is a chronic inflammatory dermatosis of pilosebaceal follicles occurring in more than 85% of young population in age of 11 to 25 years. The prevalence of acne in adolescence is significantly higher among male patients. In 20% of patients acne can persist even after the age of 20 which is more common in women. In most cases, acne is present in form of mild to moderately severe clinical picture.
Approximately 15-30% of patients suffers from a clinically severe form of acne which requires intensive care to avoid scarring and this is often great psychological burden for young individual.
Considering the fact that patients with acne are suffering from numerous psychological problems, including lowered self-esteem, social withdrawal, anger, anxiety and depression it is critical to evaluate not only the clinical picture of this condition but also psychosocial impact which is sadly often neglected.
In general, it is falsely believed that the condition will resolve spontaneously over time which is why many patients do not seek help of a dermatologist. This is especially dangerous in patients with severe form of acne in terms of eventual scarring and psychological trauma as a result of not treating the condition in its early stage.
Acne is not result of poor hygiene. Excessive cleaning or scrubbing with various products can worsen the condition and result in redness and peeling. Self-squeezing techniques often worsen the condition causing increased inflammatory response which in turn stimulates skin hyperpigmentation and scarring.
What causes acne?
It is believed that the size of the sebaceous glands and their sensitivity to hormonal influence are inherited, as well as the person’s tendency to follicular keratosis (cornification). Androgen hormones play important role in acne forming in a way that although blood levels do not have to be elevated androgens do increase sebaceous glands sensitivity. Under the influence of androgens sebaceous glands increase sebum (oil) secretion, process of keratinization of (cornification) follicles is damaged and otherwise normal skin bacteria flora starts to multiply consequently leading to comedone formation and inflammatory skin reaction.
The increased secretion of sebum is one of the main prerequisites for acne development and due to keratinization disorders dead epithelial cells and sebum can build up in the hair follicle, providing favorable conditions for bacterial growth and the consequent emergence of comedones.)
Acne in adults
It’s considered that the 15% of women and 5% men are prone to acne in their adult years. In adults acne appear more frequently on chin and along the lower jaw. These skin changes occur due to various etiological factors, such as hormonal fluctuations during the menstrual cycle in women. Acne tends to be common problem in women with polycystic ovary syndrome who often suffers from insulin resistance or hyperinsulinemia along with the secretion imbalance of sex hormones.
Stressful periods, such as school/college exams, certain medications and usage of inadequate care preparations can also rise proneness to acne in adulthood.
Diet and acne
Impact of diet on acne aggravation is often subject of a discussion. Over the years opinions have changed but according to recent studies excessive consumption of foods with high glycemic index seems to worsen the acne.
Treatment
Since acne is often a chronic problem, it is very important to start effective therapy in early stage of condition. Type of treatment depends upon several factors such as severity of clinical lesions, conditions duration, scaring tendency and effectiveness of current treatment(s).
Before starting the treatment, it is important to consider the factors that are important in the pathogenesis of the condition; more factors included in planning the therapy the greater therapy effect. Standard treatment includes topical preparations with comedolytic and anti-inflammatory action as well as systemic administration of antibiotics or isotretinoin.
The treatment of acne is a long process that requires good dermatologist-patient cooperation, ensuring thus effective control over the outbreak of new changes. It is often necessary to wait a few weeks after prescribed therapy in order for effects to be visible. Short-term worsening of acne at the beginning of treatment should also be expected.
