Acne a real disease

The search for beauty is a natural tendency in the human being and since the most remote antiquity man has tried to modify his appearance to obtain a more aesthetic image.Today’s society imposes a canon of beauty in which the facial skin must be perfect; smooth, without imperfections, smooth, homogeneous, without spots or wrinkles and with a slightly tanned tone. Hence, dermatological diseases that affect the face, such as acne, generate a great psychological impact on our patients, contributing to low self-esteem and states of anxiety and depression.
With our current knowledge and the treatments that we have it is inconceivable that acnes are not treated and improved. Passive postures such as “she will heal when she gets married or when she turns thirty” are not understandable, much less going to “beauty centers” to perform “cleanings”, laser treatments or other procedures that do nothing more than maintain the idea that acne is a small skin problem that anyone can solve and that it has nothing to do with the rest of our body. Nothing is further from reality; acne is a disorder closely related to our endocrine system, and the dermatologist is the best trained specialist to treat it early and prevent its consequences, in the form of undesirable marks and scars,
This article aims to explain clearly and concisely what it is, how it is treated, and disprove false beliefs about acne

What is it?

It is a chronic inflammatory disease of the pilosebaceous follicle of unknown cause. Its etiopathogenesis is influenced by four main factors that will be the target of the different treatments: obstruction of the pilosebaceous canal, increased secretion of the sebaceous glands dependent on androgens, alterations in the bacterial microflora with the presence of microorganisms such as P. Acnes and release of inflammation mediators leading to acne papules and pustules

Who can get it?

It typically occurs in adolescence, affecting 80% of this population group. It is more serious in men than in women. However, there are some special forms of acne that can affect newborns (acne neonatorum) or adults exposed to certain industrial products (occupational acne), or people who take certain medications such as oral corticosteroids (drug-induced acne), these being less frequent clinical forms than classic juvenile acne.

What are your symptoms?

Acne manifests itself clinically with various types of lesions, and several of them may occur in the same patient. These lesions can be inflammatory and non-inflammatory. Non-inflammatory include closed and open comedones “blackheads” and inflammatory ones include reddish papules, pustules, nodules and cysts. These last two are the most important, since in their evolution they can leave residual scars, which are the most important sequela of acne and can justify a more aggressive initial therapy by the dermatologist.
Some patients may present with more serious symptoms associated with fever and poor general condition (acne fulminans) and that require early systemic treatment.
Depending on the type of lesions and their severity, acne can be classified into several grades:
Mild (comedonian)
Moderate (papulo-pustular)
Severe (nodule-cystic)
Very severe (conglobata and fulminans).
Acne lesions are mainly located on the face (forehead, cheeks and chin), back, shoulders and the presternal region, which are the seborrheic areas of the body.

How is it diagnosed?

The diagnosis is made clinically by the presence of one or more elementary lesions.
In some patients in whom acne is associated with other alterations such as menstrual disorders, hair loss, seborrhea or increased hair, it is necessary to perform a complementary hormonal analysis that will allow to rule out the presence of hormonal alterations and better guide the treatment.

How is it treated?

Acne treatment is based on two modalities: topical and systemic. The choice of one modality or another will depend on the severity of the acne. Treatment guidelines are as follows:
Mild acne
Topical treatment: exfoliants (salicylic acid, glycolic acid), benzoyl peroxides, azelaic acid and retinoids (tretinoin, isotretinoin and adapalene).
Moderate acne
Topical treatment: benzoyl peroxide, retinoids and antibiotics (clindamycin or erythromycin).
Severe acne
Systemic treatment: systemic antibiotics (tetracyclines), for 3 to 6 months. Systemic retinoids (isotretinoin) administered at doses of 0.5 to 1 mg / kg / day for 5 months allow a complete cure in almost all patients. In some patients it is necessary to administer more than one treatment cycle.
Patients with proven hormonal alterations (elevated androgen levels) may benefit from antiandrogenic treatments or oral contraceptives.

Very severe acne
Systemic treatment: Isotretinoin associated with systemic or intralesional corticosteroids.
Surgical treatment: in some patients it is necessary to perform drainage of the cysts or mechanical removal of the comedones as complementary treatments at the best skin specialist in south delhi.
Sequelae: in patients with secondary acne scars, it is possible to carry out corrective treatments provided that there are no active lesions. Among others, we have chemical peels with glycolic and salicylic acid or other somewhat more aggressive methods such as dermabrasion or fractionated Erbium Yag laser, which allow us to improve the appearance of patients with a quick recovery and minimal “social loss”

It is important that patients avoid handling the lesions and are consistent in performing the treatment.

What is the prognosis?

Acne is generally a pathology that affects adolescents and young adults and tends to resolve over the years. In young men it tends to resolve between 20-25 years, while in women it can persist until 30-40 years.
The most unfavorable prognostic factor is the presence of residual deep scars, which can remain permanently.
Acne has always been a cause for concern, generally cosmetic. As often happens in these cases, a series of myths have arisen about acne, its possible causes and treatments, in some cases very absurd. Let’s review and debunk the 10 most widespread myths about acne:

1) Acne is only a cosmetic factor.
When a teenager suffers from very severe acne, the self-image is severely affected, self-esteem is lowered, and it can lead to severe depression. This can negatively affect social relationships and lead to social isolation.
2) Acne is caused by poor hygiene.
Of course, skin hygiene is very important. A face wash with soap and water once or twice a day will help to keep our skin healthy. However, the oil that causes acne occurs below the surface of the skin, and there it is impossible to clean, then acne does not occur due to lack of hygiene.
3) Acne is caused by certain foods
Chocolate has been the main protagonist of this myth for years. No studies have found scientific proof that chocolate causes acne.
4) Acne passes by itself
There are many types of treatments, from mild to powerful drugs. Obviously, it will be the dermatologist who tells us what to do, but it is absurd to say that in all cases it happens alone and there is no need to act.