Types
The following clinical forms are distinguished:
- Adolescent acne (acne juvenilis) is most severe during puberty and usually heal after a few years. Blackheads and small lumps are the main signs, mostly seen on the face and back.
- Acne conglobata is more common in males and involves deep lumps, pus-filled cysts, and large blackheads. This type of pimple often affects the armpits, groin, and buttocks. Scars form during the healing process.
- Acne keloid involves the formation of raised scars within pimple breakouts.
Causes
The mechanism of acne vulgaris involves the interaction of many factors that cause the formation of comedones and the development of inflammation.
There are many causes of pimples, including:
- Increased sebum production
- Blockage of the pilosebaceous apparatus by the corneal plug
- Colonization of the excretory duct by Cutibacterium acnes bacteria
- Inflammatory reaction
- Immune reaction
Male sex hormones, called androgens, also play a part – they encourage the production of sebum. High levels of androgens in the blood, known as hyperandrogenism, can lead to pimples, but most people with acne vulgaris do not have too many androgens.
There’s a suspicion that diet can affect pimples, where milk and high-glycemic-index products might have a negative effect.
Genetic factors play an essential role in causing these skin issues. People with persistent pimples usually have family members who have also had acne.
Factors That Exacerbate Pimples
The course of pimples is chronic, usually in the summer the lesions improve. Various factors may contribute to the exacerbation of acne lesions, such as:
- Repeated mechanical injuries to the skin caused by scrubbing the skin with cosmetics (soaps and astringents)
- Increased consumption of milk and products with a high glycemic index
- Stress
- Insulin resistance
- Too little body weight or excessive body weight (measured according to the BMI)
Emotional And Social Effects Of Pimples
The impact of pimples on the emotional state depends on several individual factors – starting from mental sensitivity and resilience, through the professed system of values and primary self-esteem, to external circumstances, such as support from the environment or access to specialist care.
Due to the ubiquitous cult of the body and the power of media messages full of retouched, flawlessly smooth faces, skin ailments often cause complexes and lower self-esteem. People struggling with pimples also tend to blame themselves and look for their sources in improper care, poorly selected diet, or negligence. They immerse themselves in a paralyzing sense of guilt, which, combined with a sense of shame, often leads to social withdrawal.
All this translates into their social life and everyday functioning in study and work. Low self-esteem prevents you from taking up professional challenges and achieving your goals.
Diagnosis
The doctor diagnoses pimples based on the clinical picture, interview, and additional tests performed. Some people require additional tests, such as hormonal tests.
Skin Care
Wash the face twice daily. It helps to remove impurities, dead skin cells, and extra oil from the skin’s surface. Cleaning more often than twice daily may do more damage than good. Use warm water and a mild facial cleanser. Using an intense soap can harm already inflamed skin and induce more irritation.
Peeling
Regular exfoliation prevents the formation of horny plugs at the mouths of the sebaceous glands and hair follicles, which, by blocking the excretion of sebum, lead to the formation of blackheads or, as a consequence, inflammatory eruptions. The selection of the appropriate peeling depends on the type of pimples and skin reactivity. In the case of inflammatory lesions, especially purulent ones, avoid mechanical peelings as they could cause the lesions to spread.
Toning
Toning is not an essential step in skin care, but properly selected products can enhance the effects of other cosmetics. Skin toning should be done every time our skin comes into contact with water and cleansing agents – gel, facial foam, or peeling, regardless of whether we cleanse our face during the morning or evening toilet. It is especially important in the evening because during night care, we usually also apply moisturizing creams or serums to our facial skin, which are supposed to improve the condition of our skin. Toned skin will absorb the applied products much better.
Serum
When caring for problematic skin, it is worth using a serum that normalizes the functioning of the sebaceous glands. Cosmetics with a concentrated content of ingredients such as niacinamide (vitamin B3), zinc, azeloglycine, lactobionic acid, prebiotics, probiotics, and postbiotics will support the skin in the fight against imperfections and reduce the visibility of dilated sebaceous gland openings. Serums with acids will also work well in evening care.
Moisturizing
Properly moisturized skin stops producing excess sebum. When choosing moisturizing cosmetics for acne-prone skin, you should avoid comedogenic ingredients, which may contribute to the formation of blackheads.
After applying a moisturizing cream, you cannot forget about protection against UV radiation and applying a product with a high SPF filter (minimum 30).
Can You Squeeze Out Pimples?
Acne skin lesions (blackheads, inflammatory lumps) should not be squeezed out, as this may result in unsightly scars and discolorations that are very difficult to treat later.
Over-the-counter Medications
For people with mild acne, you can initially try self-treatment with over-the-counter products. Over-the-counter acne treatments may include products containing salicylic acid, benzoyl peroxide, sulfur, alpha-hydroxy acids, adapalene, or tea tree oil. Combining several measures may be more effective than using just one product.
Treatment
The doctor will recommend appropriate treatment depending on the type of acne and its severity. Some methods are effective for treating non-inflammatory pimples (e.g., blackheads). In contrast, others are effective for acne associated with inflammation (e.g., inflammatory nodules) of the skin or in people with both non-inflammatory and inflammatory acne lesions. Usually, combining different medications is more effective than treatment with one drug. Acne treatment involves both topical medicaments applied to the skin and oral tablets.
Local Treatment
Different topical treatments are used to manage pimples, including:
- Local retinoids are typically applied once daily, but due to potential skin irritation, they can be used less frequently, for example, every other day. Although retinoids are fundamental in acne therapy, their irritating effects may deter some patients, as initial use can cause burning, redness, and dry skin. Consequently, doctors may recommend starting with less sensitive areas of the face or using them only 2-3 times a week, then gradually increasing the frequency to allow the skin to adjust and improve tolerance. Retinoids can cause skin irritation and increase the risk of sunburn. Use sun protection (SPF 30 or higher) when using retinoids. Pregnant women should avoid using retinoids.
- Topical antibiotics with antibacterial properties that reduce inflammation – are usually applied once or twice a day. Local and oral antibiotic therapy should not be used simultaneously.
- Azelaic acid is available in 15–20% cream or gel form. This preparation is well-tolerated, making it especially recommended for patients with delicate, sensitive, dry, or atopic skin and individuals with pimples discoloration due to its brightening effect. It is safe for use during pregnancy.
- Other topical anti-acne products such as salicylic acid and glycolic acid.
Oral Treatment
Acne is treated with oral antibiotics, retinoids, and hormonal medications. It applies to moderate and severe forms of pimples but also 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 tetracyclines and macrolides.
Oral antibiotics are not used alone but are combined with local treatment, e.g., with preparations with retinoids or benzoyl peroxide applied to the skin. After completing treatment with oral antibiotics, the doctor may recommend maintenance therapy with topical medications (retinoids or azelaic acid) to prevent acne flare-ups.
Retinoids
Oral retinoids are powerful drugs that are effective in treating severe acne. They cure or significantly improve acne in most people.
Oral retinoids are usually taken as tablets once or twice daily with food for several months and then discontinued. In some cases, pimples can initially get worse before it improves. To decrease the risk of an initial acne flare-up, retinoids are occasionally given at a lower dose for the first month of treatment.
Retinoids are a very effective drug, but their use is associated with the risk of many side effects. For this reason, and due to the need to periodically perform laboratory tests (before treatment, 4 weeks after starting treatment, then every 3 months), dermatologists should perform retinoid treatment. Due to the harmful effects on the fetus and the higher risk of obstetric complications, it is necessary to use effective contraception, starting at least 4 weeks before treatment and maintaining it for at least 4 weeks after its completion. Retinoids do not affect spermatogenesis and can be safely used in men.
Hormonal Treatment
Hormone 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. This also applies to some types of intrauterine devices and other forms of contraception (e.g. injections).
The benefits of using birth control pills and other hormonal medications may not be noticeable until three to six months after starting treatment. Treatment with hormonal drugs is not recommended during pregnancy.
Treatment During Pregnancy
Many anti-acne medications cannot be used during pregnancy. Any woman who is pregnant or intends to become pregnant should consider discontinuing acne treatment before attempting to become pregnant and discuss further management with her healthcare provider.
Diet
When considering whether there is an ideal diet for pimples, we should remember that acne is a skin disease. Therefore, an appropriate diet will not bring satisfactory results, but it may be a significant element of anti-acne treatment. On the Internet, we can find many opinions about what type of diet will be most effective in reducing the symptoms of acne. It includes, among others, gluten-free, vegan, paleo or ketogenic diets. Unfortunately, not all of them may be suitable for us. If it is not properly balanced, it may lead to deficiencies in our body.
Vitamins and minerals also play a significant role in the acne diet. Particularly important are:
- Zinc
- B vitamins
- Antioxidants
Sources
- Adolescent acne vulgaris: current and emerging treatments. NIH.
https://pubmed.ncbi.nlm.nih.gov/36525984/ - Acne Conglobata. NIH.
https://pubmed.ncbi.nlm.nih.gov/29083736/ - Acne Keloid. NIH.
https://www.ncbi.nlm.nih.gov/mesh?Db=mesh&Cmd=DetailsSearch&Term=A10.165.450.300.425.125%5BAll+Fields%5D - Overview, Symptoms, & Causes. NIH.
https://www.niams.nih.gov/health-topics/acne - The Psychosocial Impact of Acne Vulgaris. NIH.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029236/ - Acne: Diagnosis, Treatment, and Steps to Take. NIH.
https://www.niams.nih.gov/health-topics/acne/diagnosis-treatment-and-steps-to-take - Keep Your Skin Healthy. NIH.
https://newsinhealth.nih.gov/2015/11/keep-your-skin-healthy - Understanding Acne. NIH.
https://newsinhealth.nih.gov/2010/01/understanding-acne - Over the Counter Products for Acne Treatment and Maintenance in Latin America: A Review of Current Clinical Practice. NIH.
https://pubmed.ncbi.nlm.nih.gov/33683089/ - Treatment Modalities for Acne. NIH.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6273829/ - Diet and acne: A systematic review. NIH.
https://pubmed.ncbi.nlm.nih.gov/35373155/
