Dr Lushen Pillay recently presented a CPD-accredited webinar for Medical Chronicle titled: Optimising acne management: The fusion of innovative ingredients. This webinar was sponsored by Glenmark.
To watch a replay of this webinar and earn a CPD point, go to:
https://event.webinarjam.com/go/replay/653/m26v2u7q3t4vwu35gsg
Acne is a chronic inflammatory disease of the pilosebaceous follicle (hair follicles and associated sebaceous glands) and the basic lesion is the comedo. It manifests itself on the face and upper part of the torso.
The most frequent areas are those with a high number of sebaceous glands:
- Face: 92%
- Back: 61%
- Chest: 45%.
It is one of the most frequent dermatological pathologies that affects almost 80% of adolescents between the ages of 13 and 18. In adolescents, acne accounts for 25% of visits to a dermatologist
Acne is caused by the interactions of four main factors:
- 1. Ductal hypercornification: The follicles are covered with sebum and keratinocytes.
- 2. Bacterial colonisation and proliferation colonisation of follicles by Cutibacterium acnes (a normal anaerobe in humans).
- 3. Sebaceous hypersecretion excess sebum production
- 4. The release of multiple inflammatory mediators.
Acne can be classified as:
Non-inflammatory: It is characterised by comedones
Inflammatory: Characterised by papules, pustules, nodules, and cysts.
Pathophysiology
The comedone is a non-inflammatory lesion that can be open (‘blackhead’) or closed (‘pimple’).
Its evolution can give rise to inflammatory lesions (papules or pustules) as a result of the proliferation of bacterial flora inside the follicle, generating inflammation and visible redness, with infection in the case of the pustule. These inflammatory lesions can worsen (nodules, cysts) and lead to severe forms and permanent scars.
Acne triggers
Age: During puberty, androgen release stimulates sebum production.
Hormonal changes: During pregnancy or menstruation.
Cosmetics: The use of inadequate cleansers, lotions, creams that can cause the obstruction of follicles.
Food: There is no evidence that any diet or food increases the risk of acne. It’s recommended to control the intake of sugars and fats.
Stress: Stress can aggravate acne. There is an increased release of sebum by sebaceous glands.
Approximately 75% of patients have mild to moderate disease. Such patients can generally be managed in the community with topical treatments with or without systemic antibiotics. Approximately 25% have moderate to severe disease. These patients require systemic treatment and are generally referred to the dermatologist for management.
Dermocosmetic treatment
Dermocosmetics are used as an integral part of acne management to improve the skin appearance, as adjuvant to medical treatment and help prevent new imperfections.
Dermocosmetics have the potential to be used as monotherapy or adjunctive therapy. They come in the following forms:
- Those which have a sebostatic effect, such as topical antioxidants and niacinamide.
- Agents targeting abnormal keratinization, such as salicylic acid, lipo-hydroxy acid, alpha-hydroxy acids, retinol-based products and linoleic acid.
- Agents targeting Propionibacterium acnes, such as lauric acid.
- Anti-inflammatory agents such as nicotinamide, alpha-linolenic acid and zinc salts.
Summary
Acne can occur at any age. Treat early. Extremely effective therapies are available. Take note of side effects and special precautions. Patients should follow a simple skin care routine to support treatment. Dermacosmetics play an important role in acne management.
