The course of acne is punctuated with frequent flare-ups in the affected and hence acne is to be approached as a chronic disease which requires active treatment intervention and a maintenance program for optimal control of the inflammatory pimples. During the adolescent years acne can cause untold heartbreaks and psychosocial impacts, which makes it a disease to be handled with proper care and knowledge.
Is Acne a Disease or a Normal Physiological Problem of the Adolescence?
Acne is a disease of the pilosebaceous unit which includes the hair follicle and the associated sebaceous gland. It is not just a normal age related phenomenon, as hormone related pathological changes assisted by the bacteria propionibacterium acnes occur in acne and result in long lasting effects on the skin, like pigmentation and scars. The Global Alliance to Improve Outcomes in Acne in their report presented as a supplement to the May issue of Journal of American Academy of Dermatology advocates approaching acne as a chronic disease requiring initial aggressive therapy followed by maintenance therapy to avoid the complications and minimize the social and psychological fallouts of the acne.
When it is very mild and limited to a few numbers of comedones, acne can be considered physiological. The presence of inflamed papules, pustules or presence of nodules and acne cysts calls for active treatment of the acne.
How Common is Acne?
Acne is the commonest skin disease. It affects approximately 85% of young people. Previously thought to be a disease of the adolescence, acne is also common in adults from 20 to 35 years of age. The common acne is called acne vulgaris. There are many variants of acne like neonatal acne, drug induced acne, chloracne, acne excoriee, keloidal acne etc.
How Does Acne Occur?
Many factors play a role in the causation of acne, including a hereditary predisposition, effect of androgenic hormones and many other external and internal factors. After puberty, androgen hormones stimulate the sebaceous glands to increase their size and produce more sebum, an oily liquid intended to keep the skin smooth and supple. The sebum is a good growth media for certain bacteria, which in turn produces inflammation within the hair follicle and the surrounding dermal structures. Depending upon the severity of the inflammation, the types of acne also vary in different individuals and at different times in the same individual.
What is the Age Incidence of Acne?
Contrary to popular belief, acne can occur at any age, from neonates to old age. Mostly acne is seen in early puberty to early adulthood, i.e., the ages of 12 to 25 years. About 50% of teenage acne can continue to adulthood. Some people, especially females, tend to have an occasional flare ups into their 30s. At the age of 40, 1% of males and 5% of females still have active lesions of acne.
Does Acne Differ in Males and Females?
Males and females are affected equally in acne, though the severity of acne is more in males. Almost all boys and 90% of girls will have had an attack of acne during their teen age. Acne conglobata or nodulocystic acne is more common among males.
What are the Common Areas of the Body Affected by Acne?
Acne can develop on any hair bearing area, though it is most common on the face, as this is the area with the maximum density of sebaceous glands. In the face, the cheeks, nose, chin and forehead are mostly affected, in that order most of the time. Acne on face is most commonly known as the pimples or zits. Acne also occurs on the chest, shoulders, upper back, buttocks and thighs.
Is it True that Excess Dandruff is the Cause of Acne, Especially on the Forehead?
Dandruff and acne have got some common features as their causes, like increased seborrhea, oily skin and the effect of the androgenic hormones. Hence both are complementary; one is not cause of the other.
What are the Common Signs and Symptoms of Acne?
Whiteheads and blackheads are the earliest skin lesions in acne. Depending upon the severity acne is divided into different types of acne, the comedonal, papular, pustular and nodulocystic.
In presence of inflammation, in the pustular and nodulocyctic variety, the acne eruptions can be red, painful and hot and tender on touch.
The skin of acne sufferers is usually greasy and oily and most of them suffer from concomitant dandruff during the acne attack or later in their life.
Oiliness and sudden eruptions can sometimes cause an itchy feeling on the acne affected area.
Though acne is the commonest skin disease affecting more than 85% of world’s population at least once in their life time, there are many misconceptions and myths regarding acne vulgaris.
Simpson NB & Cunliffe WJ. Disorders of the Sebaceous Glands in Rook’s Textbook of Dermatology.2004; 7: 43.1-43.75.
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.