Acne (pimples)

Acne is a common skin condition that occurs when hair follicles become clogged with oil (sebum) It is a common problem of all ages. Can you believe it if I tell you, even a newborn can develop acne? Yes, neonatal acne is due to transfer of maternal hormones to the child. It is a self limiting problem, but it can cause scarring in the child’s tender face.

As the kids grow, just before puberty when the hormonal production starts, acne starts with a small white head over the forehead, nose and chin. Later on it is shifted to the cheeks as well. 90% of the teenagers get acne one or the other time. Though it is not a serious problem, it can cause serious psychological disturbances. Kids can have social anxiety and depression due to severe acne. Identifying it at the earliest stage is important. Early treatment can prevent permanent scarring. It can also help in building confidence in the children. It is important to create awareness about sebum production and how the dead skin cells block the pores to cause acne. It is essential to create awareness in children to seek early treatment and use the right products on their skin.

How does acne form?

It starts with hair follicles becoming clogged with oil (sebum)and dead skin cells and getting inflamed. It can appear in various forms, including blackheads, whiteheads, red bumps, pustules and cystic lesions. Acne typically affects areas with a high concentration of sebaceous glands, such as the face, neck, shoulders, back, and chest.

Causes of Acne:

Hormones: Androgens (male sex hormones) and their fluctuations are an important cause of acne , especially during puberty, menstruation, or stress. These hormones cause an increase in oil production.
Excess Sebum: Overproduction of oil can clog pores, trapping bacteria and dead skin in the oil gland opening.
Bacteria:The major culprit of acne, the cutibacterium acnes (P. acnes) bacteria can thrive in clogged pores, leading to inflammation.There is a genetic predisposition to grow them more, as our immune system plays a major role in keeping them under check.
Diet: High-glycemic foods are known to cause acne and dairy may contribute to acne in some people. Insulin-like growth factors (IGF) have receptors on the oil glands and indirectly sugars control the sebum levels in the skin.
Stress: Can worsen acne by increasing cortisol, a stress hormone secreted in the body, which may stimulate oil glands leading to excessive sebum production.

Types of Acne:

Blackheads and Whiteheads: These are non-inflammatory types, appearing as small bumps on the skin. These are often the earliest signs of puberty in children.
Papules and Pustules: Inflammatory lesions, appearing red and swollen, often filled with pus. Adult acne, cosmetic acne and heat induced acne predominantly have these lesions.
Nodules and Cysts: Deep, painful lumps under the skin that may lead to scarring. These may be associated with hidradenitis suppurativa, pilonidal sinus and multiple sebaceous cysts.

Acne Treatments:

Topical Treatments: Products with benzoyl peroxide, salicylic acid, or retinoids help reduce bacteria, exfoliate, and prevent clogging of skin pores. Many preparations like gels, lotions and creams are available. Dermatologists often prescribe combinations of it as they work faster together.
Oral Medications: Antibiotics, hormonal treatments, or isotretinoin are prescribed by dermatologists for severe cases. Antibiotics like doxycycline, minocycline, lymecycline, azithromycin are used either continuously for months or in pulses. Hormonal treatments are used in treatment of adult acne. Isotretinoin is a wonder drug in severe scarring acne. It is also a drug used in acne excoriae and gram negative folliculitis.
Lifestyle Changes: A balanced diet with fibres and less refined sugars, plenty of water intake, good skin hygiene, and stress management are essential for long term control of acne.
Professional Treatments: Chemical peels are very useful in controlling acne breakouts as they unclog the pores by exfoliation. They also help in reducing the sebum generation and clearing the blemishes. Intense pulsed light therapy works directly on the acne causing bacteria. IPL also reduces the red marks left during the healing process of acne. Microdermabrasion helps to improve skin quality in acne patients especially when the non inflammatory lesions are predominant. However microdermabrasion should not be performed when the lesions are inflammatory and also if the skin is sensitive.

Tips for Managing Acne:

Gentle Cleansing: Wash your face twice or thrice a day with a mild cleanser.
Non-Comedogenic Products: Get your skin care prescribed by dermatologists to make sure the products are non-comedogenic.
Hands Off: Avoid touching or picking at acne, which can worsen inflammation and lead to scarring.
Stay Hydrated: Hydration helps maintain skin barrier and aids in healing of acne.

Everyone’s skin is different, so finding the right combination of treatments may take time.

Nowadays, we see a lot of teenagers experimenting on the products. As dermatologists, we recommend the right kind of product for their changing skin, Medicated face washes, and acne control creams, go a long way in maintaining the skin hygiene and health. So next time your teenager child asks about acne, do not say it is a minor problem as it is not minor for the children because it affects their mental status and their school performance. Taking them to a dermatologist and getting a proper prescription will definitely help in improving the quality of skin as well as how the child develops self image.

Dermatologists at Subodha skin and cosmetic clinic, manage acne based on its severity, underlying causes, and the patient's skin type. Treatments typically involve a combination of topical and oral medications, as well as lifestyle modifications and procedures and treatments at times. Here’s how the treatment may be expected for your acne.

1. Topical Treatments

Retinoids: Help in unclogging pores and reducing inflammation (e.g., tretinoin, adapalene).
Antibiotics: Topical antibiotics like clindamycin are often combined with benzoyl peroxide to reduce bacteria and inflammation.
Salicylic Acid & Benzoyl Peroxide: These are over-the-counter treatments that help reduce oil production and exfoliate the skin.
Azelaic Acid: it helps to reduce inflammation, bacteria, and pigmentation from acne.

A combination of one or the above ingredients may be prescribed to you. Some common side-effects like irritation and allergic reactions can be managed immediately if they occur.

2. Oral Medications

Oral Antibiotics : Prescribed for moderate to severe acne to target bacteria (e.g., doxycycline, minocycline).
Oral Contraceptives: This is typically prescribed in adult acne, that is pimples in women who have crossed their teenage years and suffer from late onset acne. These are birth control pills that can help regulate hormones contributing to acne. Certain hormonal tests may be prescribed before starting the treatments.
Isotretinoin (Accutane): Isotretinoin is used for severe, cystic acne that doesn’t respond to other treatments. It reduces oil production and can lead to long-term remission. It is also prescribed for patients whose scars are early even though they don’t have severe acne. It is also prescribed for compulsive picking of acne which is also known as “acne excoriae”. Strict avoidance of pregnancy is required throughout the treatment and one month following treatment as the medicine can cause small formations in the baby if conceived during the treatment. The drug typically takes one month to get out of the body after that pregnancy, maybe planned. The other common side effects include dryness of mouth and lips, dry skin, depression. Depression and suicidal tendencies were recorded. However, the quality of most of the patients improves and they overcome depression, if acne is the reason for their depression. No doubt-This is a wonder drug in the treatment of acne. However, it is a prescription based drug and the doctor needs to monitor the cholesterol levels and liver function test when you are on the medication.

3. In-Office Procedures

Chemical Peels : Exfoliate the skin (removal of dead skin cells) and help clear acne and post-inflammatory hyperpigmentation.Typically AHA’s help in treating post inflammatory hyperpigmentation and BHA’s help reduce acne.
Laser and Light Therapies : Intense pulse light or Ipl treatment, Laser toning by Q switched Nd-YAG , blue light treatment are used to control active acne. They help to reduce bacteria, oil production, and inflammation. It also helps in reducing scar formation, as they help in controlling inflammation early in the process of acne.
Corticosteroid Injections: Used for large, painful cysts to reduce swelling quickly. Lower doses are preferred as to minimise the side effects of steroids.

4. Lifestyle and Skincare Adjustments

we at Subodha skin and cosmetic clinic, believe in improving the lifestyle and fixing the root cause of acne. Here are some recommendations we give to our patients on a daily basis
Skincare Routine: We recommend non-comedogenic and oil-free products, regular cleansing, and moisturizers suitable for acne-prone skin. Do not forget to add a good sunscreen, preferably gel or lotion based, as they help in reducing the post acne hyperpigmentation.
Dietary Changes : Some may recommend reducing high-glycemic foods or dairy, though this varies per individual. We, at Subodha skin and cosmetic clinic, believe in restricting the foods in a realistic way, so that our patients are not deprived of the joy of food on a daily basis. We believe in educating our patients on what to choose and when to eat rather than restricting a blanket strict diet.
Stress Management : Since stress can exacerbate acne, managing stress is very important.

Each treatment plan is tailored to the individual's needs, and it may take several weeks to months to see improvement. Regular follow-ups help adjust treatment as needed. Many times, adding a procedure like salicylic peel and mandelic acid peel can help in reducing the inflammatory acne and speed up the Recovery. We can also combine intense pulse, light therapy or Ipl therapy as it brings down the inflammation and acne induced redness quickly. Speak to your dermatologist to get more information about it.

To women, in their mid-30s and 40s again, acne hits back. This time it is called adult acne or hormonal acne. Due to hormonal changes in the body during middle age, women go through weight gain, unwanted hair on the face, hair loss, and hair thinning. It also includes dull -skin and lower face acne or the jawline acne. Seeking medical help from a dermatologist can get back a glowing skin and a pimple free face. This time it may not be just the face washes and the creams procedures like Ipl and chemical peels may be necessary.

Acne is a medical condition and very much treatable. It can help me to gain your confidence back. Also, the timely lifestyle modifications can improve the quality of life and give long term health benefits. So acne is not just a skin problem, it is a medical condition that needs attention! Schedule your appointment to get into the right path.