Acne

Comprehensive information on the causes, symptoms, and treatment of dermatological lesions resulting from excessive sebum production.

Symptoms and Causes

Acne is a dermatological condition characterized by the formation of pimples and skin abnormalities due to the accumulation of sebum, bacteria, and dead skin cells in the hair follicles. Although it is most common on the face, it can also appear on other areas of the upper trunk.

Depending on its characteristics, acne is divided into two main groups:

Comedogenic acne: also called comedonal acne, this is a mild condition as it affects the most superficial layer of the skin.

Blackheads: the pore remains open and appears dark.
Whiteheads: the pore surface is closed, forming a small whitish bump.

Non-comedogenic acne: a more severe condition, affecting the intermediate or deep layers of the skin.

Papules: red, inflamed bumps.
Pustules: pus-filled cavities.
Nodules: inflammation involving more than one follicle in the dermis.
Cysts: cystic acne is characterized by suppurative lesions in the dermis, which may result in scarring.

Although in most cases acne resolves during adolescence, it may persist into adulthood. Medical advances now allow lesions and marks to nearly completely disappear, even in severe cases.

Symptoms

The most characteristic symptoms of acne are:

Comedogenic acne: typically concentrated on the forehead, nose, cheeks, neck, back, and chest.

Visible, non-painful lesions.
Blackheads or whiteheads.
Occasionally, red bumps.
Rough texture in the affected area of the skin.

Non-comedogenic acne: appears in the same areas as comedogenic acne, particularly the face, neck, back, chest, and shoulders.

Inflammation.
Redness.
Tenderness to touch.
In some cases, especially cysts, suppuration.

Causes

Acne develops due to the following causes:

Comedogenic acne: occurs when pores or hair follicles become blocked with sebum and dead skin cells.

Blackheads: since the pore is open, accumulated material darkens due to oxidation from oxygen exposure.
Whiteheads: the sebum remains white because it is trapped inside the pore and does not contact air.

Non-comedogenic acne: the hair follicle ruptures, and in addition to the accumulation of sebum and dead cells, bacterial proliferation occurs, resulting in infection.

Risk Factors

The reasons for these accumulations of sebum and dead cells can vary. The most common risk factors include:

Age: most prevalent during adolescence, but can occur at any age.
Hormonal changes: hormonal acne is caused by increased androgens, leading to enlargement of sebaceous glands and higher sebum production.
Certain foods: excessive carbohydrate intake is associated with increased sebum production.
Some medications: corticosteroids and testosterone-containing drugs can induce acne.
Oil-rich cosmetics.
UV radiation exposure.
Excessive friction.
Stress: while not a direct cause, it can exacerbate existing acne.
Family history.

Complications

Acne-related complications include:

Scarring: after pimples and blemishes heal, indentations may remain. In severe cases, keloid scars may form, characterized by raised, protruding tissue.
Hyperpigmentation: affected skin areas become darker where lesions were present.
Hypopigmentation: in some cases, the skin lightens in affected areas.
Low self-esteem.
Depression.

Prevention

Although acne cannot always be prevented, following a specific skincare routine can help maintain skin health and prevent worsening of the condition:

Avoid touching areas with pimples to prevent spreading infection.
Do not squeeze lesions.
Clean the skin with a gentle product without excessive rubbing.
Use oil-free, non-comedogenic cosmetics.
Avoid irritating products.
Protect skin from sun exposure.
Maintain a balanced diet.
Drink adequate water to stay hydrated.
Manage stress as much as possible.

Which Specialist Treats Acne?

Acne is managed by medical-surgical dermatology and venereology.

Diagnosis

Acne diagnosis is clinical, based on skin observation. The specialist’s experience in evaluating lesions determines their severity.

Treatment

Acne treatment should be tailored to the severity of lesions. The most effective options include:

Oral medications: creams or lotions applied directly to lesions to reduce or eliminate them. Useful in mild to moderate acne.

Retinoids: prevent follicular blockage. Must be used for a prescribed period to avoid skin damage, with sun exposure minimized during treatment.
Antibiotics: eliminate bacteria and reduce inflammation. Typically require combination with other drugs for optimal efficacy.

Topical medications: used for moderate to severe acne.

Antibiotics: target severe infections. Compliance with medical guidance is essential to prevent resistance.
Oral contraceptives: prescribed to women of childbearing age using contraception, combining estrogen and progestin. Results may take time.
Antiandrogens: block effects of androgen hormones.
Isotretinoin: commonly known as Roaccutane, used for patients unresponsive to other treatments. Highly effective in reducing sebaceous gland size and normalizing sebum production. Initial worsening may occur, followed by significant improvement. Requires monitoring due to potential severe adverse effects (depression, inflammatory bowel disease, teratogenicity).

Phototherapy: LED light applied externally to address various acne effects. Different wavelengths have distinct properties, aiding in scar smoothing, pore refinement, texture improvement, and hyperpigmentation control. Light penetrates to deeper skin layers.
Laser treatment: laser penetrates skin without damage, generating heat to modulate sebaceous glands. Also reduces scars and marks. Severe cases may require multiple sessions over months, with improvements often noticeable after the first month.