Acne outbreaks have been embarrassing teenagers for years. There’s nothing quite like a fresh crop of tender, red, pus tipped pimples to make you want to hide your face away. While pimple ‘cures’ are numerous – from applying toothpaste to lathering on onion juice – many will only serve to inflame your skin and perhaps even create scarring, warns Dr. K .Satgurunathan, Consultant Dermatologist.
At the same time he emphasises that acne is often easily treatable – offering a temporary freedom from zits until the surge of hormones that trigger them have had time to settle.
Acne: pimples to cysts
“Acne is primarily a teenage disease,” says Dr. Satgurunathan, explaining that among its causes are hormonal fluctuations and genetics, though the misuse of cosmetics and overexposure to the sun have been known to play a part as well. Stress has been known to aggravate acne. Though the evidence isn’t strong, diet is also believed to affect the condition. Dr. Satgurunathan recommends his patients cut back on the consumption of milk and sweets like chocolate and ice cream which in some cases are believed to exacerbate acne.
Acne can also be a symptom of hormonal imbalances like polycystic ovarian syndrome (PCOS). Patients may complain of irregular periods and excessive body hair. Such cases often require a team with a dermatologist working with an endocrinologist or a gynaecologist to solve the problems.
Dr. Satgurunathan explains that Acne vulgaris – i.e. of the common type - can manifest in different forms. Sebaceous glands or oil glands are found in the hair follicles or pores and are responsible for the production of sebum. Sebum is an oil which lubricates your hair and skin, a natural moisturizer, as it were.
When these glands become overactive under the influence of the hormone androgen (as they frequently do in teenagers) pores can become clogged. The clogging occurs because dead skin cells that were meant to slough off, fail to do so (hyperkeratinization). Bacteria, like Propionibacterium acnes, now come into the mix and can become trapped inside these pores and multiply with alacrity. Swelling and redness ensue – the start of inflammatory acne.
Whiteheads are the result of pores getting clogged up, closing up but still bulging from the skin. A pore that is clogged but remains open can have its surface darken, creating a blackhead. Sometimes the wall of the pore gives way, and the sebum, bacteria and dead skin cells seep under the skin and a pimple rises up. A pimple can become capped with pus – the body’s reaction to bacterial infection. Further up the scale, clogged pores that go deep into the skin can cause nodules or cysts, which are larger than pimples and can be quite painful.
Acne outbreaks usually occur on the face, neck, shoulders, upper back, and chest.
As there are different forms of acne, so too there are different kinds of scars. These result from the body’s attempts to heal itself. Some scars take the form of ‘icepick’ scars where there are indentations on the skin’s surface, others are dubbed rolling scars, and these give the skin a rolling, wave like appearance. Acne is also characterised by post inflammatory pigmentation – this can be treated with a mild bleaching agent says Dr. Satgurunathan. Unfortunately, scars remain notoriously difficult to get rid of. It’s much easier to reduce the acne itself.
For teenagers, acne can be a source of acute embarrassment and low self-esteem. Many people assume that teenagers cannot escape at least one bout of acne and subsequent scarring, but Dr. Satgurunathan emphasises that this is not true. In particular when parents know they themselves had severe acne it’s a good idea to seek a doctor’s advice early on, he says. It can also be seen as a matter of just holding on for long enough: “The good news is that, for most people, acne goes away almost completely by the time they are out of their teens, but the scars remain for life,” says Dr. Satgurunathan.
Many patients have trouble identifying their acne and may mistake it for a rash. In consultation with friends, a beautician or even with a pharmacist they might choose to apply over the counter creams which sometimes include steroids. This is ill advised in particular because different forms of acne require different kinds of treatment. “Treatment has to be individualised for a patient,” says Dr. Satgurunathan.
Once the causes of the acne are understood, a dermatologist will consider prescribing medication. These may either be designed to address the hyperkretanization – ensuring the dead skin cells fall off normally and do not clog the pores – or to kill the bacteria P. Acnes. Medicines might be also prescribed for its anti-inflammatory effects on the skin or to return to balance hormones in the body.
However, it’s important to be patient. “A lot of people expect a dramatic cure and when that doesn’t happen, they just discontinue treatment,” says Dr. Satgurunathan, explaining that the “crops of acne simply appear again. It has to be controlled till the body itself gets rid of it.”
He also keeps an eye out for other possible causes of acne. Sometimes it can be as simple as a certain hair cut, where hair might fall over the forehead and irritate the skin there. Some people also develop acne thanks to their clothes – for instance shoulder pads in blouses might irritate the tender skin there and induce acne formation.
For an unfortunate few, acne strikes in adulthood, says Dr. Satgurunathan and for them the condition can be equally embarrassing as it is for their teen counterparts. Acne can be debilitating. Sufferers might not want to go to school or work, and it can negatively affect self image to the point that people are unable to form relationships, he says. “People of all ages are very concerned about their appearance,” he says, explaining that quite understandably, people would like to show the world a face free from acne.
Myth: It’s a matter of hygiene.
Fact: While it’s true that washing your face every day helps you get rid of dead skin cells, excess oil, and surface dirt, washing too enthusiastically can lead to dryness and irritated skin, both of which can actually make your acne worse. Gently wash your face no more than twice a day, and gently pat dry. Avoid harsh exfoliants or scrubs, both of which are skin irritants. In addition, steer clear of toners containing high concentrations of alcohol – they’ll dry out your skin.
Myth: Pop a pimple to get rid of it faster.
Fact: Though you might be able to get rid of the white zit temporarily, remember that this is actually worse in the long run. Your pimple will simply come back up, and probably leave a scar. This is because squeezing a pimple actually pushes bacteria and the content of the pimple deeper into the skin.
Myth: When it comes to acne medication, the more the better.
Fact: Even though some acne medications are dispensed over the counter, they’re easy to abuse. Those containing active ingredients like benzoyl peroxide and salicylic acid in particular can dry your skin out and eventually cause more blemishes