What is Acne?
Acne is a medical condition characterized by infection and inflammation of the pores in the skin. The most commonly affected areas include the forehead, cheeks, chest, and back. The condition frequently occurs in adolescent males and females due to increases in androgen levels. It may also occur in patients with other underlying diseases such as polycystic ovarian syndrome. Acne often leads to self-consciousness and reduced confidence due to its cosmetically displeasing appearance and typical age of onset.
Severe forms of acne can also be painful and decrease quality of life. They cases often require chronic therapy by a dermatology specialist.
What Causes Acne?
It is caused by genetic and environmental factors such as hormonal changes and bacterial infection. Patients typically develop red irritating bumps on the face and other regions due to bacterial infection and inflammation of the pores in the skin. The most common bacteria implicated in the development of acne is Propionibacterium acnes.
The pores fill and get plugged with dead skin debris, sebum, and bacteria – which promote skin irritation and inflammation. This can acutely result in redness, swelling, and pain of the skin lesions – these are frequently referred to as “pimples.” Patients may also develop comedones, which is the medical term for “black heads.” These are chronic forms of pimples that due not generally become inflamed.
How Common is Acne?
It is exceedingly common in the United States and responsible for frequent primary care visits. It most frequently affects adolescence likely as a result of increased androgen levels during puberty. Severe cases of the condition often require referral to a dermatology specialist – especially when first-line and conservative measures were unsuccessful.
Approximately 35%-90% of the adolescent population has acne. Acne usually begins improving and resolves around at age 30 – in some cases it can persist. Post-adolescent acne is typically seen in women, as opposed to adolescent acne, which is more predominant in men.
Signs and Symptoms
Symptoms and signs of acne typically include red, painful, and swollen bumps on the face, back, or chest. These skin lesions are typically small pustules, but sometimes they may become large or cystic, which can ultimately lead to scarring and deformation of the skin. Symptoms tend to occur in adolescent males and females undergoing puberty. This is likely related to the hormonal changes that occur during that time period. Rosacea is a skin condition similar to acne that generally affects middle-aged adults.
The diagnosis is made based on symptoms and physical examination. There are no tests that you doctor needs to order to confirm the diagnosis. In severe cases that are unresponsive to first-line treatment, your doctor may refer you to a dermatologist. In these cases, they may biopsy the skin lesions or send pus for gram stain and culture.
Women with acne and signs of hyperandrogenism should typically be evaluated for diseases such as polycystic ovarian syndrome, congenital adrenal hyperplasia, or adrenal/ovarian tumors.
Acne Treatment and Medication
Comedonal acne is typically treated with one or more of the following agents:
- Topical retinoids Retin-A (tretinoin)
- PanOxyl or Benzac (benzoyl peroxide)
- Finacea (azelaic acid)
- Differin (adapalane)
- Tazorac (tazarotene)
Patient may also benefit from the addition of a topical antibiotic gels such as Acnegon (clindamycin) and Eryacne (erythromycin).
Studies show that the combination of benzoyl peroxide and a topical antibiotic is more effective than either agent alone.
In more severe cases of acne, a topical retinoid, topical benzoyl peroxide, and an oral antibiotic are typically indicated. Oral antibiotics are generally used for a up to 3-4 months. Commonly prescribed oral antibiotics include:
Patients with very severe acne not responsive to these measures may require Accutane (oral isotretinoin).
Hormonal therapy is an additional therapeutic option in moderate to severe acne in women. It is often used in combination with topical retinoids and antimicrobial agents. These typically include Aldactone (spironolactone) and oral contraceptives. Commonly prescribed contraceptives include:
- Ortho Tri-Cyclen - estrogen combined with norgestimate
- YAZ - estrogen combined with drospirenone
- Estrostep - estrogen combined with norethindrone
- Dalgard F, Gieler U, Holm JØ, et al. Self-esteem and body satisfaction among late adolescents with acne: results from a population survey. J Am Acad Dermatol 2008; 59:746. - https://www.ncbi.nlm.nih.gov/pubmed/19119094
- Haider A, Shaw JC. Treatment of acne vulgaris. JAMA 2004; 292:726. - https://jamanetwork.com/journals/jama/fullarticle/199214
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.