Acne

Acne

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What is acne?

Acne is a common skin condition that causes pimples on the face, neck, shoulders, chest and back.1a

Acne can be emotionally stressful and depending on its severity can lead to scarring of the skin. 2a

Acne occurs when the hair follicles become clogged with oil or sebum and dead skin cells. Sebum is prevented from leaving the skin through the pores.1a

Acne can appear in different forms which include: 2e

Noninflammatory lesions (Comedones i.e. whiteheads and blackheads)

Comedones are created when the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria. When comedones are open at the skin surface, they’re called blackheads because of the dark appearance of the plugs in the hair follicles.2d,3a When comedones are closed, they’re called whiteheads and are slightly raised skin-coloured bumps.1bg,3a

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Formation of Skin Pimples and Acnes4

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Inflammatory lesions

The blocked sebum-filled hair follicle promotes overgrowth of a bacterium, Propionibacterium acnes, which is normally present in the hair follicle. Propionibacterium acnes breaks down the sebum into substances that irritate the skin, producing skin eruptions which we commonly refer to as acne pimples1g.
Inflammatory lesions take the form of: 2e
 

 

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Symptoms1b

While most acne occurs on the face, it is also common on the back, shoulders and upper chest.

Three levels of acne severity are identified – mild, moderate and severe.9

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What causes acne?

Four main factors cause acne2c

These are:

  • Excess oil or sebum
  • Hair follicles clogged by oil and dead skin cells
  • Bacteria
  • Inflammation

Factors that can trigger or worsen acne include:2b

Hormones

Male hormones called androgens increase in both boys and girls at the time of puberty. They cause the sebaceous glands to enlarge and make more sebum. Hormonal changes during midlife, particularly in women, can lead to breakouts

Medications

Medicines containing corticosteroids, androgens or lithium are known to cause acne

Diet

Certain dietary factors, including carbohydrate-rich foods e.g. bread and chips may worsen acne

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Treatment1cd

General care of acne is very simple:

  • Affected areas should be gently washed once or twice a day with mild soap
  • Cosmetics should be water-based as very greasy products can make acne worse
  • Although there are no restrictions on specific foods that a person can eat, a healthy balanced diet should be followed.

Beyond these routine measures, acne treatment depends on the severity of the condition.

  • Mild acne1d

Topical medicines are applied to the skin. They work by killing bacteria (antibacterials) or alternatively they dry up or unclog the pores. Antibacterials that are commonly used include the 2 antibiotics clindamycin and erythromycin, and benzoyl peroxide. Other topical medicines are salicylic acid, resorcinol and sulphur.
They work by drying out the pimples and cause slight peeling but are less effective than antibiotics or benzoyl peroxide. If topical antibacterials fail, doctors may prescribe other medicines that help to unclog the pores like tretinoin. While tretinoin is very effective it is irritating to the skin and also makes the skin more sensitive to sunlight.

  • Moderate acne1e

Oral antibiotics that are given by mouth are usually prescribed to treat moderate acne. Examples of these antibiotics include tetracycline, doxycycline, minocycline and erythromycin.

  • Severe acne1f

When oral antibiotics are not effective in treating severe acne, oral isotretinoin is considered the best treatment. Isotretinoin is the only medicine that can potentially cure acne. It is generally prescribed for 20 weeks. While isotretinoin is highly effective, it can have serious side effects such as harming a developing foetus.
As a result, women taking isotretinoin must use strict contraceptive measures to ensure that they do not fall pregnant. Other acne treatments may be used for specific people. For example, a woman with severe acne that worsens with her menstrual period, may be prescribed an oral contraceptive by her doctor.

Medical References

1. van Dyk JC, et al. South African guidelines for the management of nocturnal enuresis. SAMJ 2003;93(5):338-340.
2. Hjalmas K, et al. Nocturnal Enuresis: An International Evidence Based Management Strategy. J of Urology 2004;171:2545-2561.
3. Kiddoo DA. Nocturnal enuresis. CMAJ 2012;184(8):908-911.
4. van Kerrebroeck P, Nørgaard JP. Desmopressin for the treatment of primary nocturnal enuresis. Pediatric Health 2009;3(4):311-327.
5. Vande Walle J, et al. Practical consensus guidelines for the management ofenuresis. Eur J Pediatr 2012:1-13.
6. Neveus T, et al. Evaluation of and Treatment for Monosymptomatic Enuresis: A Standardization Document From the International Children’s Continence Society. J of Urology 2010;183: 441-447.

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