Key Points
- Acne vulgaris is characterised by comedones (blackheads and whiteheads), papules, pustules, nodules, and/or cysts
- It primarily affects the face and upper trunk
- Most common in adolescents, though it can occur at any age
- Diagnosis is clinical, made through examination of the skin
- Treatment depends on severity and includes topical and systemic agents to reduce sebum production, comedone formation, and inflammation.
1. Definition
Acne is a chronic skin condition causing oily skin, spots, and sometimes painful, inflamed areas. It most commonly develops on the:
- Face: Experienced by almost all patients
- Back: Affects over 50% of people with acne
- Chest: Around 15% of patients have acne here.
2. Epidemiology
- Prevalence: Acne affects about 10% of the global population, making it the eighth most common disease worldwide
- Age: Predominantly affects adolescents and young adults (ages 12-25 years)
- Gender: Boys tend to experience more severe acne during adolescence, while women are more commonly affected in adulthood.
3. Risk Factors
- Genetics: Family history increases the risk of developing acne
- Medications: Drugs like corticosteroids, testosterone, and lithium can cause or exacerbate acne
- Smoking: Associated with acne, particularly in adults.
4. Causes
Acne arises from overactive oil glands, leading to a build-up of oil, dead skin cells, and bacteria in hair follicles, causing inflammation. The most common trigger is puberty, due to increased androgen production, which stimulates sebum production and excess keratinocyte growth.
Other triggers include:
- Hormonal changes: e.g. pregnancy or menstrual cycle.
- Occlusive cosmetics: Skin products or clothing that trap oil and sweat
- High humidity and sweating
- Certain medications: e.g. corticosteroids or testosterone.
Note. Common myths: inadequate face washing, eating chocolate, and sexual activity do not cause acne.
5. Symptoms
Acne presents in various forms, each with specific characteristics:
- Blackheads (comedones): Open pores filled with oil and dead skin, appearing black due to pigmentation
- Whiteheads: Closed comedones that appear firm and do not empty when squeezed
- Papules: Small red bumps that may be tender
- Pustules: Papules with a white tip, filled with pus
- Nodules: Large, painful lumps under the skin
- Cysts: Deep, pus-filled lumps that resemble boils, with a higher risk of scarring.
6. Diagnosis
Acne is diagnosed based on a physical examination of the affected areas, including the face, back, and chest.
7. Treatment
Mild acne can often be managed with over-the-counter (OTC) treatments, available at pharmacies:
- Benzoyl peroxide: The most commonly used OTC treatment
- Salicylic acid: Helps dry out pimples and prevent new ones.
When to see a GP:
- Moderate to severe acne, or if OTC treatments are ineffective, requires prescription medication such as:
- Topical retinoids
- Topical antibiotics
- Azelaic acid
- Oral antibiotics
- Combined oral contraceptive pill (for women).
For severe acne or if treatments are ineffective, referral to a dermatologist may be necessary. Treatments include:
- Oral isotretinoin: For severe, cystic acne.
8. Complications
- Scarring: Particularly with nodules or cysts
- Discolouration: Post-inflammatory hyperpigmentation may leave dark spots
- Infection: Picking or squeezing can lead to secondary bacterial infections
- Cysts: Can cause pain and more significant scarring
- Keloids: Raised, thickened scars may develop after acne
- Psychological impact: Acne can lead to anxiety, depression, and reduced self-esteem, significantly affecting mental health.
9. Outlook
Acne typically resolves in adulthood, but some individuals may continue to experience symptoms beyond their teens.
10. Prevention
Recommendations for preventing or managing acne include:
- Gentle skin washing: Helps remove excess oil and dead skin cells without causing irritation
- Post-exercise washing: Sweat can clog pores, so it’s important to cleanse the skin after physical activity
- Non-acnegenic products: Use oil-free lotions and makeup that do not block pores
- Avoid hair products near the face: Hair gels and sprays may worsen acne
- Wear loose clothing: Tight clothes can irritate acne on the chest or back.
Should patients pop pimples?
It is advised not to pop or squeeze pimples, as this can worsen inflammation, increase the risk of scarring, and lead to secondary infections.
