Acne: What Is, Symptoms, Causes, Diagnosis, and Skincare

What Is Acne?

Acne is a chronic skin disease affecting the pilosebaceous system. Its standard characteristic is the occurrence of open and closed comedones, papules, pustules, nodules, pseudocysts, and purulent cysts located in seborrheic areas, i.e., in places where there is increased sebum production – face, back, neck, arms, and upper back.

Acne is a skin disease. One of the standard causes is the secretion of too much sebum. It comes to the surface of our skin through the sebaceous glands. The channels leading to the glands can become clogged with excess sebum and calloused epidermis, forming so-called comedones, i.e., non-inflammatory acne lesions.

Symptoms

The most characteristic symptoms of acne are pimples. They often appear on the face, mainly on the forehead, chin, cheeks, back, and upper chest. Lesions may also appear on the arms and buttocks. It is a typical course of teenage acne. In adult acne, painful eruptions usually appear on the lower part of the face, the jawline, and the side parts of the neck.

Specialists divide acne depending on the stage of its formation and course into:

• Non-inflammatory changes – blackheads (comedones acne) and oily skin
• Inflammatory changes – papules, pustules, cysts, purulent infiltrates, commonly known as pimples
• Post-inflammatory changes – discoloration, scars, and keloids

The tendency to blackhead formation usually precedes the appearance of inflammatory acne lesions and is associated with increased sebum production, leading to pilosebaceous glands’ blockage. Blackheads are a non-inflammatory symptom of acne and come in two types:

• Open, dark comedones (caused by oxidation of the keratin plug)
• Closed comedones (visible as unevenness on the skin, with yellow sebaceous plugs)

All these imperfections are characteristic of oily skin and may, but do not have to, be related to acne.

What is Oily Skin?

Oily skin is grey-yellow, usually quite thick, and shiny. Its surface has enlarged pores and blackheads (small black dots visible to the naked eye). The skin has a poor blood supply, is often pale in the morning, and has dilated capillaries that are rare.

It tolerates weather conditions like cold, wind, sun, and temperature changes. Internal factors such as hormonal disorders, nervous tension, and digestive system disorders have a significant impact on the condition of this complexion.

Oily facial skin is considered unsightly because it is often gray and earthy and prone to forming comedones – dark or light lumps from dead epidermal cells and secretions produced by seborrheic glands.

Causes

The mechanism of acne involves the interaction of many factors that cause the formation of comedones and the development of inflammation.

There are many causes of acne, including:

• Increased sebum production
• Blockage of the pilosebaceous apparatus by the corneal plug
• Colonization of the excretory duct by acne bacteria and
• inflammatory reaction
• Immune reaction

Various types of hormonal disorders result in an increase or sudden decrease in the concentration of sex hormones. This, in turn, translates into increased activity of the sebaceous glands and, as a result, overproduction of sebum, resulting in eruptions on the skin. Sex hormones that may, to a greater or lesser extent, influence the appearance of skin changes are:

• Androgens – these are male sex hormones. These include testosterone, dihydrotestosterone, androstenedione, and dehydroepianrostenedione (DHEA)
• Progesterone – a female sex hormone, regulates the menstrual cycle and also plays an essential role during pregnancy
• Estrogen is a female hormone produced by the ovaries (in men, it is produced in very small amounts in the testicles). In women, it affects the hydration and condition of the skin, as well as, among others, the work of the cardiovascular system

Androgens and testosterone have the greatest impact on the appearance of hormonal acne. In the case of female sex hormones, the occurrence of skin changes is influenced by estrogen. It is especially noticeable just before menstruation or during menopause.

Chronic stress can cause acne not only in teenagers but also in people who have already gone through puberty. Due to excessive sebum secreted, the skin quickly becomes keratinized and clogged. It contributes to the appearance of numerous inflammatory lesions on the skin surface. Interestingly, stress acne is often so intense that pus cysts even accompany it. Deterioration of the skin condition may additionally intensify emotional stress, which translates into additional intensification of symptoms. In such a state, you should realize that there is a strong connection between the emotions you experience and the stress associated with them and skin changes.

A diet rich in processed products with a high glycemic index contributes to the severity of seborrhea. Therefore, avoid dishes made from white flour and sugar. Moreover, dairy products also hurt the development of acne because they increase the insulin-like IGF-1, which also significantly stimulates sebum production. Enrich your diet with healthy Omega-3 and Omega-6 fatty acids, zinc, and selenium in appropriate proportions.

Inadequate care (especially the use of heavy, pore-clogging creams and foundations) by clogging the openings of the sebaceous glands intensifies inflammation in the skin.

In the summer, many people with acne notice an improvement in their skin’s appearance. This is due to the sun’s temporary drying effect on the sebaceous glands. Unfortunately, in the fall, most people will experience a sudden and intensified recurrence of problems—the “dry” glands receive a signal that they need to catch up on sebum production.

Sudden temperature changes may increase sebum production. A hot and humid climate is particularly unfavorable for acne development, as bacteria can easily multiply in these conditions. Its severe symptoms may also be related to using sun protection products with clogging formulas.

The sequence of events that leads to the formation of acne lesions is not precisely known. It is suspected that a microcomedone is formed first, then closed comedones and open comedones, papules, pustules, and inflammatory nodules. The process by which microcomedones develop and evolve into other acne lesions remains to be elucidated but is suspected to be influenced by a combination of several factors, including hyperkeratinization of hair follicles, increased production of sebum by the sebaceous glands of bacteria that are normal component of the skin’s bacterial flora.

Diagnosis

Acne is an easily diagnosed condition. It usually does not require additional tests. Since hormonal changes often cause it, the doctor may order additional hormonal tests, including:

• Testosterone
• Androstenedione
• DHEA or TSH
• LH and FSH
• FT4
• Progesterone

During diagnosis, acne is also differentiated from other types of skin lesions.

Treatment

The doctor will recommend appropriate treatment depending on the type of acne and its severity. Some methods are effective for treating non-inflammatory acne, while others are effective for acne associated with skin inflammation or in people with both non-inflammatory and inflammatory acne lesions. Usually, combining different drugs is more effective than treatment with one medicament.

Acne treatment includes topical medications, i.e., medications applied to the skin, and general treatments, i.e., oral tablets.

Local Treatment

Various preparations are used topically to treat acne, including:

• Acne is often treated with preparations that contain retinoids – they can be both topical and systemic. Cosmetics for acne are also highly recommended, and when used in daily care, they can support pharmacotherapy. Retinoids regulate the processes of epidermal cell renewal by exfoliating the stratum corneum and regenerating cells in the basal layer. These substances accelerate the skin’s healing process and increase its resistance to external factors, e.g., solar radiation. Preparations based on retinol help reduce skin inflammation, improve its elasticity, reduce seborrhea, reduce the problem of comedonal acne, and remove discolorations resulting from acne.
• Some anti-acne preparations contain benzoyl peroxide combined with a retinoid or antibiotic. Benzoyl peroxide can irritate the skin, causing redness and peeling.
• Topical antibiotics that have antibacterial properties and reduce inflammation. They are usually used once or twice a day. Local and oral antibiotic therapy should not be used at the same time.
• Other topical anti-acne products include salicylic acid and glycolic acid.

Anti-acne drugs should not be applied to “spots” (i.e., only on visible lesions) but on the entire surface of the affected skin, which allows for the microcomedones elimination invisible to the naked eye and the appearance of new lesions prevention.

Oral Treatment

Acne can be treated with oral antibiotics, retinoids, and hormonal medications. It applies to moderate and severe forms of acne and patients with less severe lesions if the disease significantly impairs the quality of life or if the acne lesions disappear, leaving scars.

Antibiotic Therapy

Antibiotics include macrolide. Oral antibiotics are not used alone but are combined with local treatment, e.g., with preparations containing retinoids or benzoyl peroxide applied to the skin. After completing treatment with oral antibiotics, your doctor may recommend maintenance therapy with topical medications to prevent acne from recurring. The duration of treatment with oral antibiotics should not exceed 12 weeks.

Hormonal Treatment

Hormonal treatment may be necessary in some people. Estrogen can help balance the effects of androgens, which is why estrogen treatment in the form of birth control pills is sometimes recommended for women with acne. Not all oral contraceptives should be used to treat acne, and some may even make acne worse. It also applies to some types of intrauterine devices and other forms of contraception (e.g., injections).

The advantages of using birth control pills and other hormonal methods may not be detectable until three to six months after starting treatment. Moreover, the specialists do not recommend treatment with hormonal drugs during pregnancy.

Skincare

Skincare is an essential part of acne treatment. It includes proper skin hygiene, moisturizing creams use, and sun protection.

The key role here is played by selecting appropriate cosmetics and the regularity and sequence of individual treatments.

There are three standard stages in facial care: cleansing, toning, and moisturizing. In the first step, it is significant to remove makeup thoroughly and then cleanse the skin using a gentle cleansing agent. Let’s not forget about regular exfoliation of dead skin with peeling—depending on the skin type, we can do it 1-2 times a week.

The first step will undoubtedly be to recognize its type correctly. It will make it easier to determine which nutrients will be particularly helpful for a specific skin type and choose the right cosmetics.

It is necessary to use non-comedogenic sunscreen preparations for acne-prone skin (e.g., creams). The recommended SPF protection is at least 30. Sun protection is critical, especially during treatment with retinoids – retinoids are usually used in the evening and a moisturizing cream with SPF in the morning.

Acne Scars

Acne scars are particularly challenging to treat because they are usually atrophic (tissue loss, characteristic, often extensive cavities), and due to the inflammation and purulent lesions that appear in the course of acne, they are challenging and incorrect to heal. To remove them, it is necessary to use professional treatments, such as:

• Laser therapy – the specialists use fractional lasers, which damage the tissue in “columns” at the scar site without disturbing the epidermis. It triggers a response in the skin in the form of repair processes and accelerated healing.
• Carboxytherapy – subcutaneous administration of carbon dioxide triggers repair and regeneration processes in the skin. The widening of blood vessels facilitates the flow of blood, oxygen, and nutrients, and regular use of carboxytherapy contributes to scar reconstruction and its disappearance. Additionally, mechanical puncturing of the skin with CO2 needles has a positive impact on this process.
• Microneedling – skin stimulation with needles (e.g., with a special derma roller) stimulates it to rebuild and regenerate. During the treatment, active substances with a brightening or regenerating effect may also be administered to the skin, which additionally supports the treatment of the scar. Combining microneedling with RF radio wave technology is an even more effective method.
• Chemical peeling is a chemical acid preparation used for chemoexfoliation treatment. It exfoliates the skin to improve its condition, appearance, and health. For acid exfoliation treatments to be safe, they should be performed only by specialists with the necessary knowledge and qualifications. Controlled skin damage induces healing and remodeling processes in which new and healthy ones replace damaged cells.

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