​ Acne Vulgaris: Symptoms, Treatment | Pharmacological & Surgical Therapy

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Acne Vulgaris is a common chronic skin condition affecting susceptive hair follicles, commonly in the facial region, neck, shoulder, and chest. It is characterized by comedones ( primary acne lesions ), papules, pustules, nodules, and cysts causing spots all over the affected area. It can vary from mild and severe. Acne Vulgaris is non-communicable and is not infectious.

Acne is mostly encountered among adolescent and young adults between 12 and 35 years of old which accounts for at least 15% of all dermatology visits. About 8 in 10 people have acne at some point in life. Both the sexes male and female are affected equally, although the onset is earlier in the female because they reach puberty at younger than males. Acne becomes more prominent during adolescence because at this time the Endocrine glands that influence the secretions of the sebaceous gland are hyper functioned. Acne appears to be from genetic, hormonal or bacterial factors.

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During puberty, the increased androgenic influence stimulates the sebaceous glands, causing them to secrete natural oil called sebum (which prevents your skin from drying out) arises to the top of hair follicles and flows out onto the skin surface. Acne develops when hair follicles get clogged with accumulated sebum and dead skin cells, which later on gets inflamed. This can lead to spots appearing like bumps (papules), pustules (white in color containing fluid or cysts).

Symptoms

Acne is divided into inflammatory and non-inflammatory type (blackheads and whiteheads). It consists masses of keratin sebum and bacteria inside the diluted follicular ducts. Propionibacterium acnes (p.acne) that infest harmlessly on your skin, can grow inside follicles and can contribute to
inflammation (swelling) in spots. The acne with inflammation pustules, nodules, cysts, abscess which results in scarring and destructive tissues of the skin. It may be painful, tender to touch and heat. In very severe condition, the cysts are accumulated and may join to form a larger and deeper inflamed region (acne conglobata) which is rare. Pain, inflammation, mild fever and fatigue seen in very severe cases. Other than that, an individual has psychological issues such as depression, lower self-esteem, lack of confidence, fear of rejection from a peer. If acne is disfigured and mishandled it might get worse and complicate the situation.

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How do we diagnose Acne Vulgaris?

Diagnosis is based on presenting sign and symptom, observation and examination of the skin lesions. The general history and assessment may involve your menstrual cycle (in female) for the possibility of a hormonal cause, eating and sleeping pattern. Women may report a history of flare-ups a few days before menses. The presence of typical type comedones along with the excessive production of oil is characteristic. Oiliness is more prominent in a midfacial region; whereas other facial areas may appear dry. Biopsy of a lesion is necessary for definitive diagnosis. Lab tests for pus culture and blood may be tested for other diagnostic purposes.

Treatment: The main objective of the treatment is to reduce bacterial colonies, decrease sebaceous gland activity, prevent follicles to plug, reduce inflammation, secondary infection, minimize scarring and eliminate the predisposing factors of acne. There is no predictable cure for the disease but the combination of therapies are available that can effectively control acne vulgaris.

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Pharmacological therapy

Acne medications containing either salicylic acid or benzoyl peroxide are very effective at removing the sebaceous follicular plugs. However, it may cause irritation or excessive dryness since each of our skin is different and sensitive. A person should be instructed to discontinue any topical product if such irritation and dryness occurs. Benzoyl peroxide, Benzoyl erythromycin (benzamycin) are available by the prescription of a dermatologist. Vitamin A (tretinoin) is applied topically to clear keratin plugs. The person is cautioned against the sun exposure while on topical medications because it may cause sunburn. Improvements may take 8 to 12 weeks. Topical antibiotic treatment is common for suppression of bacterial growth; decrease comedones, papules and pustules along with the oral antibiotics, tea tree oil which kills bacteria, you will find tea tree oil in gels, cream and oils. Please follow the direction carefully and instructions given by the dermatologist.

Surgical therapy

It is less needed. Treatment includes comedones extraction, injection of corticosteroids into the inflamed lesions, incision and drainage for pus. Patients with deep scars may be treated with deep abrasive therapy.
(Dermabrasion) in which the epidermis and some superficial dermis are removed down to the level of scars. Reoccurrence of comedones is common after the extraction.

Preventive measures

Prevention of the scarring is the most important goal of therapy for everyone. The chances of scarring increases with the severity of acne. Severe acne usually requires longer-term therapy with systemic antibiotics and daily based care for your skin. The discontinuation of medications can lead to more flare-ups and further deterioration of skin with more chances of getting deep scars. Each and everyone should understand not to frequently touch, rub or squeeze the acne with any certain types of tool or with bare fingers, resulting in infection, scarring and worsen the problem. Proper use of medication only after consultation with dermatologists.

Home based remedies/care

  • Follow the instructions and precaution before taking a prescribed medication.
  • Wash your face and other affected areas with mild soap and water twice a day to remove surface oils, dirt and prevent obstruction of the sebaceous gland.
  • Best to avoid the use of cosmetics, shaving creams and lotion which can aggravate acne, unless a patient is advised otherwise.
  • Use moisturizers to keep skin from drying out.
  • Diet is usually not believed to play a major role in therapy, however the elimination of specific food (oily, junk food, spicy) or food products (dairy products and alcohol consumption).
  • Drink plenty of water, fruit juices and increase the intake of fruits and vegetables.
  • Regular workout and exercise for healthy body and skin.
  • Maintenance of general hygiene, cleanliness, clean environment and fresh air.
  • If you want to use makeup then use water base preparation.
  • Sleep enough.
  • Protect your skin from the sun and other sources of ultraviolet rays.
  • Visit your dermatologist for follow up.

Take care of your skin.

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