Although everyone relates it to the development and maturity period, not only adolescents have acne . It is true that the symptoms of this disease are more common during puberty, but acne can appear even in babies, and some people develop acne-prone skin in adulthood.
There are many forms of acne classifications. Sometimes it is classified according to the age at which it appears, thus distinguishing between baby acne, adolescent acne, adult acne, etc., but it can also be differentiated based on the severity of its symptoms. In other cases, the different forms of acne are grouped according to the external causes that lead to oily and problematic skin (cosmetic acne).
With the appearance of acne, the skin becomes oily and white or black bumps appear, both open and closed, on the face, neck, shoulders, chest and back. In moderate and severe cases, the skin becomes red and inflamed papules and pustules appear.
How does acne occur?
There are pores on the surface of the skin, and sebaceous glands below it. We could say that these follicles are where the hairs are inserted, where the ends of the hairs that we do not see on the surface of the head are contained. Interestingly, that little bag that each hair contains is also where the fat is excreted. Because of this, someone may have oily hair or skin. Thus, this sack is called a pilosebaceous follicle, and the multiple follicles that we have are connected to the sebaceous glands, which produce sebum, fat. Sebaceous glands secrete this oily substance, sebum , to lubricate hair and skin, but sebum production can be stimulated by conditions such as weather conditions, certain medications, hormones, and genetics.
If sebum and dead skin cells accumulate in the follicles, there is a good base for the development of bacteria such as Propionibacterium acnes, Staphylococcus epidermidis or Malasezzia furfur , all capable of accumulating and creating a plug , inflammation and swelling. The result is red, inflamed skin. Thus, acne is an inflammatory disease of the pilosebaceous follicle, directly related to the presence of androgens (either by genetics, microorganisms, medications, etc.).
In severe cases of acne, the follicle wall bursts in the last phase of inflammation, releasing lipids, fatty acids, corneocytes, bacteria and cell fragments, causing further deep inflammation in the surrounding tissue.
Most cases of acne clear up on their own after puberty, however, effective treatments are needed to prevent permanent scarring.
hormones
As we mentioned, acne is directly related to androgenic hormones , which are intensely secreted at puberty and affect the enlargement of the sebaceous glands. Androgens are male sex hormones and correspond to testosterone , androsterone, and androstenedione. Androgens, basically testosterone, are secreted by the testicles, but also by the ovaries in women (androstenedione) and by the adrenal cortex of the adrenal glands (mainly dihydroepiandrosterone).
The alteration in the response of the sebaceous gland to androgens, among other possible but less probable factors, leads to an increase in sebum secretion and the appearance of acne.
As for acne in adulthood, it can occur in women with conditions induced by hormones, such as polycystic ovary syndrome. Psychological stress can also be a trigger for acne in adult women.
Acne can be stressful, affect facial aesthetics, and can sometimes be painful. Therefore, the person should contact a dermatologist , whether it is a milder form or not. This prevents deterioration of the condition and scar formation and speeds up the healing process. The dermatologist will identify the factors that have influenced the appearance of acne, determine the treatment, and give advice on proper nutrition and care.
acne treatment
Mild forms are mainly treated superficially based on gels, soaps, lotions and creams, depending on the type of skin. The ingredients that these preparations contain are usually azelaic acid and benzoyl peroxide (with an antibacterial effect), retinol (clogs pores), resorcinol and salicylic acid (removes blackheads and pimples).
When it comes to severe forms of acne that threaten to leave scars, a visit to a dermatologist is mandatory. If it is pure and inflamed acne, a corticosteroid injection may be recommended, after which the inflammation will disappear and no scar will remain.
Oral antibiotics are prescribed for severe forms of acne that are overpopulated with bacteria. They are usually tetracyclines and erythromycin. According to the doctor’s recommendations, they can be used up to 6 months.
In adult women, due to hormonal imbalance, skin changes and even acne occur. So, gynecologists often recommend oral contraceptives. The most important thing is that the gynecologist excludes all risk factors for the use of oral contraceptives, so it is important not to “self-medicate”, but to consult a professional.
When other medications and treatments don’t help, oral retinoids are prescribed. Its side effects can be serious, so the patient must agree that they want to be treated with it. These include mood swings, dry mouth, dry skin, nosebleeds, etc. Vitamin A should be avoided during therapy to avoid vitamin A toxicity.
Ultimately, the causes of acne are as different as its duration . The child is likely to inherit problem skin from the parents, but there are many other factors. It is important that when acne appears, it is treated to prevent scar formation. To achieve this, several factors related to emotional state, diet, care or lifestyle in general must be taken into account.
To avoid acne complications , keep emotional stress, cigarettes, sugars, sugary drinks, and alcohol to a minimum. Don’t squeeze pimples to prevent them from reddening, or worse, closing your pores and creating scars. The face should be cleaned twice a day with preparations suitable for the type of skin. Make-up should suit sensitive skin, and be sure to remove make-up before bed. A person with acne should keep it away from the face while talking on the phone. Glasses should be cleaned regularly, as well as tissues or anything that comes into contact with the skin. Excessive sun exposure is also a risk factor. It increases the production of sebum and sweat, which is a good base for bacteria.
References:
Acné (2020, revisión). National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/acne#a
Adult acne. (s.f.). American Academy of Dermatology Association. https://www.aad.org/public/diseases/acne/really-acne/adult-acne
Azelaic Acid Topical. (2016, review). MedlinePlus. https://medlineplus.gov/druginfo/meds/a603020.html
Bagatin, E., Costa, C. S., Rocha, M., Picosse, F. R., Kamamoto, C., Pirmez, R., et.al. (2020). Consensus on the use of oral isotretinoin in dermatology – Brazilian Society of Dermatology. Anais brasileiros de dermatologia, 95 Suppl 1(Suppl 1), 19–38. https://doi.org/10.1016/j.abd.2020.09.001
Fitz-Gibbon, S., Tomida, S., Chiu, B. H., Nguyen, L., Du, C., Liu, M., Elashoff, D., Erfe, M. C., Loncaric, A., Kim, J., Modlin, R. L., Miller, J. F., Sodergren, E., Craft, N., Weinstock, G. M., & Li, H. (2013). Propionibacterium acnes strain populations in the human skin microbiome associated with acne. The Journal of investigative dermatology, 133(9), 2152–2160. https://doi.org/10.1038/jid.2013.21
Lin, C.Y. (s.f.). Intralesional steroid injection. DermNet NZ. https://dermnetnz.org/topics/intralesional-steroid-injection
