Acne is the most common skin disease, with an incidence so high that some even consider it a physiological condition accompanying a certain stage of a person’s life. However, the severe forms are far from harmless and can have an extremely negative effect on quality of life, leading to depression and social isolation. For this reason, it is important that acne be recognized and properly treated.

Symptoms of acne

Pimples and scars. These are the most common symptoms of acne.

They usually appear around puberty, but no age group is unaffected. An example of late-onset acne is the so-called. Adultor acne (acne of adulthood), which is characterised by the appearance of pimples mainly in women over 25 years of age. In all types of acne, the pimples are mainly on the face, but often the back and chest are also affected to some extent, and in adultor acne, the chin and neck area is characteristically affected.

The pimples may be one or two or many, may be only prominent reddenings or with a large white tip; may be painful to the touch deep subcutaneous growths, with reddened and thickened overlying skin. In addition to the appearance of pimples, acneic skin tends to become oily and form a large number of comedones.

In women, the appearance of pimples can be associated with the menstrual cycle. Although at first glance acne is an obvious diagnosis, in practice it is not always so easy to distinguish it from some other skin diseases with a similar picture such as rosacea and folliculitis caused by yeast. A correct diagnosis by a dermatologist is therefore fundamental for successful treatment.

When the active phase of acne has passed, usually after some of the pimples remains a symptom for life – scars. They can be of different shapes and sizes. In some cases, they appear only as enlarged pores, and when they have caused deeper damage to the skin, they can be described as “craters from a moonscape” or “dry riverbeds running down the cheeks”.

The severity of acne does not always determine the severity of the scars that will remain after it, which is why its treatment is mandatory, even in its mildest forms.

Causes of acne

Contrary to most understandings in society, the causes of acne for the most part lie in the skin itself. Four interrelated and simultaneous processes are responsible for this:

1. Formation of microcomedones;
2. Secretion of sebum;
3. Overpopulation of bacteria;
4. Appearance of inflammation.

The impact of one of the components immediately reflects on the others. For example, increased secretion of sebum is a prerequisite for both easier formation of comedones and an increase in the number of bacteria, as fatty acids serve as food for them. The bacteria lead to inflammation with which the pustule is already present. In fact, “problem skin” as acne patients describe it, is the result of the above events.

The “internal” causes of acne include hormonal problems. They are more common in women and are usually associated with polycystic ovary syndrome (PCOS).

Sometimes corticosteroid preparations are used in the treatment of various diseases, which lead to the appearance of steroid acne. Such can also occur in the skin of the face, mainly around the mouth and nose when using asthma inhalers containing corticosteroids.

In men, the abuse of anabolic steroids is a common cause of severe and difficult to treat forms of acne.

Diet and acne

“What is the influence of food and diet on the appearance of pimples?” is the most frequently asked question by people with acne.

The research here is conflicting, but if we have to point to the prime suspects, it is sweets and dairy. Foods rich in sugar lead to a spike in insulin, which stimulates follicles to produce sebum and also the cells on their walls to divide, increasing the likelihood of blockages and the formation of microcomedones. In milk and dairy products there are growth factors that also lead to similar phenomena. This correlation between diet and the appearance of pimples is not valid in everyone, and the surest way to check is to do a strict elimination diet for at least a month, followed by gradual inclusion of single products and monitoring of the skin condition.

Types of acne treatment

Treating acne starts at home because even the most effective treatments are done once in a while, and the care we take at home is constant. For this reason, we put the right cosmetics in the first place.

The principles of treatment are the same for all types of acne, with the peculiarity that for adultory acne, therapies are usually longer and milder forms often require more aggressive approaches.

Use of medication

The use of appropriate medical cosmetics is key to successful acne therapy.

The daily facial care ritual includes the following products – a wash, an active product, a sunscreen and a moisturizer to be used as needed. Since acneic skin is usually oily, gels are the most suitable cleansers, and if the skin is prone to comedones – exfoliating cleansers with weak acids are perfect. Active cosmetic products can be applied in the morning and evening or only in the evening.

Different manufacturers rely on different ingredients, but most often in the active products we have a derivative of retinol or some acid – salicylic, malic and others. When exposed to the sun, the use of sun protection is fundamental, the most suitable are the special non-comedogenic series for oily skin. Include a moisturizing product if needed, as acne therapy often leads to drying of the facial skin. Adhering to these general principles in selecting appropriate cosmetics can significantly improve or even cure mild forms of acne without the need for drug therapy.

The use of medication is indicated in moderate and severe forms of acne, as well as in all cases where the cosmetic approach alone does not lead to a satisfactory effect.

Medications are divided into products for application to the skin and systemic therapy. Of the products for applying to the face, azelaic acid and benzoyl peroxide are most commonly used. After them are various antibiotic creams and vitamin A derivatives. According to the prevailing cause of the appearance of acne, the most correct product is also selected, therefore all drugs should be appointed only by a dermatologist.

Therapy of acne

Systemic therapy of acne includes antibiotic tablets, hormonal preparations and isotretinoin, which is a derivative of vitamin A. Of all the listed methods of therapy, isotretinoin is the most effective means of influencing acne, but due to the side effects and limitations that the preparation imposes, it is used only for the most severe forms of acne or in cases where the effect of other therapies is unsatisfactory.

Hormonal preparations are most often contraceptives given to women with accompanying menstrual disorders or those with adultor acne. In the latter, spironolactone, which is a type of diuretic, can also be administered as systemic therapy.

In addition to drugs, the fight against acne involves cosmetic and medical procedures. Of the cosmetic procedures, the most important is facial cleansing by a medical aesthetician. It solves one of the fundamental problems responsible for the appearance of pimples – the clogging of follicles and the formation of comedones. Facial cleanses are determined by the skin’s tendency to form comedones and are done at certain intervals, most often one per month.

Medical chemical peels also play an important role in the treatment of acne. Depending on the predominant component, an appropriate peel is selected – salicylic, trichloroacetate, glycolic and others. Usually, several peels are appointed in succession, after which their frequency is diluted. Besides exfoliating the skin and having a comedonolytic effect, peels destroy bacteria and soothe inflammation.

Laser treatments for acne

Of the apparatus procedures, lasers play the biggest role.

They can be used both in the active forms of acne and in its consequences, namely – scars. Immediately after the passage of the active phase of acne, unpleasant redness remains at the sites of pimples, which can persist for months. For them, the perfect procedure is the Frac3 laser treatment. For old acne scars, laser resurfacing is the gold standard. As a milder alternative in terms of recovery period can be classified the apparatus microneedling procedures with radiofrequency. With both methods, it should be noted that they rely on the skin’s ability to regenerate and the positive effects of them begin to become visible after months.

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