What is acne and is it an "adolescents’ disease"?

Acne is one of the 10 most common diseases in the world and affects many hundreds of millions of people every year. Although it most often appears in adolescence, affecting over 80% of teens in the western world, it can also occur in children and adults.

The skin’s appearance caused by acne can lead to anxiety, poor self-esteem, and in extreme cases even to depression and suicidal tendencies.

Many people tend to attribute the disease to oily skin, and it is indeed more common in this type of skin, but it can be found in a variety of skin types, including dry skin, since the trigger for its formation lies in sebaceous gland overactivity, which is greatly affected by hormonal activity.

How is acne formed?

Acne disease has a significant genetic predisposition, and in fact genetics is the main cause of the formation of about 80% of acne cases.

The androgen hormones (male hormones) play a significant role in the formation of acne in both genders, as their presence causes an increase in the amount of sebum secreted from the sebaceous glands. When sebum mixes with dead cells it can form a clot at the gland’s outlet, the milk that accumulates in it serves as a fertile breeding ground for bacteria and thus acne is formed. Common manifestations of the disease include white or black heads, comedones, inflammatory lesions and subcutaneous cysts.

Acne will appear mainly in areas saturated with fat – face, upper chest and back.

Since acne is associated with hormonal presence, it usually disappears on its own after a period (between weeks and a few years), so the perception in the past was that there is no need to actively treat the condition. Today, we know that one of the most serious side effects of acne is skin scars, which are extremely difficult to get rid of. Therefore, the recommendation of dermatologists is to actively treat the disease as soon as it appears.

Acne – Ways to Treat and Avoid

The existing treatments for acne are many and various and are usually tailored to the severity of the problem. The treatments range from a change in lifestyle – for example a reduction in the consumption of simple carbohydrates (such as sugar), through medications applied to the skin or by swallowing to medical procedures.

How to prevent acne?

Since acne is a disease that is mainly affected by genetic and hormonal factors, it cannot be completely avoided. At the same time, studies have shown that a diet rich in complex carbohydrates, and low in simple carbohydrates, may reduce the chance of acne, as it lowers the amount of blood sugar (glucose).

When the blood sugar level rises rapidly, the body releases the hormone insulin. Excess insulin in the blood may cause the mammary glands to secrete more sebum and thus increase the risk of acne formation. Among the foods that cause an increase in the amount of insulin – and therefore those suffering from acne are advised not to consume them – can be found foods with high hyper-glycemic value, such as pasta, white rice, white bread and sugar. Avoiding these foods will, to some extent, reduce the appearance of acne.

How can acne be treated?

The most popular way to treat acne is through substances that can be applied directly to the skin: Azelaic Acid, Salicylic Acid, Benzoyl Peroxide and Retinoids. Some of these substances are defined as prescription drugs, but there are recent substitutes based on herbal extracts, most of which do not require prescription drugs. Such substitutes include Arbutin, Bakuchiol and others.

Swallowing medications for acne can include antibiotics, although concerns about rising body’s resistance to antibiotics has made this drug less popular today. There are several types of birth control pills that help treat acne in women. In severe cases of acne, isotretinoin-based medications, such as Roaccutane, are used, which can have significant side effects.

Acne scars

Acne scars form as a result of an inflammatory process of the dermis and are common in 95% of acne patients. Scarring is especially common in severe cases of acne but can also occur in less severe cases. Acne scars are sorted according to whether the abnormal healing response has led to excess production or loss of collagen at the location of the acne appearance.

Atrophic acne scars, or depressed scars, are the most common – appearing in about 75% of cases and are the result of collagen loss in the healing process. Hypertrophic scars are rare and are characterized by excess collagen as a result of a poor healing process of acne. These are stiff scars that protrude from the skin.

Acne stains

Another type of acne scar appears in the form of dark spots on the skin – post-inflammatory hyper-pigmentation (PIH). Inflammation caused by the skin due to acne, causes overactivity of the melanocyte cells responsible for the production of melanin in the skin, thus forming dark spots at the appearance of acne. The phenomenon is more common in people with dark skin, and although it is likely to pass – fading of the spots can take months and even years, and in extreme cases settle in the skin forever. Sun exposure increases the settling of these spots.

How to treat acne scars?

Unlike active acne treatment, capsule medications or cosmetics for topical application are not effective in treating acne scars. Acne scars can only be treated with energy-based medical equipment (such as laser or RF) or deep chemical peels. These treatments require a recovery period of several days to about two weeks during which the skin is irritated, red and even peeling. During this period, known as acute recovery, direct exposure to the sun must be avoided. After the immediate acute recovery the skin will usually be red for several additional weeks to months following the treatment.

A word from the doctor – is it possible to remove acne scars?

Acne scars are among the leading factors that cause the patient to seek a significant cosmetic procedure. Currently available advanced technologies provide impressive and significant results in blurring acne scars, but one must keep in mind that this is a marathon and not a sprint. Treating acne scars with medical equipment will require a series of several treatments, with a recovery time between them, and can take from several weeks to many months. Improper use of energy-based equipment, at high intensities or not tailored to the specific skin, can lead to significantly detrimental side effects, such as pigmentation or skin deformity. On the other hand, treatment by a professional, with skilled and experienced hands, is usually safe and involves very few risks and side effects.

At the same time, it is important to clarify! Acne scars cannot be completely removed (except in a significantly invasive procedure, which requires hospitalization and review, such as a deep peel), and the end result of the treatment will be blurring of the scars compared to the initial condition.

Because of the difficulty in achieving the "perfect result", treating acne with active remedies or ointments in real time will always be effective and preferable to trying to treat the scars it leaves behind.

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