Acne: symptoms, causes and treatment

Medically reviewed: 19, November 2023

Read Time:17 Minute

Papules, pustules and comedones – is there an effective treatment?

The disease of the sebaceous glands, characterized by congestion and inflammation of the hair follicles, is called acne (acne), or acne. The variety of causes and clinical manifestations of acne, its frequent occurrence at different ages, caused cosmetic problems make this disease relevant for many medical professionals.

The term “acne” reflects the cause-and-effect relationship of skin manifestations from the general state of the organism. In the emergence of acne, infections, disorders in the genetic, endocrine and immune apparatus play an important role, digestive and neuropsychic disorders.

Acne rashes occur almost at any age: from the period of newborn to old age. Previously, acne was considered a very teenage problem, but in recent decades, cases of acne in patients 25-35 years of age have become more frequent. The most common form of acne is juvenile acne, observed in patients 12-24 years in almost 90% of cases. Acne rash brings many experiences about its appearance to people of any gender and age.

Symptoms of acne

Excessive elements in acne are represented by closed and open comedones, papular and pustular acne, nodular and cystic formations.

Comedones

Closed comedones are non-inflammatory nodular formations of white color, not having an outlet on the surface of the skin. Further accumulation in the pores of the secretion of the sebaceous gland, the cells of the epithelium, the pigment, and dust leads to the formation of open comedones with a black tip protruding above the surface of the skin. Typical localization of comedones – the skin of the forehead and chin.

Further adherence to the already existing obstruction of the hair follicle of the inflammatory process leads to the development of papulo-pustular acne, and in severe forms – cystic cavities, phlegmonous and necrotic acne.

Papular acne

Papular acne (Latin “papula” – nodule, pimple) – an elevation, a dense tubercle above the skin the size of a pea of ​​reddish-cyanotic color. Multiple papules impart an uneven appearance to the skin. Papules may undergo reverse development or a further transition to pustules.

Pustular acne

Pustular acne (Latin “pustula” – pustule) is a painful bladder with purulent contents of a softer consistency than the papule. Small, up to 5 mm in diameter, pustules usually heal without a trace, after large pustules often there are cicatricial defects.

The further development of inflammatory elements of acne can lead to the appearance of nodes and cystic cavities. The nodes are large infiltrates (more than 5 mm in diameter) located in the dermis and subcutaneous fat. With reverse development, the nodes disintegrate, ulcerate and heal with a scar. Cysts are cavities filled with pus, purple-cyanotic color. Cyst healing also occurs with the formation of a scar.

Mechanism of development of acne

The mechanism of acne is caused by the mutual action of 4 factors:

  • Excessive secretion of sebaceous glands.

Hyper secretion of sebum leads to a decrease in its bactericidal properties and a change in consistency. The secretion of the sebaceous glands becomes dense, forming plugs in the ducts and blocking them. It is often observed during a period of rapid puberty in adolescents and in the last week of the menstrual cycle in women.

  • Follicular hyperkeratosis.

At the heart of the development of follicular hyperkeratosis is a violation of the normal process of constant renewal of hair follicle cells. Thickening of the superficial stratum corneum of the hair follicles, along with greasy stoppers, creates an additional obstacle to the outflow of the secretion of the sebaceous glands.

  • Reproduction of propionic bacteria of acne (Propionibacterium acnes).

Microorganisms in large numbers living on the skin of healthy people, under certain conditions, can cause the development of acute inflammatory reactions. Sebaceous horny plugs of hair follicles are a favorable environment for their enhanced reproduction and active vital activity. The leading role in the appearance of acne belongs to propionic bacteria acne.

  • Inflammation.

Active reproduction of propionic bacteria acne leads to a response of tissues and the development of inflammation in them.

Endogenous causes of acne

At the root of the appearance of acne is a violation of the function of the sebaceous glands – hypersecretion of sebum. This occurs under the influence of a number of internal and external causes, creating a fertile soil for the development of acne.

Testosterone and acne

One of the most common causes of acne in the adolescent period is hormonal changes in the body. Active release of steroid hormones, especially androgens – male sex hormones, and in girls and in young men causes increased secretion of sebaceous glands. Skin fat changes its properties, turning from liquid to dense and viscous.

Features of the hormonal background and skin reactions can be inherited. Therefore, the likelihood of teenage blackheads in young people whose parents suffered from acne is much higher than that of their peers with unhealed heredity.

Premenstrual acne

The level of steroid hormones in women fluctuates during the menstrual cycle and rises to its final phase. This circumstance is associated with the appearance of acne eruptions about a week before menstruation in 70% of women. Even those who do not suffer from acne, often note the appearance of single acne on the chin on the eve of menstruation.

“Hormonal” acne

The appearance of acne and acne in the adolescent period is physiologically determined. However, if acne persists in adulthood, then this is a serious signal to think about your health. Usually, the presence of such spots indicates a violation of the production of sex hormones.

In women, the so-called hormonal acne can be caused by polycystic ovaries, pregnancy or abortion, conditions associated with abrupt changes in the hormonal background.

Endocrine disorders in the activities of the adrenal gland or pituitary gland also affect the occurrence of acne. So, the state of hyperandrogenism (excess of male sex hormones – androgens) is often accompanied by the appearance of acne. Therefore, for adults suffering from acne, it is mandatory not only to visit a cosmetologist or dermatologist, but also a number of laboratory studies, consultations of an endocrinologist and gynecologist (for women).

Hyperkeratosis.

Thickening of the superficial horny layer of the skin – hyperkeratosis – can develop under the influence of a number of factors: hormonal background, vitamin A deficiency, exposure to harmful chemical substances (eg lubricating oils) or mechanical factors (friction, pressure). Thickened horny flakes, along with altered sebum, clog pores, being a favorable environment for the development of the microbial process.

Diseases of the gastrointestinal tract

Many researchers the appearance of acne is directly dependent on the nature of nutrition and the state of the patient’s gastrointestinal tract. Indeed, the prevalence of carbohydrate foods in the diet and the deficiency of essential amino acids and healthy fats lead to hyperfunction of the sebaceous glands. In some cases, nutrition correction can normalize the secretion of sebum and get rid of acne.

According to medical statistics, in more than 50% of people acne occurs against the background of already existing gastritis and dysbiosis, another 30% – against the background of pathological conditions of the intestine.

Locations of localization of rashes depend on the lesion of one or another part of the digestive tract. Eruptions in the nose, cheeks, corners of the mouth can indicate changes in the pancreas, in the temporal region – the gallbladder, over the upper lip – thick, and on the forehead – the small intestine.

Therefore, the state of the digestive tract plays an important role in maintaining skin health. Normal intestinal microflora, which provides 70% of human immunity, prevents the formation of new acne and provides healing of those already available.

Individual skin microflora

In the skin and estuaries of the sebaceous glands of a healthy person, there live the propion bacteria acne and granulosum, epidermal staphylococcus, mites, mushrooms, etc. Under normal conditions, they do not cause any problems, but the imbalance in the body (hyperandrogenia, acne) leads to their active reproduction and inflammatory processes in the skin.

Stress

The stress itself does not cause acne, but its effect on the hormonal and immune status of the body can aggravate the manifestation of acne, causing new acne eruptions and weakening protective mechanisms.

Immune system disorders

Weakening of immunity can be caused by a number of reasons: stresses, diseases of the digestive system, etc., but always has as a consequence a decrease in the body’s resistance to various adverse effects. Against the background of a decrease in the protective mechanisms of the skin, even usually “neutral” microorganisms can cause considerable harm.

Exogenous causes of acne

Cosmetics (comedogenic cosmetics as causes of acne)

“Provocator” for the emergence of acne can be and, so-called, comedogenic cosmetics, i.e., clogging pores and contributing to the appearance of acne: creams, powders, lotions, blushes, etc.

The comedogenic substances include:

  • oils (corn, coconut, mineral , peach, almond, soy),
  • lanolin,
  • petrolatum,
  • oleic acid,
  • sulfur,
  • squalene,
  • sorbitanoleate,
  • sodium lauryl sulfate,
  • myristyl lactate.

Masking of acne with cosmetics further aggravates the course of acne. Therefore, when buying care products and decorative cosmetics should choose products with the inscription: “not comedogenic”.

Heat and humid climate

To aggravate the course of acne or cause its appearance can be high humidity and hot climate. Eruptions are more often localized on the chest, neck, back – those areas that are most irritated later.

Sun and ultraviolet

Ultraviolet in moderate doses desiccates and disinfects acne, and sun tan levels the skin color, thereby masking acne acne. However, the overabundance of ultraviolet radiation has a completely opposite effect. Increased secretion of sebum and additional drying of the stratum corneum lead to an aggravation of acne and an increase in the number of acne. This mechanism works also with tanning on an open beach, and in a solarium.

Professional contact with toxic substances

Professional activity of many people is connected with direct contacts with household and industrial chemistry (for example, oil products, lubricating oils, chlorine, etc.), causing the appearance of acne through the development of hyperkeratosis of the skin and hair follicles.

Extruding acne

Attempts to squeeze out pimples and thereby independently get rid of them can lead to the opposite result. When squeezing acne, the infection penetrates deeper layers of the skin, seeding non-inflamed elements, leading to their infection and suppuration. Especially dangerous is squeezing out pimples in the face of the nasolabial triangle, because the risk of drifting an infection with blood flow into the meninges is great.

Cleaning the face with a scrub during the period of inflammatory skin rashes should be ruled out. Effective and safe treatment of acne can only be carried out by a specialist dermatocosmetologist.

Constant friction and mechanical pressure on the skin (when wearing headdresses, tight collars and other clothes) causes the appearance of acne in these areas.

Medication for acne

In the treatment of many diseases of internal organs to date, steroid hormones are used that cause the appearance of drug acne. This form of acne is characterized by the sudden appearance of acne, coinciding with the onset of corticosteroids. The appearance of acne is also observed in women who stop taking birth control pills.

Excessive cleanliness

Excessive cleanliness, if not paradoxically, can also trigger the appearance of acne. Frequent washing dries out facial skin, lowers its protective properties and exacerbates the manifestation of acne. However, hand washing should be regular to avoid spacing the infection from the source of inflammation throughout the surface of the skin.

Stages of development of acne

At the basis of the development of acne lie violations in the work of the sebaceous glands, leading to the formation of sebaceous horny plugs in their ducts. On the surface of plugs (comedones), pathogenic bacteria begin to multiply, causing irritation and suppurative inflammation of surrounding tissues.

Acne eruptions are mainly localized in the region of the chin, nose, forehead, back and chest areas, the largest accumulation of sebaceous glands. Elements of acne can be non-inflammatory (comedones) or inflammatory (papules, pustules) character.

Depending on the severity of the flow of acne, four stages of the process are distinguished.

  • 1 stage.

A mild form of acne. Characterized by the presence on the skin of closed and open comedones without signs of inflammation, single papules. The treatment of acne at this stage is not difficult.

  • 2 stage.

Moderate manifestation of acne. Elements of acne on the skin are represented by a large number of closed and open comedones, acne (10-20 papules) with signs of inflammation. The prognosis of cure at this stage is long (6-8 weeks), but favorable.

  • 3 stage.

Severe form of acne. The same signs as in the second stage are noted, but the amount of inflammatory elements on the skin increases to 20-40. Special therapy is required.

  • 4th stage.

Extremely severe form of acne. It is characterized by a large number of papules, pustules, nodes (more than 40 elements). Requires serious specialized treatment.

Acne Treatment

Main goals

  • Prevention of the emergence of new comedones.

Includes proper care for the problem skin and measures for general improvement of the body.

  • Removal of existing comedones.

It is carried out with the help of comedolytic drugs and comedo-extractors at home or in beauty salons.

  • Decreased sebum secretion.

Achieving a significant clinical effect is possible with a decrease in secretion by 30% or more. Used drugs are a group of retinoids, hormones – estrogens, antiandrogens.

  • Removal of the inflammatory process and prevention of its spread.

It is achieved by applying antibacterial drugs externally and orally.

  • Reduction of cosmetic defects of scarring.

Produced by the method of dermabrasion, laser therapy, cryotherapy.

Complex therapy

Passing the course of procedures in the beauty salon plus active home care with recommended medications.
Combined external treatment with drugs of systemic effects (which have an effect on the whole organism).
The use of drugs that affect the entire chain of the mechanism of development of acne (hypersecretion of sebum, increased keratinization of hair follicles, reproduction of microbes, inflammation).

The presence of chronic processes in the body (gynecological, endocrine, gastrointestinal diseases, foci of chronic infection) can interfere with the treatment of acne and reduce its effectiveness. Therefore, in parallel with the treatment of acne should be treated concomitant pathology.

In the treatment of acne, a large number of external drugs are currently being used.

Drugs of external action in the treatment of acne

Benzoyl peroxide has a strong keratolytic and bleaching effect, which has been used for over 20 years in dermatology to treat ichthyosis and skin pigmentation. Its property of “dissolving” keratinized tissues and pronounced antibacterial action allows the use of benzoyl peroxide and for the treatment of mild to moderate acne.

The combination of benzoyl peroxide with antibiotics, azole compounds, sulfur preparations in combination preparations significantly increases the effectiveness of its use.

Azelaic acid has a pronounced anticomedogenic, antibacterial and anti-inflammatory effect, but does not affect the production of sebum.

Tretinoin is a synthetic retinoid, an analog of vitamin A. It is used in the treatment of acne externally with ineffectiveness or individual intolerance of benzoyl peroxide. Eliminates the available comedones, and prevents the emergence of new due to the normalization of the processes of keratinization of the epithelium and a decrease in the secretion of sebum.

Benzoyl peroxide, azelaic acid and tretinoin are first-line drugs in the treatment of acne. They are effective for long-term use (from 3 months or more). Sometimes their use causes skin irritation, which is usually eliminated by reducing the frequency of application to the skin or reducing the concentration. In the treatment of acne with these drugs, simultaneous use of two or more agents, as well as temperature changes and active insolation, is unacceptable.

Antibiotics for external use

To external use of antibiotics in the treatment of acne resorted in cases when there is no effect of treatment with first-line drugs or combination therapy in the treatment of complicated forms of the disease. To the disadvantages of treating acne with antibiotics include the development of the effect of habituation and insensitivity of propionic bacteria.

Erythromycin is considered one of the most effective antibiotics against acne. High antibacterial and anti-inflammatory activity of erythromycin is even more pronounced in its combination with zinc. Zinc, in turn, reduces the secretion of the sebaceous glands and loosens the pores, facilitating the local action of erythromycin.

Clindamycin does not cause habituation to the cutaneous microflora and is highly active against propionibacteria and staphylococci.

Systemic antibiotics are used internally in combination with local therapy with a moderate degree of acne. Of the antibiotics of the tetracycline group, minocycline or doxycycline is often used because of their high antimicrobial activity, rapid absorption and intense accumulation in the sebaceous glands. Less commonly in the treatment of acne are used clindamycin, erythromycin and sulfanilamide group preparations.

Treatment of acne with systemic antibiotics suggests their long (at least a month) reception. During this period, the intestinal and vaginal dysbiosis can develop, a stable habituation of the skin microflora. Other complications from taking antibiotics are ulcerative lesions of the esophagus, stomach ulcer, softening of the nail plates (onycholysis), the appearance of hyperpigmentation on the skin and nails, etc.

It is necessary to take into account the interaction of antibiotics with other drugs so that their effect does not overlap. If the antibiotic treatment is not expressed or has a long-term effect, it should consider changing the drug or prescribing retinoid drugs.

Antiandrogens

In the treatment of acne in women, a combination of external treatment and the intake of hormonal contraceptives containing antiandrogens or estrogenic profile is possible. Heavy forms of acne require combined (external and general) treatment.

The absence of clinical effect from the treatment for more than 3 months is one of the indications for the prescription of Isotretinoin, a synthetic analogue of vitamin A. The advantage of this drug is its effect on all the mechanisms of acne (increased sebum secretion, follicular hyperkeratosis, microorganism multiplication, inflammation). The course of treatment with isotretinoin is from 4 months to a year.

Hardware methods for treating acne are additional and are only applicable at the stage of comedones. These include massage and facial cleansing, surface cryotherapy, laser therapy, darsonvalization, etc.

Surgical manipulation is not widely used in the treatment of acne, because it leads to the formation of gross scars. In the treatment of abscessing forms of acne, purulent foci can be cut off with corticosteroid preparations.

From the experience of complex treatment of acne

As practice shows, the best result is provided by a comprehensive approach to the treatment of acne.
Since it was previously noted that doctors of many specialties are called to solve the acne problem in commonwealth, it was necessary for patients with acne to undergo a comprehensive examination from a dermatologist, gastroenterologist, endocrinologist, gynecologist. The choice of methods and the duration of the course of treatment was determined by the degree of severity and severity of acne flow, taking into account individual characteristics.

The average course of acne treatment was 7-8 months. At the first stage, it included external treatment with azelaic acid and gel with metronidazole, as well as doxycycline. In addition, cryomassage and darsonvalization were prescribed. A month later the course was carried out chemical peeling with fruit acids in gradually increasing doses. In parallel, the correction of the revealed disorders in the endocrine, sexual, digestive systems was conducted.

A month later, an intermediate assessment of the effectiveness of acne treatment showed a stable tendency to improve: the disappearance of pustular eruptions was noted in 89%, a reduction in the number of comedones in 71.2% of patients, and the process of salivation decreased. In the future, there was a persistent remission.
Forecasting acne treatment

When predicting long-term results of acne, the following points should be considered:

Acne is a chronic, intractable disease, since hereditary predisposition or provoking factors can cause a new exacerbation, even if the disease has not been resumed for several years. However, knowing the reasons provoking a new wave of acne eruptions, you can clearly control and quickly remove acne exacerbations, prevent the development of gross cicatrical skin changes (post-acne) and the formation of persistent cosmetology defects.

  • If the disease has already occurred, the changes in the skin are irreversible, and one can not achieve its former ideal condition.
  • A full course of acne treatment is a long process, taking from 4 months or more.
  • Treatment of acne can occur with exacerbations of the process, especially in the first months, when the mechanisms of the development of the disease are suppressed.
  • It is necessary to conduct a full course of acne treatment, without interruptions, even if there has been a noticeable improvement. An untreated acne at any time can declare itself a new aggravation.

Despite the fact that acne is an adult disease that will accompany you all your life, do not despair. The modern choice of techniques and preparations of external and systemic application allow to considerably facilitate the course of acne, to timely prevent its exacerbations, to avoid serious complications and destructive changes in the skin. Today acne treatment is carried out at all stages of the development of the disease, allowing to achieve good cosmetic results and long-term remission.

This article is written by

Cassandra Westwood - dermatologist
Cassandra Westwood - dermatologist
Dr. Cassandra Westwood is a board-certified dermatologist with a comprehensive background in dermatological care. She obtained her medical degree from Johns Hopkins University School of Medicine.

Throughout her career, Dr. Westwood has contributed to various healthcare institutions, including her tenure at Massachusetts General Hospital, where she specialized in the diagnosis and treatment of skin disorders. Her clinical proficiency extends to managing a diverse range of dermatological conditions, such as acne, psoriasis, and skin cancers.

Presently, Dr. Westwood serves as a dermatologist for NetdoctorWeb, a prominent online health platform. In her role, she distills her clinical experience and expertise into accessible articles, offering valuable insights on skin health and dermatological concerns. Through her work, she contributes to the dissemination of accurate and reliable health information to a wider audience.

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