Medically Reviewed by Dr. Elisabeth Vincent Hamelin
Acne (also called acne vulgaris) is a skin condition characterized by various degrees of inflammation of the “pilosebaceous bulb”, that is, of the small but complex structure from which the hair is born and from which the sebum is produced, a particular type of grease that keeps the skin soft and lubricates the hair. Depending on the severity, acne can affect the skin in its surface layer with the formation of blackheads and boils, or the deeper one with the formation of nodules and cysts. All these lesions appear more pronounced on the face, neck, chest and shoulders, where the sebaceous glands are present in greater numbers. In women, clinical manifestations can be more pronounced around the mouth while in males they can be limited to the trunk. Deep inflammatory lesions sometimes leave small purple and unsightly scars.
When it occurs
Acne occurs mainly in the adolescent period. In fact, almost 90% of males and 80% of females suffer from puberty. Girls tend to experience acne earlier (14-16 years) than boys (16-19), but it is in the latter that the most serious forms are found. The peak of gravity is observed around 17-19 years, starting from twenty years tends to improve spontaneously and mostly disappears within 25 years. Only sometimes does it affect adulthood and, in this case, predominantly the female sex. It can also worsen in the vicinity of menstruation, while in pregnancy it can have an unpredictable trend.
What are the causes
A fundamental role in the onset of vulgar acne is played by sex hormones, which explains why acne appears in puberty, a period characterized by an increase in hormonal production. Responsible are androgens, mainly male sex hormones but also produced by the female organism, which, among other important functions, also exert their effects on the activity of the sebaceous glands of the face, neck and shoulders. In some cases, however, there may be an exaggerated sensitivity and reactivity of the individual to completely normal hormonal levels. Other types of acne recognize different causes.
Over time, many wrong beliefs have formed about acne, which probably derive from poor knowledge of the problem.
- It is not true that nutrition, especially if rich in fats, chocolate and salami, can favor the onset or worsening of acne. This belief is not supported by any scientific evidence and must therefore be reduced: therefore there is no need to change the diet, even if reducing the dietary intake of fats and sugars can benefit health in many other ways.
- It is not true that being in the sun “dries” pimples and heals acne. Sunlight is now considered less important than it used to be: it can have some utility in improving the aesthetic aspect of acne and is in any case more active than artificial ultraviolet rays (UVA lamps and beds) as long as exposure is not continued for too long and intense periods. In this case, there is a risk of aggravating the situation due to the thickening and consequent hardening of the skin, induced by solar radiation, which causes further obstruction of the hair follicle. Exposure also risks proving to be dangerous (toxic-allergic reactions) if done in conjunction with therapies with certain antibiotics (tetracyclines) or isotretinoin (eg Roaccutan) or to further aggravate the situation when particular products are used on the skin. acne (e.g. benzoyl peroxide).
- It is not true that greasy hair that rests on the face can cause acne or make it worse. Hair is also affected by the condition of excessive production of fat by the sebaceous glands, which occurs mainly during adolescence.
- It is not true that acne improves if you have sex, nor does it get worse in their absence.
- It is not true that acne comes to those who have poor personal hygiene, indeed the people who are affected often have an even excessive attention to cleanliness.
Why acne lesions are formed
Each pilosebaceous bulb is connected to the surface of the skin through a channel, which ends with a small orifice, through which both the hair and the sebum pass. Normally sebum, produced by the sebaceous glands, comes out through this opening on the surface of the skin, making it greasy and shiny, but without any consequence if not aesthetic.
Under certain conditions, an excessive increase in the production of sebum (such as that linked precisely to hormonal mechanisms) can lead to the formation of a real plug that obstructs the follicular canal through which the sebum should flow. Thus the closed blackhead is formed, a small bag (microcysts) which gradually grows due to the continuous production of obstructive material. In addition, local conditions favorable to the development of bacteria (among which the most important is Propionibacterium acnes) are created inside the blocked follicle, which transform fat into irritants which cause inflammation of the bulb making it more susceptible to infections. Under the pressure of the accumulated products, the follicle dilates until the wall breaks. When this occurs, part of the contents of the follicle pours into the surrounding dermis and causes a more or less serious inflammatory reaction depending on the depth at which the rupture occurs. The most common superficial lesions, characteristic of mild or moderate acne, are the papules, solid and painful masses, and the pustules, boils full of pus. Deeper lesions, expression of a more serious acne are the nodules and the cysts.
Simple blackheads or open comedones, rarely cause more serious injury. The dark coloring of the top of the blackhead is not due to dirt, as is commonly believed, but to the deposition of melanin and probably also to the oxidation of sebum and dead cells.
To date there are no fully resolving acne treatments; however, there are many remedies to combat it and measures and behaviors that, in most cases, allow a rapid improvement of the appearance of the skin and therefore of the psychological conditions of those affected.
When specific treatment is needed, it must first be remembered that the results are not immediate and that it is important to continue the therapy constantly, without interrupting it at the first improvements. Normally the treatment lasts a long time, it can give an apparent initial worsening and takes several weeks before producing satisfactory results.
The objectives of the treatment consist in limiting the duration of the injuries, alleviating the psychological discomfort, and preventing scars, always keeping in mind the limit of the drugs available, capable of temporarily controlling the clinical manifestations, but not of “treating” acne in a way definitive.
The choice between the various acne therapies is conditioned by the different level of acne severity.
Some simple steps allows for a rapid improvement in the appearance of the skin.
First of all, compliance with strict hygiene rules is fundamental:
- the face should be washed gently with liquid acid soaps, drying it with a soft cloth without rubbing. The use of common soaps is in fact counterproductive since, being excessively degreasing, they stimulate a greater production of sebum at a later time;
- you should not crush the blackheads, break the pustules or remove the crusts. If not carried out by expert personnel, these maneuvers not only are not very reliable, but even risk proving harmful because they can cause infections and cause the appearance of scars;
- for make-up it is preferable to turn to non-comedonic products, lean or water-soluble creams: there are specifically formulated products on the market that do not aggravate the obstruction of the pores. The same applies to products to be used for cleansing makeup that must be regularly removed.
The market offers the consumer many cosmetic products suitable for “impure or acne-prone skin”. Some are simply non-aggressive detergents, containing various substances, which can be used for daily washing, even if they do not offer substantial advantages compared to a common acid soap; others contain disinfectants but, given the short contact time, they are unlikely to prove of any use. Abrasive cleaners (scrubs) remove dead cells from the surface of the skin: they can be useful when the condition to be treated is so mild that it does not yet require any pharmacological intervention. On the other hand, they should be avoided when acne requires specific treatment since, by irritating the skin, they make the simultaneous application of some effective drugs impractical. However, they should be used in moderation (no more than 2-3-times a week) so as not to be too aggressive for the skin. Alcoholic lotions, being excessively degreasing, can have a counterproductive effect if used for a long time. Topical cortisone preparations should not be applied to acne lesions.