Acne Vulgaris

 

Overview

 

One of the most common skin conditions amongst adolescents is acne, which most commonly appears on the face, back and chest. This could potentially lead to self esteem and psychosocial effects. Although acne is most common in teenagers, it can persist into adulthood or even appear for the first time later in life.

 

Symptoms

 

·      Acne often begins with early signs such as whiteheads (closed comedones) and blackheads (open comedones).

·      Inflammatory acne is characterized by red bumps (papules) and pus-filled lesions (pustules).

·      In more severe cases, deeper and more painful lesions such as cysts and nodules may develop.

·      As acne heals, it can lead to scarring—either atrophic (sunken or pitted) or hypertrophic/keloid (raised and thickened).

·      Dark spots (post-inflammatory hyperpigmentation) may also appear after lesions resolve, particularly in darker skin tones or when acne is picked at.

 

Causes

 

Possible triggers for acne include :

·      Hormonal changes - Acne is most often associated with hormonal changes during puberty, but it can develop at any age.

·      High stress levels

·      Blocked / covered skin, such as from cosmetics, sports gear, or chin straps

·      Medications, including anabolic steroids, progestins, lithium, isoniazid, and phenytoin

·      Menstruation (in females)

·      Acne is known to run in families. If both your mother and father had acne, it's likely that you'll also have acne.

 

How to manage acne

 

·      Minimise stress

·      Cleanse gently using a mild soap or cleanser and lukewarm water. Avoid very hot or very cold water, as this can aggravate acne.

·      Avoid squeezing or picking at blackheads or spots—this can worsen inflammation and increase the risk of permanent scarring.

·      Choose non-comedogenic products. Avoid make-up, skincare, and sunscreen products that are oil-based or labeled “comedogenic.” Instead, use water-based, non-comedogenic options that are less likely to clog pores.

·      Always remove make-up completely before going to bed.

·      If your skin is dry, apply a fragrance-free, water-based moisturizer (emollient).

·      Wash your hair regularly and try to keep it away from your face to prevent further irritation.

·      Have at least seven to eight hours of sleep every night. Avoid irregular sleep schedules.

 

What are the treatments available?

 

Topical Treatments

·      These alone might be sufficient for mild acne, but can be used in combination with oral therapies for moderate / severe acne

·      Some examples are benzoyl peroxide (available over the counter), adapalene (Differin) and topical antibiotics (both are available in pharmacies)

·      Combination treatments with more than one active ingredient may be prescribed.

·      Your doctor might recommend using different topical products for the day and night.

·      If skin irritation occurs, stop using the topical treatments for a few days and apply a light, fragrance-free, non-comedogenic moisturiser to the affected areas. Once irritation improves, restart the treatment on alternate days instead of daily.

 

Oral Antibiotics for Acne

• Commonly used in moderate to severe acne as a first-line treatment.
• Examples include doxycycline, erythromycin, and minocycline.
• Usually taken once or twice daily, as directed by your doctor.
• Improvement typically takes 6 to 8 weeks. Treatment is often continued for several months to maintain results.

 

Oral contraceptives

·      This is an option for treatment of acne in female patients.

 

Oral Isotretinoin

·      A strong oral medication used for severe acne or acne that does not respond to other treatments.

·      Visible improvement often occurs within a few weeks. Treatment usually lasts for 6 to 12 months.

·      Blood tests are needed before and after treatment to check liver function and cholesterol levels.

·      Pregnancy tests are required for female patients before and during treatment as it can cause severe birth defects if taken during pregnancy.

 

When to seek medical advice

 

·      For mild acne, talk to your pharmacist about over-the-counter treatments.

·      If your acne doesn’t improve with pharmacy treatments, or it’s affecting your mood or confidence, see a GP.

·      Consult a GP if you have moderate to severe acne or painful nodules or cysts as these may need prescription treatment to prevent scarring.

 

Sources :

https://www.nhs.uk/conditions/acne/

https://www.singhealth.com.sg/symptoms-treatments/acne-vulgaris