ACNE VULGARIS (PIMPLES)

Overview of Acne Vulgaris

Acne vulgaris, also known as common acne, is a skin condition that represents the commonest form of inflammatory dermatitis, which occurs when the follicles of the skin are blocked with bacteria, sebum, and dead skin cells. The blocked follicles give rise to blemishes on the skin like pimples, blackheads, whiteheads, and cysts which mostly affect the face, back, and chest. Acne can present as non-inflammatory lesions, inflammatory lesions, or a mixture of both. It is also a disorder of the sebaceous glands in the skin that produces various oils (sebum) and fatty acids to help keep the skin firm and supple.

Types of Acne Vulgaris

Acne vulgaris is classified into two main types:

1. Inflammatory Acne Vulgaris

2. Non-Inflammatory Acne Vulgaris

Inflammatory Acne Vulgaris

This is a type of acne that comes with redness and inflammation accompanied with pains on the skin. It is caused by bacteria, dirt, and excessive oil in the hair follicles.  Examples of inflammatory acne are pustules, papules, nodules, and cysts.

Non-inflammatory Acne Vulgaris

It’s a type of acne vulgaris that does not come with pain or swelling and is caused by sebum clogged in the hair follicle of the skin. It mostly appears on the face chest and back. It is also known as comedones which include whiteheads and blackheads. The treatment recommended for comedones is mainly salicylic acid which is found mostly in cleansers, toners, and moisturizers and serves as a great exfoliator for the skin.

Blackheads (Open comedones)

They are small dark bumps and lesions that appear on the skin characterized by their black appearance, the top of the pore stays open. It occurs when the pore of the skin gets blocked with dead skin cells, dirt, and excess sebum.

Whiteheads (closed comedones)

The whitehead is a type of acne in which the pore of the skin gets clogged with sebum, bacteria, and dirt, and the top of the pore stays closed. It appears white and could be caused because of stress, hormonal changes, and genetics.

The severity of Acne Vulgaris

1. Mild Acne: This category of acne is where the non-inflammatory acne falls in, the blackheads and whiteheads are sometimes treated with salicylic acid-based cleanser or benzoyl peroxide-based cleanser.

2. Moderate Acne: The pustules and papules are moderate acne that might not be treated with over-the-counter medications it may require having an appointment with the dermatologist to get an oral or topical treatment.

3. Severe Acne: Nodules and cysts are the most severe type of acne and should not be popped or picked because they could lead to severe scars. This type of acne requires a dermatologist appointment to get it treated.

Causes of Acne Vulgaris

The various causes of Acne Vulgaris are listed below;

1. Excessive oil production

2. Bacteria

3. Obstruction of the follicles of the skin with dead skin cells

4. Polycystic Ovarian Syndrome (PCOS)

5. Some medications that contain corticosteroids

6. Gastrointestinal Conditions like Dysbacteriosis, Ulcerative colitis

Risk factors for Acne Vulgaris

These include:

1. Age

2. Hormonal changes

3. Genetics

4. Diet

5. Cosmetics and lotions

6. Lifestyle

7. High Humidity

8. Stress

Signs and symptoms of Acne Vulgaris

The symptoms of Acne vulgaris are typical which are;

1. Blackheads

2. Swelling of the skin either on the face, chest, back shoulder, or the T-zones on the face

3. Erythema

4. Tenderness

5. Small red tender bumps (papules)

6. Whiteheads

7. Pimples with pus at the tip (pustule)

8. Big large, painful bumps under the skin (nodules)

Prevention of Acne Vulgaris

Prevention of Acne Vulgaris is done in many ways which are listed below;

1. Staying hydrated all the time

2. Washing the face with warm water and mild soap at least twice a day to remove excess oil, dirt, and sweat daily

3. Changing pillow sleeves at least twice weekly to avoid dirt and oil accumulation

4. Limit the use of makeup to prevent blockage of the skin follicles

5. Avoid frequent touching of the face so as to prevent the spread of germs and dirt to the face

6. Always wear sunscreen to prevent skin damage

7. Avoid harsh scrubbing of the face to prevent irritation and damage to the outermost layer of the skin

8. Ensure that whatever you put on your head is clean and not dirty also keep your hair clean

9. Reduce intake of foods that can cause acne-like oil.

10. Try and keep your stress level in check to prevent breakouts

Treatment of Acne Vulgaris

Acne Vulgaris is treated with different options which are;

1. Topical Agents

2. Antibiotics

3. Diet

4. Hormonal Therapy

Topical Agents

The choice of topical agents can be made depending on the individual age, severity of the acne, and the site of the acne. Benzoyl Peroxide, niacinamide, Retinoids, azelaic acid, and salicylic acid are the topical agents used for the treatment of mild to moderate acne. For acne in children who have not attained puberty yet, it’s advisable to use mild topical agents like differin, tretinoin, and benzoyl peroxide to treat mild acne.

Systemic Antibiotics

Systemic antibiotics are mostly used for the treatment of moderate acne, studies have also shown that the use of tetracycline and macrolides are effective in the treatment of acne while doxycycline has proven to be more effective than tetracycline. Oral erythromycin and azithromycin are to be used for individuals whose tetracycline is contraindicated (pregnant women).

The Antibiotics should be prescribed and only used for the span of 2 to 4 months so as not to develop drug resistance.

Diet

Changes in diet have not proven to be effective in the treatment of acne, but various studies have shown that acne can be linked to a high intake of oily foods and milky products so it is advisable to reduce the intake of oily food and milky products.

Hormonal Therapy

The hormonal therapy used is mostly estrogen therapy in combination with progesterone, which suppresses the sebum production and reduces oiliness of the skin, dominant oral contraceptives are administered on a cycling regimen by a doctor, and this therapy is not used for men.

Surgical Treatment of Acne

The Surgical treatment options for acne are listed below;

1. Cryotherapy

2. Dermabrasion of scars

3. Laser therapy

4. Drainage of pustules and cysts

5. Excisional therapy of sinus and cysts

Complications of Acne Vulgaris

These include:

Self-esteem Challenges: Acne doesn’t affect the skin of an individual but also affects how an individual feels about themselves which could be very challenging at times. Most of the time there is a feeling of unattractiveness, insecurity not being able to interact well with people which develops into low self-esteem issues in the long run.

Post-inflammatory hyperpigmentation: After the acne has been healed the skin becomes hyperpigmented because of excessive deposits of melanin causing the skin to give rise to darkened spots which fade over time with proper use of sunscreen.

Excoriated acne: It’s a type of acne complication that happens when there is consistent touching of the face and popping of pimples.

Scarring: It occurs when the acne has healed and there is the development of scars and keloids.

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