About acne and acne remedies

Pimples or acne is a very common skin problem in adolescents. Majority of adolescents develop some form of acne and require acne remedies.

The skin contains two types of glands-sweat glands and sebaceous glands. The sebaceous glands produce an oily substance called sebum.

Acne results from an obstruction of the sebaceous gland. This results from over production of stratum cornenum cells. There is an enzyme called testosterone 5-alpha reductase in sebaceous follicles. This converts testosterone in plasma to dihydrotestosterone. The latter stimulates cell division in the basal cell layer.

Acne starts as a microscopic swelling under the skin called microcomedo containing sebum and bacteria. This progresses to either non-inflammatory or inflammatory acne. There are two types of non-inflammatory acne lesions-whitehead (closed comedo) and blackhead (open comedo).

If the obstruction is at the mouth of the sebaceous follicle the result is an open comedo. The opening is filled with stratus corneum (Horny layer) cells.

The black color is caused by oxidation of melanin and is not due by dirt. It cannot be washed away. It is not advisable to squeeze the lesion as it can rupture causing irritation and inflammation.

If the obstruction is at a deeper level the result is a closed comedo or whitehead. This results from cystic swelling of the follicular duct immediately below the epidermis. It is usually skin colored or white and appears as a small swelling under the skin.

Acne lesions are mostly located on the face, upper chest and back. If open or closed comedones are the predominant lesions the condition is called comedonal acne.

Some teenagers develop inflammatory lesions like papules (small solid elevated area on the skin which is less than one centimeter) pustules (a small swelling filled with pus) and nodules (larger than papules). If a nodule is filled with semisolid material it is referred to as a cyst.

If papules are the predominant lesions the condition is called papular inflammatory acne. If pustules are the main lesions the condition is called pustular inflammatory acne and if the dominant lesions are nodules and cysts the condition is called nodulocystic acne. The last one represents the most severe form of acne.

Complications: Infection can cause increased swelling and severe pain. Occasionally scarring can occur. Psychological problems can arise as acne can adversely affect the look of the face.

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Treatment: This depends on the stage of acne. Several acne remedies are available both local and systemic. Local treatment will be sufficient in majority of affected teenagers.

It is extremely important to remember that acne will not disappear overnight. One should not get carried away by the ads in the media and try all sorts of medications without consulting a doctor. A medicine which works well for one person can cause problems when used by another person.

The local agents can be kerotolytics or antibacterial. Systemic medications include oral antibiotics and oral retinoids.

Keratolytics: Use of local kerotolytics is the mainstay of acne treatment. They act by removing the excess keratin and opening of the sebaceous follicles. The most effective keratolytics are the Retinoids. The Retinoids commonly used are Tretinoin (retinoic acid), Adapalene and Tazarotene.

Retinoids are preferably used in the evening after washing the face with a mild soap and drying the face. They can cause irritation and peeling of skin. Hence in the beginning one of them may be left for half an hour and the face washed. The duration should be gradually increased.

Once well tolerated the cream may left overnight. Only a small amount of cream should be used and it should be spread all over the face taking care to avoid contact with eye and mouth. All retinoids predispose to sunburn and hence one should not go out in the sun after applying.

If a retinoid alone is not enough one may try either Benzoyl Peroxide gel or azaleic acid in the morning and a retinoid in the evening. Benzoyl Peroxide has antibacterial activity and it kills the organism Propionibacterium acnes which is responsible for inflammation.

It also removes the excess of dead cells in the superficial layer of the skin and opens the pores of sebaceous glands and prevents accumulation of sebum. Azaleic acid also has antibacterial properties. This regimen will control majority of acne.

Local antibiotics may be used if infection is widespread and they control overgrowth of bacteria resulting from obstruction to the glands. Local antibiotics are less effective than systemic antibiotics but cause fewer side effects. They are useful in papular inflammatory and pustular inflammatory acne.Commonly used local antibiotics are Erythromycin and Clindamycin. The latter is more effective.

If infection is severe systemic antibiotics may have to be used. Commonly uses are Erythromycin, Tetracycline, Minocycline and Doxycycline.

In nodulo-cystic acne the drug most effective is an oral retinoid called Accutane. This drug has many side effects and should only be taken under the supervision of a doctor. It should never be taken by pregnant women as it can cause birth defects.

The duration of treatment depends on the response and varies from individual to individual. Local keratolytics have to be continued even after all lesions have disappeared.

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