About 80% of adolescents (between 13- and 18-years) experience acne, making it one of the most common dermatological conditions. Acne is multifactorial, with four primary factors driving its development:
- Hyperkeratinisation and comedoformation: The process begins with hyperkeratinisation, where hair follicles become clogged with sebum and keratinocytes, leading to the formation of comedones, the initial lesions of acne. Comedones can be either open (blackheads) or closed (whiteheads). If untreated, these can evolve into inflammatory lesions such as papules, pustules, nodules, and cysts.
- Bacterial proliferation: Cutibacterium acnes, a normal skin bacterium, thrives in the sebum-rich environment created by clogged follicles. This bacterial proliferation triggers an immune response, leading to inflammation, redness, and swelling commonly associated with acne lesions.
- Sebaceous hypersecretion: Sebaceous glands in individuals with acne- prone skin tend to overproduce sebum, contributing to excess oiliness on the skin's surface. This overproduction of sebum is often linked to hormonal changes, particularly during puberty, menstruation, or pregnancy, which stimulate androgen release.
- Inflammatory mediators: The final factor involves the release of inflammatory mediators in response to bacterial colonisation. This inflammation can result in varying intensities of acne, from mild papules and pustules to severe nodules and cysts, potentially leading to permanent scarring if not treated early.
Acne can be categorised into non-inflammatory and inflammatory lesions. Non-inflammatory lesions include comedones, while inflammatory lesions result from bacterial proliferation and include papules, pustules, nodules, and cysts. Severe inflammatory lesions can lead to permanent scarring, emphasising the importance of early intervention and proper treatment.
Common triggers of acne include hormonal changes, inadequate skin care products, certain foods with high glycemic indices, and stress, which can exacerbate sebum production. Acne severity ranges from mild, with comedonal and papulopustular acne, to severe, with nodular, cystic, and conglobate acne. Identifying the severity is crucial for tailoring appropriate treatment plans.
Acne can have significant psychological impacts, particularly during adolescence, leading to issues like anxiety, depression, social withdrawal, and even suicidal ideation. Therefore, effective acne management is vital not only for physical health but also for mental well-being.
Treatment options for acne vary depending on the severity. For mild cases, topical treatments like retinoids, benzoyl peroxide, and antibacterials are commonly used.
Systemic treatments, such as oral antibiotics or isotretinoin, are reserved for more severe cases. Isotretinoin, in particular, is highly effective, addressing all aspects of acne pathogenesis, including sebum production. However, it requires careful monitoring due to potential side effects, such as dry skin, liver function abnormalities, and teratogenic risks.
In managing acne, it is essential to regulate sebum production, prevent follicular obstruction, control bacterial proliferation, reduce inflammation, and prevent scarring. Patients should be educated on the importance of a consistent skincare routine, including the use of moisturizers and sunscreens, while avoiding the use of topical steroids and oily cosmetics.
Overall, while acne is common and often considered a normal part of adolescence, its potential to cause lasting physical and emotional scars underscores the importance of early and effective treatment.
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