What is Acne
Clinical classification of acne
eight classifications of acne
Acne is a chronic problem
Possible causes of blocked
Pilosebaeceous Glands:
  • Genetic
  • Hormonal Changes (Menstruation, Pregnancy, Stress, Taking contraceptives)
  • Oil based skin care products
  • Certain drugs
  • Sweating and humid areas
  • The structure of skin
    Structure of the skin consists of 3 layers:
    Stratum Corneum, Epidermis, Dermis, embedded inside is the pilosebaceous unit (sebum secreting pores and hair follicles). Acne is caused by clogging of this pilosebaeceous unit.
    Treatments for acne
    Topical acne treatments
    Oral medications for acne
    Laser acne therapy
    Topical acne treatments
    Oral medications for acne
    Cosmetic / Laser therapies for acne
    Topical treatments for acne are usually antibiotics such as Tetracyclines. It is not suitable for people who are allergic to tetracyclines. Apart from its bactericidal action, it has unique acne healing properties.
    Topical Vitamin A such as retinoic acid can combat acne effectively. However it is an expensive and fragile compound. During storage it must avoid sunlight and heat, and when mixed together with other chemicals such as tetracyclines it may have a very short shelf life.
    First general fruit acids (BHA) is the strongest of fruit acids. Namely Salicylic acid and Benzoylperoxide, they can open up clogged pores and hence reduce pore size indirectly. A strong preparation can clean up all the acne effectively within several days after an initial bursting phase of all available acne. However it does makes the skin rather dry.
    Newer generations fruit acids has 2nd and 3rd generations. 3rd generation topicals are rather mild, with strong moisturizing properties, but not effective for severe acne. 2nd generation acids are slightly stronger, and can combat severe acne. Concentration ranges from 4 to 20%. They have the additional benefits of making the skin smoother and shine better with smaller pores. Even though they are effective and can be used daily, often titration is needed from a milder 3rd generation building up to a stronger 2nd generation concentration. Thus it is best if it is prescribed by an expert conversant in these products.
    A course of tetracyclines (usually 3 months) can control acne. However it may recur after cessation of medications. It may cause a more frequent bowel opening. Furthermore, it can cause yellow discoloration of teeth during growth, so is not suitable for children or pregnant women.
    Oral Contraceptives
    There are two preparations of OC pills that can help reduce acne. They are limited to female use and has the side effect of the usual OC pills. These are Drospirenone + Ethinylestradiol, Cyproterone Acetate + Ethinylestradiol.
    Oral Vitamin A
    Oral Vitamin A can effectively remove sebum production permanently by an as yet unknown mechanism. Thus reducing acne formation permanently in most cases after being taken for 3 months. However it does not help in acne scars. It is rather expensive and is teratogenic, thus not for people trying for children. A minor 1 in 500 will go on to develop reversible depression.
    Both acid peels and Intense Pulsed Lights can remove active acnes immediately, while CO2 and other lasers, Dermabrasion, or microneedle therapy can remove acne scarring and the deep pigmentation left by old acne scars. These treatments are the only way to remove scarring.
    Daily skin care for acne
  • Choose a right cleanser (or one with fruit acid).
  • Keep hair clean and tie them up to give the skin breathing space.
  • Avoid squeezing out acne, or picking it with a needle. It can disrupt the elastic layer of the dermis leading to permanent scarring.
  • Avoid touching the acne with the fingers, it can introduce more germs to an already inflammed area.
  • Avoid oily based skin care products.
  • It is best to treat acne under guidence of people conversant in all modalities