ACNE is the most common skin disease. It is due to the increased production of sebum — the oil of the skin — by the sebaceous glands. In women this usually starts at puberty, that is, after the first menstrual period, and is due to the release of hormones at this time, as well as bacteria on the skin that act on the sebum.
In people of colour the inflammation stimulates the pigment cells, and they lay down extra pigment, causing spots.
Acne is most common in teenagers and young adults. Pregnancy may also induce outbreaks of acne. Anything that interferes with a woman's cycle can lead to acne — for example, changing the birth control pill or ceasing to take the birth control pill. Some women also develop acne at menopause.
Other causes of acne:
You may have inherited a tendency towards having acne.
Acne may be triggered by the wrong use of cosmetics, especially heavy, oily and greasy cosmetics.
Some drugs, eg steroids, can cause acne. In Jamaica where a lot of women are using bleaching creams that contain steroids, this is a common cause of acne.
The appearance of acne
•In acne you get comedones (small bumps). Whiteheads are closed comedones and blackheads are open comedones.
•There are also solid bumps called papules.
•You can also get bumps filled with pus, which are called pustules, or tender lumps which are called nodules.
•There can also be large, tender lumps called cysts, which are filled with fluid.
The sites of acne
Acne is usually found on the face, the chest, the back and the shoulders.
Grades of acne
Acne is graded as mild (a few bumps), moderate (more bumps), and severe (many more bumps).
Complications of acne
In acne you may get scars which may be depressed, that is, lower than the surface of the skin, or elevated — raised scars. You can also get dark spots — hyperpigmentation. This happens when there is an inflammatory response in the skin which stimulates the pigment cells and they lay down extra pigment.
Treatment of acne
Acne may be treated with topical products and may include retinoids, eg Retin-A , Differin or Deriva; benzoyl peroxide preparations, eg Pernox, Benzac, Proactiv; or antibiotics, eg Cleocin. The doctor may also prescribe oral medicines — antibiotics , birth control pills, retinoids like Accutane, or Spironolactone, a diuretic which is very effective.
There are several procedures used in treating acne, including facials, which may include light treatments or ultrasonic treatments. Chemical peels can be mild or deep, using a variety of chemicals like glycolic acid or salicylic acid. The doctor may also use microdermabrasion to exfoliate the skin, or microneedling — where an instrument with many small needles is used to pierce the skin and stimulate regeneration. Laser can also be used to treat acne as a stand-alone procedure, and it helps in tightening and rejuvenating the skin.
Acne is usually prevented by the use of retinoids. Very often they will need topping up with some antibiotic, topically applied, or salicylic toner.
Dr Neil Persadsingh, MBBS, Dip Derm, Fellow of the American Academy of Dermatology, is a skin specialist practising from 6 Caledonia Avenue, Kingston 5. Contact him at 906-9999, 960-2797, or e-mail firstname.lastname@example.org.