Acne results from oily skin and the appearance of pimples on the face, upper back and chest. More embarrassing than serious, acne (sometimes called "acne vulgaris") is typically a skin disease of adolescents that can have significant psychological repercussions. In 90% of cases, it disappears spontaneously between the ages of 20 and 25. However, when this skin disease is particularly severe, scarring may remain permanently.

What is acne?

Acne is a skin disease that mainly affects teenagers. Even if it is not serious, it can have significant psychological consequences at the age when it appears, mostly due to the way others look at it. Because of an excess of sebum production, most often because of the hormonal upheavals of puberty, this skin disease can require a long and restrictive treatment. In the vast majority of cases, acne disappears spontaneously in adulthood. Although it can cause the appearance of infected pimples (pustules), it is not an infectious disease. It is an increase in the production of sebum by the skin that comes along the obstruction of the hair follicles (where the hair forms) and the proliferation of microorganisms.

Acne rosacea (or just rosacea) is a disease that has nothing to do with acne vulgaris. 

Who is affected by acne?

To a more or less intense degree, acne affects more than 70% of adolescents, especially boys. In the majority of cases, it is minor and hardly needs treatment. Nevertheless, even moderate one can have psychological impact and social consequences. Adult women can also have this skin disease, particularly a few days before menstruation, when starting oral contraceptive treatment (pill), during pregnancy or at the time of menopause.

What are the symptoms of acne?

Acne lesions occur mostly on the nose, forehead, cheeks, upper back, shoulders and upper torso. Retentional acne results in blackheads or whiteheads. Meanwhile, inflammatory acne results in nodules and cysts that can leave red marks that tend to disappear over time, sometimes leaving a dark spot or scar. In general, it progresses in flare-ups, with periods of relief here and there.

The different types of acne:

Broadly, there are two types depending on the absence or presence of inflammation around the skin lesions. This inflammation results in red, swollen lesions that are warmer than the surrounding skin.

Retentional acne:

This form is devoid of signs of inflammation. The lesions are open (“blackheads”) or closed (“whiteheads”) comedones, resulting from the accumulation of excess sebum in the hair follicles.

Inflammatory or mixed acne:

This form is all about inflammation. The lesions can be superficial (papules which can develop into pustules) or deep (nodules and cysts). When the nodules and cysts rupture, they can leave more or less lasting scars, or red marks that tend to disappear over time, sometimes leaving a patch that is a little darker than the rest of the skin.

Causes of acne:

Acne is the combination of several factors. Understanding the mechanisms behind it's appearance is essential to understand the treatments that are prescribed to cure it.

Sebum hypersection:

Sebum is an oily substance produced by sebaceous glands present in hair follicles, the little sacs within the skin that make body hair. Usually, the sebum release causes its diffusion out of the follicles to form a thin film on the skin to protect it from drying out and external aggressions. In the case of acne, the sebaceous glands of the face and upper body secrete an abnormally high quantity of sebum: the skin becomes oily. This excessive secretion is the result of the action of sex hormones, whether at the time of puberty or, in adult women, at certain times of the menstrual cycle or pregnancy.

What is induced acne?

Induced acne is one that appears under the action of certain medications. The drugs most often responsible for it are:

• sex hormones (testosterone, estrogen, birth control pills, etc.),
• cortisone derivatives,
• medicines intended to reduce the action of the immune system (immunosuppressants),
• certain antibiotics,
• antiepileptics,
• Certain antidepressants,
• lithium (for bipolar disorders treatment).

This acne is reversible when the responsible treatment is stopped.

What is seborrheic retention?

In acne, the walls of the channel that connects each orifice of the hair follicles to the surface of the skin tend to thicken, thus reducing its diameter and partially blocking the diffusion of sebum out of the follicle. This phenomenon, inaddition to the excessive production of sebum, causes an accumulation of sebum in the follicle. This increases in volume and sometimes breaks under the pressure of the building-up sebum. Seborrheic retention is responsible for the formation of comedones (black pimples and white pimples).

Follicle inflammation:

When a follicle is clogging and sebum fills it, inflammation can occur, leading to both follicle damage and the overgrowth of a microorganism called Propionobacterium acnes. This microorganism is naturally present in the follicles. In the presence of large amounts of sebum (which it feeds on), Propionobacterium acnes multiplies excessively and contributes to inflammation of the follicle and surrounding skin. Papules or nodules then form. Superinfection of the follicle by other bacteria present on the skin, resulting in the appearance of a pustule or cyst containing pus is possible.

Risk factors:

The influence of certain risk factors is responsible for the appearance of acne:

• It seems that it's more frequent in certain genetic family lines.
• The use of oily cosmetics that tend to clog hair follicles.
• Certain industrial chemicals which also clog hair follicles.
• Use of anabolic steroids to build muscle.
• Repeated rubbing on areas of the skin where acne usually develops (for example, backpacks on the shoulders).
• A tendency to sweat profusely.

Diagnosis:

The diagnosis of acne is made in view of the lesions and the characteristics of the patient (age, sex, use of contraceptives or other medications, etc.). Depending on the lesions observed and their extent, the doctor defines the degree of severity of the disease: minor, moderate or severe. Indeed, severe acne identification factors are the presence of nodules and cysts which increase the risk of lasting scarring. The doctor also asks how it affects the image of the person who suffers from it.

Depending on these different parameters, he chooses a treatment to which the patient adapts giving into consideration the severity of the acne. The treatment of acne involves different treatments, some intended to be applied to the skin, others for oral intake. In fact, about 10 and 20% of people who suffer from this skin disease require treatment. This will have to continue for several months or even a year.

Skin hygiene as a treatment:

The first element of acne treatment is the respect of skin hygiene rules. Under no circumstances should you scratch or press the pimples. This advice, repeated a thousand times, is however hardly followed, whereas the manipulation of acne lesions can lead to the appearance of irreversible scars. Resist the temptation and avoid touching the lesions other than as part of the care prescribed by the doctor. To wash, choose a “soap-free” gel or bar, which dries out the skin less. After washing, moisturize your skin abundantly even if it tends to be oily. Proper hydration protects the skin and regulates sebum production. Moreover, there are many products in pharmacies responsible for the hygiene and care of oily or acne-prone skin.

What are the complications of acne?

Apart from the scars and more colored marks on the skin, the complications of acne are mostly psychological. To prevent acne from becoming a social handicap, it is essential that people who suffer from it are medically taken care of, even if it is objectively minor. Psychological suffering is a sufficient reason for implementing drug treatment, possibly supplemented by psychological help.

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