What is Acne?
Acne is the most common skin disease. It affects 89% of teenagers to some degree.
Acne is a treatable disease that results in inflammatory and non-inflammatory lesions. A medical definition of acne is “a genetic disease evolving from retention hyperkeratosis of the follicular epithelium.”
What Causes Acne?
Medically, the cause of acne is unknown and has no real cure. Some theorize that there is a root cause that may stem from a hormonal imbalance, psychological aspects, nutrient deficiencies and genetics. For genetically prone sufferers, this implies a lifetime regimen of daily home care.
Factors Affecting Acne
Stress – Stress is the number one factor affecting acne. Stress stimulates the adrenal glands; for women this can be a problem because these glands produce much of the male hormones. Men produce only a small amount of testosterone in the adrenal glands. Since men also produce naturally higher levels of testosterone, surges of it from stress have less of an affect on acne. Usually flare-ups occur about 14 days following a stress response.
Pyoderma Faciale is the most extreme type of stress-produced acne. Large, painful, red and purple lesions are situated on the forehead, cheeks and chin.
Stress-Induced Acne causes an interruption of healing in the follicle. When the healing process is disturbed by stress (which weakens the body), white blood cells attack troubled areas and inflammation begins.
Nutrition – Avoid foods with iodides; salts, processed foods, fast foods, excessive dairy, soy sauce, MSG, alcohol, and caffeine. Some drugs are a trigger to existing acne conditions. Drink 6 to 8 glasses of pure water every day. Although there is no scientific evidence to support that incorrect nutrition causes acne, proper nutrition can aid existing acne conditions.
Hormones – Hormones affect acne. Specifically, testosterone stimulates the development of sebaceous follicles and attached oil glands. This is a factor during adolescence when hormones are very active. The fluctuation of hormones during menses accounts for acne flare-ups. It is the increase of progesterone that aggravates acne conditions in genetically vulnerable women. Increased estrogen generally relieves acne, which is why physicians will prescribe birth control pills.
Picking and Touching – Improper squeezing and ill-attempted extractions may rupture the follicle wall and cause bacteria to spread. Touching irritates skin and breeds bacteria from fingers and hands.
Drying – Overuse of very drying skin care products may cause the sebaceous glands to produce more oil.
Excessive and Abrasive Scrubbing – Over-cleansing and excessive scrubbing can over-stimulate the production of sebum in the follicle and worsen acne conditions. The formation of acne begins with sebum.
Cosmetics – Fragrances, dyes and preservatives are irritating to sensitive and acne-prone skins and should be avoided.
Skin Irritants – Soap powders (all-natural, fragrance- free is best), fabric softeners, shampoos, conditioners, hair sprays, etc. are all irritants to existing acne conditions.
Advise clients to rinse laundry thoroughly, replace pillow cases daily, and never use the same wash cloth more than once.
Types Of Acne
Acne Vulgaris – This is a self-limiting, treatable disease, primarily seen in adolescents, that involves the sebaceous glands. Acne Vulgaris usually involves a variety of lesions consisting of comeodones, papules, pustules, nodules, cysts and sequelae, such as pitted or hypertrophic scars. Propionibacterium Acnes are the bacteria that cause Acne Vulgaris.
Acne Cosmetica – A triggering topical comedogenic substance that penetrates the pore and causes formation of comeodones. Acne Cosmetica is usually the non-inflammatory type indicated by small slightly raised red lesions, whiteheads and occasional pustules.
Acne Mechanica – This is caused by friction or pressure. For acne-prone skin, rubbing or any manipulation of microcomedones may cause a rupturing of the follicle. Continual friction from material, such as a hat, will cause Acne Mechanica.
Acne Rosacea – This condition is considered adult acne and is more predominant in women than men. It is usually seen in people with northern European heritage. Acne Rosacea is recognized by erythema with telangiectasia. Lesions seem to follow along the blood vessel dilation. Papules and pustules form in the center of the face, primarily cheeks and chin, and are large and painful. See Rosacea section.
Keratosis Pilaris (KP) – This is a common skin disorder. It is a benign condition that shows up as numerous small, rough, red, or tan bumps primarily around hair follicles on the upper arms, legs, buttocks, and sometimes cheeks. KP creates a “goose bumps,” “gooseflesh,” or “chicken skin” appearance on the skin.
Anyone may develop KP. Although it is commonly a skin condition among children and adolescents, it is also seen in many adults. KP is estimated to affect between 50% and 80% of all adolescents and approximately 40% of adults. KP is a chronic skin condition that is benign and noncontagious.
KP usually improves with increasing age and may even spontaneously clear completely after puberty. However, more frequently the condition is chronic with periodic exacerbations and improvements. Many adults still have the skin condition into their 40s and 50s.
Pseudofolliculitis Barbae – This is more common in men and occurs when coarse, curved hair penetrates into the skin just before it would normally leave the follicle.
Related Skin Conditions
Seborrhea Dermatitis – This is an irritation in oily skin characterized by dry flaky, crusty patches that are red.
Perioral Dermatitis – This occurs around the mouth with clusters of small papule or pustules. Over-active oil glands cause retention hyperkeratosis.
Pathogenesis Of Acne
The natural process of the epidermal cells (stratum corneum) is constantly shedding and being replaced by new cells. When this natural process slows down, a gradual build-up forms and Retention Hyperkeratosis occurs. Skin cells stick to the surface and begin lining the inside walls of the follicles.
Acne is related to the overproduction of sebaceous gland lipids. The severity of acne correlates with the amount of sebum that has been excreted and then obstructed.
Sebum is composed of squalene, wax esters and triglycerides. When cells build up inside the follicle wall, a small impaction is formed that is called a microcomeodone.
Microcomedones are actually a mixture of dead cells, bacteria, and fatty acids from excess sebum and other cellular debris.
The acne challenge is to control all of these elements to keep a skin from developing long-term affects such as pitted sequelae. There must be a balance in the treatment of acne - peel and heal.