Acne; Causes, Treatments; Skin Care

 

Lecture on Acne

1. Introduction

Acne is one of the most common skin conditions worldwide, affecting nearly 85% of people at some point in their lives. Though often associated with adolescence, it can persist into adulthood. Acne is not simply a cosmetic problem — it can affect self-esteem, mental health, and even leave permanent scars.

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2. What is Acne?

Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit — that’s the hair follicle plus its attached oil (sebaceous) gland.

The main clinical features include:

• Comedones (blackheads and whiteheads)

• Papules and pustules (red or pus-filled bumps)

• Nodules and cysts (deeper, more painful lesions)

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3. Pathophysiology (Why it Happens)

Acne develops due to four main processes working together:

1. Increased sebum production

   • Triggered by androgens (male-type hormones present in both sexes).

   • Oily skin provides the perfect environment for acne.

2. Abnormal keratinization

   • Skin cells lining the follicle don’t shed normally.

   • They clump together, plugging the pore.

3. Bacterial overgrowth

   • The main bacteria is Cutibacterium acnes (formerly Propionibacterium acnes).

   • It thrives in clogged, oily follicles.

4. Inflammation

   • The immune system reacts to bacteria and blocked pores, creating redness, swelling, and pain.

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4. Risk Factors

• Age: Most common in teens, but can appear at any age.

• Hormones: Puberty, menstrual cycles, pregnancy, or hormonal disorders (like PCOS).

• Genetics: Family history strongly influences acne severity.

• Diet: High-glycemic foods, dairy, and certain fats may worsen acne in some people.

• Stress: Doesn’t cause acne, but can flare it.

• Cosmetics or medications: Heavy oils, steroids, or certain drugs may trigger outbreaks.

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5. Classification (Types of Acne)

• Mild: Mostly comedones, few papules/pustules.

• Moderate: More widespread papules and pustules.

• Severe: Nodules, cysts, risk of scarring.

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6. Treatment Approaches

Treatment depends on severity and patient profile.

Topical therapies (first-line for mild acne):

• Benzoyl peroxide → kills bacteria, reduces inflammation.

• Retinoids (adapalene, tretinoin) → unclog pores, normalize shedding.

• Topical antibiotics → clindamycin, erythromycin (often combined with benzoyl peroxide).

Systemic therapies (for moderate-to-severe acne):

• Oral antibiotics (doxycycline, minocycline).

• Hormonal therapies (oral contraceptives, spironolactone in women).

• Isotretinoin (“Accutane”) → highly effective but with significant monitoring.

Other approaches:

• Chemical peels, laser/light therapy.

• Gentle skin care (non-comedogenic moisturizers, mild cleansers).

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7. Psychosocial Impact

• Acne can affect self-esteem, social interactions, and mental health.

• Studies link it with higher rates of anxiety and depression.

• Addressing these aspects is as important as treating the skin.

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8. Prevention & Myths

• Washing too much doesn’t “cure” acne — over-washing can irritate skin.

• Chocolate and greasy foods are not direct causes, though diet plays a role.

• Acne is not caused by poor hygiene.

• Early treatment reduces the risk of scarring.

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9. Conclusion

Acne is a multifactorial condition involving hormones, oil production, bacteria, and inflammation. While common, it deserves serious attention because of both its physical and emotional impact. Modern medicine offers many effective therapies — but management often requires patience, consistency, and sometimes a combination of treatments.

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6. Treatment Approaches

Treatment depends on severity and patient profile.

Topical therapies (first-line for mild acne):

• Benzoyl peroxide → kills bacteria, reduces inflammation.

• Retinoids (adapalene, tretinoin) → unclog pores, normalize shedding.

• Topical antibiotics → clindamycin, erythromycin (often combined with benzoyl peroxide).

• Salicylic acid → a beta hydroxy acid (BHA) that penetrates into pores, exfoliates inside the follicle, helps unclog blackheads/whiteheads, and reduces inflammation.

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6a. Comparing Key Topical Therapies

• Salicylic Acid

  • Belongs to the beta hydroxy acid (BHA) family.

  • Best for: Blackheads and whiteheads (comedonal acne), oily skin.

  • How it works: Penetrates into pores, dissolves excess oil, and exfoliates dead skin cells inside the follicle.

  • Side effects: Can cause dryness or mild irritation, but generally gentler than benzoyl peroxide.

• Benzoyl Peroxide

  • A strong antimicrobial and anti-inflammatory agent.

  • Best for: Red, inflamed pimples and preventing antibiotic resistance when used with topical antibiotics.

  • How it works: Kills Cutibacterium acnes bacteria and reduces inflammation.

  • Side effects: Dryness, peeling, redness, and bleaching of fabrics.

• Retinoids (Adapalene, Tretinoin, etc.)

  • Vitamin A derivatives, considered the backbone of acne therapy.

  • Best for: Preventing clogged pores, treating both comedonal and inflammatory acne, and improving skin texture.

  • How they work: Normalize skin cell turnover, unclog pores, and reduce inflammation.

  • Side effects: Dryness, peeling, photosensitivity — requires sunscreen.

👉 Summary for patients/students:

• Salicylic acid clears pores and is great for oily, blackhead-prone skin.

• Benzoyl peroxide is a bacteria-killer, best for inflamed pimples.

• Retinoids prevent new breakouts and help long-term skin health, but require patience and consistent use.

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