinnamon mixture has been shown to help reduce and treat acne. A paste of 2 tablespoon of honey and 1 teaspoon of cinnamon is prepared and applied. It is allowed for 10 to 15 minutes and then rinsed off with water.
- Tea tree oil is also another home remedy. 1 part of tea tree oil is mixed with 9 parts of water. This is then applied to the spots or area with cotton wool. Tea tree oil has antibacterial and anti-inflammatory properties that help resolve acne.
- Aloe Vera moisturizer has been found helpful for acne treatment. It contains salicylic acid and sulfur that exhibit antibacterial effects when applied.
- Also taking fish oil supplements such as omega 3 fatty acids reduces acne.
- Taking foods of low glycemic levels such as fruits, vegetables, legumes, nuts, whole or minimally processed grains are helpful in reducing acne from developing.
- Exercising regularly. Exercise decreases stress and anxiety and also regulates hormones that may contribute to acne development. Exercise also facilitates enough blood circulation.
References
Bhate K, Williams HC. Epidemiology of acne vulgaris. BJD. 2013;168:474–485. 5.
Bowe WP, Joshi SS, Shalita AR. Diet and acne. J Am Acad Dermatol. 2010;63:124–141. 6.
Sibbald D. Acne Vulgaris. In: Dipiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiological Approach. 9th ed. New York: McGraw-Hill; 2014:1555–1578.
Erika Clein and Kayla McDonnell MD, 13 powerful home remedies for acne vulgaris treatment, updated 2020. .
WRITTEN AND EDITED RESPECTIVELY BY:
Dr. Abel Daartey is a pharmacist by profession, a teacher, and a mentor by nature. He enjoys reading scientific journals and articles and publications in neuroscience and related topics. He aims at churning out content that educates the public and health care providers in meeting the healthcare needs of the populace.
MPSGH, MRPharmS, MPhil.
Isaiah Amoo is a practicing community pharmacist in good standing with the Pharmacy Council of Ghana who has meaningful experience in academia and industrial pharmacy. He is a member of the Royal Pharmaceutical Society, England, UK and currently pursuing his overseas pharmacy assessment programme (MSc) at Aston University, UK. He had his MPhil degree in Pharmaceutical Chemistry at Kwame Nkrumah University of Science and Technology. He has about 5 years’ experience as a community Pharmacist and has also taught in academic institutions like KNUST, Kumasi Technical University, Royal Ann College of Health, and G-Health Consult. He likes to spend time reading medical research articles and loves sharing his knowledge with others.
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