What is Acne ?
Acne is very common and effects nearly everyone to differing degrees, normally during the teenage years.
Acne is caused when tiny holes in the skin, known as hair follicles, become blocked. The Sebaceous (oil producing) glands are tiny glands found near the surface of your skin. The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of.
Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum. Sebum is the substance that makes your head hair oily if you don't wash your hair regularly.
In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances block the follicle.
If the blocked follicle is close to the surface of the skin, it bulges outwards, creating a whitehead. Alternatively, the blocked follicle can be open to the skin, creating a blackhead. Normally harmless bacteria that live on the skin can then contaminate and infect the blocked follicles, causing papules, pustules, nodules or cysts.
It usually starts at puberty and may vary in severity from minor breakouts on the face, neck, back and chest to a more severe problems that may cause embarrassment and physical scarring. Noramlly, acne tends to resolve by the late teens or early twenties but can persist for longer into adult years.
The most devastating effect of acne is the facial scarring that may be left once the inflammatory lesions have gone. This scarring is difficult to trea,t but microneedling has been found to significantly reduce the appearance of scars.
What Causes Acne ?
The sebaceous (oil-producing) glands of patients who get acne are particularly sensitive to testosterone levels. This is a hormone present in both men and women and causes the sebaceous glands to produce an excess of oil. At the same time, the dead skin cells that are continually being shed from our skin and line the pores are not shed properly and clog up the follicles. This all results in a build-up of oil causing black and whiteheads.
In this environment, the acne bacterium, which lives on everyones skin can multiply. This triggers inflammation and the formation of red or pus-filled spots.
How can acne be Treated ?
There are a number of different methods to try and treat acne both from within and externally. Creams and skin care regime work well, but in some cases antibotic or hormone pills will also be required.
This is one of the easiest ways to help reduce acne. Adequate washing and skin care can help to remove bacteria and oils which cause acne. Cleaning the hands before touching the affected area can prevent transmission of the bacteria and further spread.
Benzoyl peroxide gel or cream may be applied twice daily, into the pores over the affected region. It is one of the mainstays of acne treatment and works by killing bacteria on the skin surface by oxidisation. Benzoyl peroxide is not an antibiotic and thus the bacteria do not form resistance to it. Another property is that it dissolves the keratin plugging the pores which can lead to spots forming. However, it can cause dryness, local irritation and redness.
Niacinamide for acne
Nicotinamide, also known as niacinamide, is the amide of nicotinic acid (vitamin B3 / niacin). Niacinamide is a water-soluble vitamin and is part of the vitamin B group. Whilst niacinamide is primarily known as an immune protectant (guards against skin cancer) and for treating areas of skin pigmentation, niacinamide has also been demonstrated to reduce sebum production and thus is a highly useful treatment for acne. Furthermore, it has a stabilising effect on epidermal barrier function and reduces water loss from the skin, therefore keeping it firm and hydrated. For further information click here.
Topical antibiotics such as erythromycin, clindamycin or tetracycline kill the bacteria found in the blocked follicles. It is applied directly to the skin in the form of a clear liquid or cream and can be as effective as oral (tablet) antibiotics but without some of the side-effect of tablets. The disadvantage is that if the acne is widespead it may not be practical to apply the cream or liquid to a large area.
Oral antibiotics used to treat acne include erythromycin and tetracyclines such as minocyclin and lymecycline (Tetralysal) to kill the bacteria. However reducing the p.acnes bacteria will not reduce the oil secretion and abnormal inflammation which cause of the blocked follicles. Secondly, resistance to p.acnes is becoming more and more common. It should be noted that it may take several weeks for these medications to cause visible results; in addition, oral antibiotics have interactions with other drugs, such as the contraceptive pill, and side effects such as an upset stomach. Patients often require months or even years of treatment with antibiotics and therefore many patients look for alternative approaches.
In females, acne can be improved with hormonal treatments. This is usually achieved with an oral contraceptive pill called dianette which reduces androgens produced.
These are a family of medicines related to vitamin A. They act by normalising the follicle cell cycle and preventing hyperkeratinization which contributes to blockage of the follicles. They can be highly effective but can cause irritation and also a flare up the acne when first used. Recently some over the counter moisturisers are advertised to contain retinoids; however, this will be in very small concentrations compared to that which is available from a doctor.