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We know that acne is a subject that affects and worries adolescents and their families a lot. Therefore, in ACNE Write For Us, this opportunity we will seek to answer some frequently asked questions on this matter while providing relevant information on how to treat this disease.
What is Acne?
It is a chronic inflammatory skin disease of the pilosebaceous unit, of multifactorial etiology, characterized by increased sebaceous secretion, formation of comedones, colonization by Cutinebacterium Acnes, inflammatory lesions, and risk of scarring.
It is one of the most frequent dermatological diseases, especially in adolescence, due to the action of androgens, with a heterogeneous and polymorphic form of clinical expression.
The maximum prevalence and intensity occur around 14-15 years of age in women and between 16 and 18 years of age in men. Although the incidence by sex is similar, more severe forms are observed in men.
This chronic disease impacts the quality of life of adolescents, especially in the psychosocial sphere, causing depression, anxiety and body image disorders. The role of the pediatrician or referring physician is relevant to carry out diagnostic guidance, early therapeutics, follow-up, accompaniment and to determine the timely referral to the specialist in Dermatology in case it is required.
How is the Diagnosis Made?
The diagnosis is clinical, confirming the presence of comedones and/or inflammatory lesions (papules, pustules and cysts). They may be accompanied by scars. These are present mainly on the face (90%), but can extend to the trunk (20%) and upper back (60%).
Within the anamnesis it is important to know: age of onset, duration, changes in the lesions, previous treatments and their effectiveness, as well as the impact of this disease on their quality of life.
In its diagnostic approach, 4 fundamental aspects must be considered: type of lesion that predominates (inflammatory or non-inflammatory), intensity/severity (stage of the lesions), extension (facial, pectoral, back) and associated factors.
The classification is clinical: mild acne (comedones), moderate acne (inflammatory lesions plus papule and pustule) and severe acne (inflammatory lesions, nodules, cysts and scars predominate).
When to Refer to Dermatology?
- Acne that presents in childhood.
- Moderate acne that has not responded to well-conducted treatments.
- severe acne
What are the Issues that are Related to Episodes of Acne Exacerbation?
- Diets high in sugar and other carbohydrates stimulate serum insulin and insulin-like growth factors (IGF-1) leading to increased androgen production and subsequent acne development.
- Stress situations determining the increase in adrenal secretion of androgens and stimulating the neuroendocrine regulation of sebocytes.
- Drugs: anabolic steroids or contraceptives with progestogens with androgenic action.
- Cosmetics with a high fat content, aggressive cleansers, soaps with an alkaline pH that alter the skin barrier and favor the formation of comedones and induce inflammation.
What Advances are there in Treatment?
The continuous advances in the pathogenesis of acne have allowed the development of new therapeutic guidelines. The gold standard continues to be the clinical interview together with a correct physical examination to organize an appropriate and individualized therapeutic plan for each adolescent, always taking into account the impact it generates on their quality of life.
The approach is interdisciplinary and requires strengthening self-care, achieving adherence to treatment, and periodic monitoring of evolution.
The Basic Guidelines of Treatment
- Adequate hygiene, once or twice a day with neutral or acid, non-irritating pH soaps, prior to topical or systemic drug treatment.
- Photoprotection of the area is recommended to avoid marks and scars, if possible with specific photoprotectors for oily skin.
- It is recommended to discontinue topical treatment in the summer months.
- Do not manipulate the lesions.
- Treat from the beginning, when the adolescent consults.
- Individualize and adapt the treatment to the type, extent and severity of acne.
- Clearly explain its efficacy and adverse effects.
The American Academy of Dermatology and European guidelines recommend:
combination therapy in all forms of acne and that topical retinoids alone or combined with benzoyl peroxide (PBO) or topical antibiotics are the initial treatment for mild/moderate forms and the most widely used option for maintenance in all forms of acne.
What Drugs do we have in Uruguay and what are their Indications?
Topical treatment:
Retinoids : they are comedolytic and anticomedogenic, have an anti-inflammatory effect and normalize keratinization. Options: Adapalene 0.1 -0.3%, Tretinoin 0.025%, 0.05%.
PBO 5-10%: acts as an antibacterial, anti-inflammatory, comedolytic and keratolytic. Its use is recommended in combination with retinoids, not in monotherapy.
Topical antibiotics (ATB) : They act due to their anti-inflammatory effect and inhibit the growth of Cutinebacterium acnes . It is recommended to use: Erythromycin 1-2% and Clindamycin 1-2% (not in monotherapy, always combined with retinoids).
Ac Azelaic 15%: Acts as an anti-inflammatory and decreases keratinization of the follicle and hyperpigmentation.
In Uruguay there are topical commercial preparations that combine these drugs: retinoid/PBO; retinoid/ATB; PBO/ATB.
Systemic Treatment:
Oral antibiotics (ATB) : doxycycline, minocycline and lymecycline. They are used in pulses of 15 days -1 month.
Hormone treatment l: oral contraceptives. Oral isotretinoin.
Other Treatments:
As adjuvant treatments, the following can be performed: removal of comodones, use of chemical peels or use of lasers.
Depending on the severity, the following may be recommended:
Mild acne: topical treatment: retinoid accompanied by topical PBO or ATB if there are inflammatory lesions.
Moderate acne : topical treatment combined with oral ATB in the pokes.
Severe acne : oral ATB, assess hormonal therapy (in women) and the use of isotretinoin.
Has your skin decided to live a second youth even though you left adolescence a long time ago? Don’t worry, it’s normal. Hormonal changes in women and that disease of this century called stress favor the appearance of pimples. But there is more…
- Are hormones to blame?
Yes. 90% of women suffer from acne at some point in their lives. Occasionally on the days of menstruation or during pregnancy. When high levels of progesterone and testosterone cause the sebaceous glands to work excessively.
- Do I get pimples from eating chocolate?
No. Acne appears due to hormonal or genetic factors. But perhaps the same hormonal disorder that makes you cry. Be angry or eat chocolate is what causes you to get a pimple.
- If I wash the skin a lot, won’t they come off?
No. Too aggressive cleansing leaves the skin unprotected, which can cause a reaction —rebound effect— with a consequent increase in sebum.
- I get my period before my period, is it normal?
Yes, due to the aforementioned hormonal change. In these cases it appears above all on the chin and jaw area, as well as at the hairline.
- I have pimples, can I skip the moisturizer?
No. You can have dry skin and have pimples. Use, yes, an oil-free moisturizer (without oils) and with anti-irritant properties.
General Perspective
Acne is a skin disorder that occurs when hair sacs become clogged with oil and dead skin cells. It causes whiteheads, blackheads, or pimples. Acne is most ordinary among teenagers, although it affects people of all ages.
There are effective acne treatments, but acne can be persistent. Pimples and rashes heal slowly, and when one starts to fade. Others appear to crop up.
When to see the Doctor
If home remedies can’t clear up your acne, see your primary care doctor. Your doctor may prescribe stronger medications. If acne persists or is severe, seek treatment from a doctor who specializes in the hide (dermatologist or pediatric dermatologist).
For many women, bad skin can persist for decades, with common outbreaks a week before menstruation. This type of acne tends to obvious up without treatment in women who use birth control.
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