Last updated date: 23-Mar-2023
Originally Written in English
The majority of youngsters will develop pimples at some time during their lives. Some people just have a few little pimples that fade away quickly. Others experience acne that is chronic and obvious. This can be extremely upsetting, especially around puberty.
Acne is a pilosebaceous unit inflammatory condition that is common in adolescence. Open (black) and closed (white) comedones, inflammatory papules, pustules, nodules, and cysts are the most common lesions, which can lead to scar formation and pigmentary alterations.
Follicular epidermal hyperproliferation with subsequent follicle-clogging, increased sebum secretion, the presence and activity of the commensal bacteria Cutibacterium acnes (previously known as Propionibacterium acnes), and inflammation are the four variables that cause acne. Furthermore, genes play a crucial role in the development of acne.
Although there are effective acne treatments available, acne can be persistent. The pimples and bumps take an extended time to cure, and together starts to fade, another appears. Acne can cause psychological pain as well as skin scarring, depending on its extent. The earlier you receive treatment, the lesser your chances of developing such issues.
Acne can have a wide range of severity. Acne is classified as mild, moderate, or severe by dermatologists. There are two varieties of acne: inflammatory and non-inflammatory. Non-inflammatory acne is a milder form of acne that most people refer to as "pimples" or "blackheads" instead of "acne."
Acne, unlike ordinary pimples, takes longer to form and lasts longer. It can sometimes leave behind little red markings or scars. Pimples that are considered ordinary form rapidly and then fade away.
Micro-comedones to closed comedones to inflammatory lesions to post-inflammatory erythema (PIE), post-inflammatory hyperpigmentation (PIH), and scarring are all stages of the acne lesions' life cycle. PIE is more common in those with fair complexion, whereas PIH is more common in dark-skinned people. Both consequences indicate clinically evident and histologically significant inflammation, which may be linked to the slow decay of non-viable P. acnes within the follicle. PIE is caused by microvascular dilatations caused by wound healing, which is interpreted as overall redness rather than apparent telangiectasia and is aggravated by repair-related epidermal thinning.
In the vast majority of cases, acne affects the face, with many patients suffering from scarring, the severity of which is related to acne grade. Acne scars are the outcome of a failed wound healing reaction to cutaneous inflammation, with inflammatory cell infiltrates present in 77 percent of atrophic scars. Different P. acnes phylotypes trigger epidermal host defenses in different ways, which contributes to acne severity differences. Early lesions elicit a significant, nonspecific immune response in patients who are not prone to scarring, which lessens as the lesions heal. Early lesions in scarring patients, on the other hand, are characterized by a lower number of epidermal CD4+ T-cells than in non-scarring patients, a reaction that becomes more prominent in resolving lesions.
Acne Clinic NYC
Why do you have to change your home care routine every two weeks?
Acne skin is capable of adapting to products. Every two weeks, we'll greatly boost your home care routine to remain ahead of your skin's ability to adapt and keep pushing your skin to clean up. If you are unable to come in regularly, we will still clear you; however, it will take longer.
What is the secret to healthy skin?
The secret to clear skin is your willingness to choose acne-safe products and receive expert acne treatments with extractions regularly.
Is it possible to get rid of acne pigment (the red or brown markings)?
Yes. Although some clients refer to them as "acne scars," they are not actual acne scars. This is a condition known as post-inflammatory hyperpigmentation (PIH). The pigmentation will be significantly reduced by the items in your home regimen and our chemical peels. Because you won't have any new breakouts, your face's skin will gradually clean up, with no new breakouts and no red or brown areas left behind.
When it comes to getting clear skin, how long does it take?
While many clients notice a difference in their skin within the first month, it normally takes six treatments spread out over three to four months to achieve at least 90% clearance. This is due to the fact that existing acne impactions require 30-90 days to reach the surface.
How often should I visit the dermatologist for acne treatment?
We recommend coming in for acne treatment every 2 weeks for the first few months to exfoliate the skin, extract acne plugs as they appear, moisturize the skin, alter your home regimen, and minimize post-inflammatory pigmentation and acne scars.
What sets your acne therapy apart from that of dermatologists?
We employ a variety of products in various strengths that can be tailored to your unique acne type and severity. You have your acne specialist who will guide you through the process of becoming acne-free. We are here to respond to your comment at any moment and will accompany you on your journey. We don't simply focus on one part of having your skin clear: makeup, lifestyle, nutrition, or medicine.
What happens after I've gotten my bearings? Will I be able to keep my clearance?
Once your acne seems to be under check, all you have to do now is keep using your home care products to stay clear. We will lessen your acne regimen after a few months to keep your clear skin with a basic skincare routine - cleanser, toner, and moisturizer.
Acne vulgaris is characterized by the production of comedones, papules, pustules, and nodules as a result of pilosebaceous units’ blockage and inflammation. Acne develops on the face and upper trunk of the body. Adolescents are those who are most affected. The examination is employed to make a diagnosis. Treatment might include several topical and systemic medications aimed at lowering sebum production, comedones formation, inflammation, and bacterial concentrations, as well as regulating keratinization, depending on the severity of the condition.
Acne is primarily a hormonal disorder triggered by androgen hormones, which peak in activity between adolescence and early adulthood. Acne is caused by sensitivity to these hormones, which can be exacerbated by surface germs on the skin and fatty acids in the oil glands.
Acne is often caused by and/or made worse by a range of things, including:
- Hormone levels fluctuation around the start of a menstrual period.
- Picking of acne sores.
- Hats and sports helmets are examples of clothing and headgear that can cause acne.
- Pollution and certain climatic parameters, particularly high humidity.
- Using oily or greasy personal care items (such as heavy creams, lotions, or hair pomades and waxes) or working in an environment where grease is regularly encountered (such as working at a restaurant where there are greasy food surfaces and frying oil).
- Acne flare-ups can be exacerbated by stress, which raises the levels of cortisol hormone.
- Some prescribed drugs.
A cystic acne is an inflammatory form of acne that results in painful, pus-filled lesions deeply beneath the skin. Cystic acne is caused by the clogging of skin pores by oil and dead skin cells.
Bacteria penetrate into the pores of cystic acne, producing swelling and inflammation. The most severe kind of acne is cystic acne. Acne cysts are frequently uncomfortable, and they are more prone to leave scars.
Excess oil and dead skin cells can clog pores in the skin, resulting in pimples. Bacteria can get stuck in the pores of the skin, along with oil and skin cells. The skin reaction involves swelling in the middle layer of the skin (the dermis). An acne cyst is an inflamed, red, swollen bump.
The following are some of the causes of cystic acne:
- Age (teens are more susceptible to cystic acne).
- Cystic acne runs throughout the family.
- Hormone changes, especially during adolescence and sometimes during menopause, as well as stress, are all factors to consider.
Acne scars are often divided into three categories:
- Ice pick scars are small, deep holes in the skin's surface that appear to have been punctured with a sharp tool.
- Rolling scars are created by layers of scar tissue forming beneath the skin's surface, giving the skin's surface a rolling and irregular look.
- Boxcar scars are downturns or craters in the skin that are circular or oval.
Acne scars are frustrating, and there is no one-size-fits-all solution. Depending on the type of scar, your skin type, and the severity of the scarring, one or a combination of the following strategies may help you enhance the appearance of your skin.
Skin-care at home. Sunscreen can assist to reduce the difference between damaged and non-scarred skin. Medicated creams containing azelaic acid or hydroxy acids, for instance, can also be beneficial.
Fillers for soft tissues. The skin over depressed scars can be plumped by injecting collagen, fat, or other material under the skin. The idea is to hide the scars as much as possible. Because the consequences are only transient, frequent treatments are required to take care of the impact. This approach has a low chance of causing skin color variations.
Injection of steroid. The look of your skin can be improved by injecting steroids into certain types of prominent scars.
Resurfacing with a laser. This method is becoming more popular, and it is frequently utilized on scars that have previously been treated with dermabrasion. People with darker skin or a history of keloid scarring are more likely to experience negative side effects from this procedure.
Dermabrasion. This technique is usually planned for scarring that is more severe. A quickly revolving brush or other equipment is used by your dermatologist to exfoliate the top layer of skin. Deeper acne scars may seem less apparent if surface scars are totally gone. Scarring and complexion color changes are two serious side effects that would occur.
Peeling agent. To remove the highest layer of skin and diminish the development of deeper scars, your doctor uses a chemical solution on the scar connective tissue. To keep the results, repeat the light and medium peels. You can only have one peel every time. Changes in complexion tone, especially when thorough peels are done on dark skin, are possible side effects.
Acne treatment should focus on the recognized pathogenic elements that cause acne. Follicular hyperproliferation, excessive sebum, Cutibacterium acnes infection, and inflammation are some of the symptoms. The degree and severity of the acne can help determine which of the subsequent treatments, either alone or together, is best for you.
Almost all acne patients should start with a mix of topical retinoid and antibacterial therapy, according to current recommendations. The combination's improved effectiveness over each monotherapy is due to complementary modes of action that target separate pathologic causes. Antibiotics have anti-inflammatory and antimicrobial properties, whereas retinoids reduce abnormal desquamation, are comedolytic, and have some anti-inflammatory properties, whereas benzoyl peroxide is antimicrobial with some keratolytic properties.
Topical retinoids are anti-inflammatory and comedolytic. Follicular hyperproliferation and hyper-keratinization are corrected. Microcomedones, comedones, and inflammatory lesions are reduced with topical retinoids. Topical tretinoin cream should be used as a first-line treatment for both comedonal and inflammatory acne lesions, and then as a long-term treatment to prevent the creation of new microcomedones.
Adapalene, tazarotene, and tretinoin are the most widely used topical retinoids for acne vulgaris. These retinoids should be used once every day to clean, dry skin, but if irritation occurs, they may need to be applied less frequently. Early usage of topical retinoids may irritate the skin with peeling and erythema, which usually disappears within a few weeks. Mild, non-irritating cleansers and non-comedogenic lotions can assist to alleviate soreness. If irritation continues, alternate-day doses may be employed.
Antibiotic resistance is frequent in C acnes (previously P acnes) and poses a serious danger to acne treatment. Antimicrobials should be used in conjunction with topical retinoids to help remove lesions faster and reduce antibiotic treatment duration. To lessen the risk of resistance, they should be used with benzoyl peroxide. Oral and topical antibiotics should not be taken together and should not be used as monotherapy. If acne recurs, use the same antibiotic as before if it was effective. The use of benzoyl peroxide for 5-7 days between antibiotic regimens may also assist to diminish resistance in skin pathogens.
Benzoyl peroxide treatments are also useful against C acnes, and there has been no evidence of bacterial resistance to benzoyl peroxide. Benzoyl peroxide is available in a range of topical forms, including soaps, washes, lotions, creams, and gels, both over the counter and by prescription.
3. Androgen receptor antagonists
Clascoterone 1 percent topical cream is an FDA-approved first-in-class topical androgen receptor inhibitor for acne vulgaris in patients aged 12 and up. The specific mechanism has yet to be discovered. Clascoterone interferes with androgens, specifically dihydrotestosterone, for binding to androgen receptors in the sebaceous gland and hair follicles.
Two-phase three randomized trials with 1440 participants supported the approval of clascoterone topical. At week 12, treatment success rates for patients who received clascoterone were statistically significantly higher than for patients getting the vehicle alone.
Systemic (Oral) Treatment
1. Oral antibiotics
In the treatment of moderate-to-severe inflammatory acne vulgaris, systemic antibiotics are a mainstay. These medications have anti-inflammatory characteristics and can be used to treat C acne. Acne is typically treated with antibiotics from the tetracycline family. Antibiotics, including doxycycline and minocycline, are often more potent than tetracycline.
Sarecycline is a novel first-in-class tetracycline-derived antibiotic for non-nodular moderate-to-severe acne vulgaris in adults and children aged 9 years and older. It has a narrow spectrum of activity compared to currently available tetracyclines, with reduced effectiveness against enteric gram-negative bacteria and anti-inflammatory properties.
It's also possible that the higher efficacy is attributable to lower C acnes resistance to minocycline. However, C acnes resistance is spreading across all antibiotic classes now used in the treatment of acne vulgaris. The effectiveness of erythromycin in the treatment of acne has been considerably diminished due to C acnes resistance to the antibiotic. Trimethoprim alone or in combination with sulfamethoxazole, as well as azithromycin, have been shown to be beneficial.
2. Hormonal medications
In the treatment of acne vulgaris, some hormone treatments may be beneficial. Estrogen is a hormone that can be utilized to reduce the production of sebum. It also suppresses gonadotropin release, which lowers androgen production in the ovary. Oral contraceptives also enhance hepatic production of sex hormone–binding globulin, lowering circulating free testosterone overall. Acne vulgaris has been successfully treated with combination birth control tablets.
Spironolactone is also sometimes used to treat acne vulgaris. Spironolactone inhibits androgen synthesis by binding to the androgen receptor. Dizziness, breast discomfort, and dysmenorrhea are some of the side symptoms.
Isotretinoin may be a highly effective systemic retinoid for the treatment of severe, resistant acne. Isotretinoin normalizes epidermal differentiation, reduces sebum excretion, has anti-inflammatory properties, and even diminishes the occurrence of C acnes.
Isotretinoin therapy should be started at a lower dose for four weeks, then raised as tolerated until a complete dose of 120-150 mg/kg is reached. In severe situations, coadministration of steroids at the start of the treatment may be beneficial in preventing initial deterioration. Some patients may respond to doses that are lower than those recommended by the manufacturer. A smaller dose given for the same duration of time may be equally successful in clearing acne as a higher dose given for the same period of time, with greater patient satisfaction. However, the advantage of sustained remission with such therapy is not as substantial as it is with regular doses. Lower intermittent dosage schedules (one week each month) are ineffective.
Some people only need one round of oral isotretinoin to achieve complete acne remission, while others require multiple courses. A small number of patients (20 percent) need a second round of isotretinoin. Patients who are younger or female are more likely to relapse.
Large inflammatory lesions have been reported to benefit from intralesional steroid injections. The excision of comedones does not affect the disease's progression, but it does improve the patient's look. Furthermore, superficial peels including glycolic or salicylic acid may aid certain individuals, while further research is needed to determine the best practice for these techniques.
Photodynamic treatment (PDT) has the most evidence of all the laser and light therapies for treating acne. A photosensitizer is placed to the skin, given time to absorb by the pilosebaceous units, and then a light source is used to activate the photosensitizer, causing reactive oxygen species to destroy the glands and diminish Cutibacterium acne.
There is also a growing body of data for the use of lasers to treat acne, either alone or in conjunction with photodynamic therapy. Small patient numbers, a lack of a control population, and comparisons to conventional treatments limit the power and quality of research.
The American Academy of Dermatology has published evidence-based acne management guidelines. As a result, all healthcare personnel who deal with acne, including primary care providers and nurses, should be aware of these recommendations and how to categorize treatment. If a health professional decides to use an oral contraceptive to treat acne, they should follow the WHO's recommendations. Finally, identifying the type of bacteria that causes acne is purely academic and should not affect acne treatment. A dermatologist consultation is highly recommended if the acne is severe. The pharmacist should be well-versed in the side effects of drugs, particularly isotretinoin and its teratogenic potential. A female of childbearing age should never be given retinoids by a pharmacist without first consulting a dermatologist. The pharmacist should inform the patient about retinoids' potential teratogenic effects and follow the risk management plan. Nurses that work in dermatology and plastic surgery assist with patient and family education, therapy monitoring, and feedback to the team.
The majority of patients have a beneficial result after treatment. Acne does, however, leave scars in many people. These can be avoided by teaching the patient not to manipulate the lesions and to seek treatment as soon as possible. Acne scars are difficult to treat after they have developed.