Acne Overview, Causes and Treatment

Jessica Lewis
October 3, 2016

A very famous quote attributed to the American writer Mark Twain says; “ Clothes make the man. Naked people have little or no influence in society. Almost 200 years later, people try to convince themselves otherwise: clothes have little to do with a man’s worth. It’s the individual the one who gives value to the things around him. Psychologists advise us to differentiate our value as human beings from that of what we own.

Real self-confidence and respect have little to do with our bank accounts or clothes. It is rather our own self-esteem and the way we interact with those around us the key elements to a happy and peaceful life. More and more articles on the subject of mind and heart relationship fill the pages of magazines. They are full of advice and through an overall optimistic tone try to encourage people to be themselves. No one can argue that there is indeed pressure coming from the mass-media. New diets, sudden weight loss of famous Hollywood stars and beauty’s idealization influence both teenagers and adults. As much as one would like to discard the notion of appearance as a crucial factor, some obstacles impede him to do so. No wonder that many high school kids face what is probably the highest rate of mental disorders of all times. Sadly the emotions’ roots are found in childhood. Many teenagers lack parental support. Others do not have a well-established idea on what a healthy and fulfilled human being looks like. In the absence of important emotional notions, it is no surprise that many of them deal with  low self-esteem. This eventually leads to problems at school, argues and even withdrawal from the social life.

In addition to those, adolescence is also the period when hormonal changes occur. In spite of being a natural process by them, self-confidence suddenly declines. Puberty turns a boy into a man and a girl into a woman. During this period, physical changes take place. The first signs of sexual maturity seem to have a rather negative impact on girls who, by the time they turn 12, start to have body image problems. The hormonal changes adolescence brings along with it do not manifest only at the sexual organs or emotional levels. They influence all sorts of modifications on the body part which is the most visible and put in contact with the exterior world: the face. In most cases, hormonal changes lead to acne.[1]

Adolescents, girls in particular, are strongly affected by it. The youngsters tend to avoid  eye contact or even interact with those of their age if the problem is a severe one. Even if it is something minor, many of them are shy because of it and find acne hard to accept. The primary concern is that others may tease them. This causes social phobia and has a significant impact  on how the adolescent will mentally develop. It is helpful to acknowledge that adolescence is a life stage like any other. It is true that the changes are sudden. In spite of that, by the time they reach 18, many adolescents feel as if they are grown-ups. The earlier rebellious acts against their elders are forgotten. By the time they turn 20, they become accustomed to their status as adults. Skin problems are a teenagers’ issue. With proper care and a balanced diet, they can be alleviated. One should seek a doctor’s advice if they do not. A physician may want to direct the individual towards a dermatologist.

Acne Reviews

Acne is common and expectable in teenagers. The hormones lead to the occurrence of many changes in girls and boys alike. Their bodies are built differently in regards to some aspects. Girls begin this process earlier than boys, but boys seem to develop faster despite the shorter period physically. What both sexes have in common is that hormonal changes do not differentiate a kid’s skin from a girl’s. Adolescents have acne. Yes, it might be disturbing, more mentally than physically, but it is a general truth. Cases of teenagers who do not experience this are rare. Even then, a few pimples can be found on their faces. Acne is something natural and should not cause shame.[2]

Acne is an inflammation of the sebaceous glands which produce more sebum than  it should.  As boys and girls approach maturity, the gland’s activity increases. The excessive production of sebum combined with dead skin cells eventually causes acne. The face, shoulders and back are the most affected areas. Acne manifests as blackheads, whiteheads and pimples if it is less severe.[3]

In the more severe cases, the inflammation reaches deeper into the skin. Cysts and scars will occur as a result. This happens because the skin is no longer able to eliminate the sebum. Rather than that, it allows the oil to seep underneath the exterior layer. Boys are generally believed to suffer less from this condition than girls. Despite this fact, acne is more damaging to them. On the other hand, girls complain about it during their menstruation when hormonal activity is associated with pimples and whiteheads’ occurrence. Acne is not necessarily caused by an unclean skin. In spite of the dangerous combination of sebum and dead cells, dermatologists don’t blame poor hygiene as the leading acne cause. They do believe that cleanliness is important for clear skin. Regular washing with anti-bacterial soap and warm water can alleviate inflammation.[4]

How Does Acne Manifest?

The skin is the exterior covering of the body and has several functions. It protects the tissues underneath it, maintains a healthy body temperature in spite of external conditions and acts as a barrier against infections. It is also responsible for producing a right amount of vitamin D when exposed to the sun. Our skin is truly magical. Still, this does not  change the fact that, like any other organ, it is prone to changes caused by hormones. The skin is the primary organ affected by the sebaceous glands’ function. Sebum excess is not specific to adolescents only. The first increase of sebum excretion happens a few hours after birth. The baby’s skin accommodates to the new environment and reaches an average state after about a week. A second one occurs around the age of 10 in girls and around 13 in boys. Girls start to have their menstrual cycle and physically develop earlier than boys. Usually, from around this age and until they turn 18, acne is an active part of their lives.

Adults as well report eruption skin cases. Two in ten adults over 45 deal with this problem.

The skin is structured in two main layers. The epidermis is the outer layer of which dead skin cells are a normal part. Every once in a while the skin renews itself and sheds them, starting a new cycle. The inner layer or the dermis is full of tiny blood vessels and nerve endings. This is where the sweat and oil glands are located. Skin is an organ with constant replacement fo dead cells with new ones. It is also the body part most exposed to lesions because of its direct contact with the external factors. Skin eruptions and inflammation are not something uncommon. Out of all skin related medical conditions, acne is the most frequent. Its development does not take into account cleanliness nor does it show any preference for a particular skin type. Be it oily or dry, its signs are present and hard to ignore.

Blackheads are a mild acne type. They are the result of hardened fatty material produced by the sebaceous glands that clog the skin pores. Following an oil excretion, the sebum interacts with air and oxidizes. The clogged pores appear to be black. Blackheads are usually harmless. They do not form skin protuberances nor are they painful. They are not visually pleasing as the skin may look unclean. If not great in number they can be removed at home without necessary asking for a dermatologist’s advice. Blackheads do not cause inflammation. This can only appear as the result of improper care during the treatment. Blackheads should not be touched with bare hands. This can lead to an eventual infection of deeper tissues and cause more severe acne types. The specialists advise people suffering from acne to be patient during treatment. Often times, acne takes long to be cured. Even in its most pure form, namely the blackheads, acne should not be addressed as something minor.

Blackheads are known as open comedones. Whiteheads are closed ones. Comedones are skin colored papules usually found on the face. They are typical for the T-zone( the area of forehead, nose and chin) because of its sebum excess. Comedones are more popularly known as clogged pores. They can occur with or without acne. Whiteheads are more prone than blackheads to infection spreading. They should not be picked at. This can lead to skin irritation and severe acne.[5]

Pimples are the middle-ground between mild and severe acne. They are not as inoffensive as blackheads nor as damaging as cysts. They are caused by the infection of a pore beneath which sebum has been collected. Pimples are visible because the inflamed lump of skin containing pus is whiter than in the whiteheads’ case. They are common in adolescents and can cause annoyance and embarrassment. People tend to squeeze them. This only worsens their condition because a small skin portion is torn apart. It is a minor case of inflammation but the body reacts nonetheless. Like in other situations where it must face infection, the body directs more blood to the affected area to fasten the healing process. As a consequence, as small as it may be, the area becomes red and swollen. Pimples are addressed as acne if large in number.

In most cases, blackheads, whiteheads and pimples are harmless unless scratched or squeezed. With proper hygiene and a balanced diet, their adverse effects can easily be countered. They do represent the onset for more severe acne types. When clogged, a pore gathers sebum inside it. The sebum is apparently an ideal environment for the Propionibacterium acnes development. While research projects are still to name an exact cause for acne appearance, these bacteria are directly linked to the skin condition. Propionibacterium acnes are a gram-positive, usually anaerobic bacteria. They are a regular part of the human skin and thrive in fat-rich areas such as the sebaceous glands.

They are generally harmless, living deep within the pores, away from the skin’s surface and possible issues caused by oxygen’s presence. Sebum is their primary fuel. Following an increase in sebum levels, the bacteria feed on the excess and multiply faster. The cellular damage produced by the bacteria’s sudden growth can trigger infection. It is therefore incorrect to assume that Propionibacterium acnes is the reason behind acne. The bacteria only cause the effects after meeting favorable conditions.

The sebum excess is the main culprit in regards to a possible inflammation spread. Aside from hormonal changes, there are no accurate reports in connection to other acne causing factors.

The infection determines a natural immune system reaction. The area surrounding the lump turns red and hot to the touch. Cysts can occur because germs spread rapidly in such conditions. At this stage, one should avoid self-medication and address a doctor as soon as possible. In order to prevent further complication, the doctor usually directs the patient towards a dermatologist if the problem is severe. There are cases in which the outer layer is so damaged that permanent scars can be a serious acne consequence.[6][7]

What Causes Acne?

Aside from the Propionibacterium acnes bacteria spreading, there are other factors believed to trigger acne. Some have been scientifically proven. Others are mere myths. In any case, people should address a dermatologist as soon as visible acne signs appear. Under no circumstances should the individual try the so-called treatments promoted by mass media. The following are known acne causes in both adolescents and adult.

  1. Hormones: trigger the activity of various glands in the human body. In adolescents, a hormonal level increase leads to physical changes. Acne is one of them. Until one turns 18, acne is regarded as something normal. Hormones affect the adults’ skin as well. The effects of fluctuation in hormonal levels are visible on a woman’s face every month, usually a week prior to her period. Men register a change in testosterone levels. Acne is most present on the face, back and shoulders.[8]
  2. Stress: when dealing with this particular factor, the adrenal glands release cortisol to help the body cope with it. At the same time, the testosterone levels increase. The hormone stimulates the sebaceous glands to produce more oil. If not prepared for a sebum excess, the skin develops blackheads, whiteheads or pimples.[9]
  3. Pollution: the present day environment does not help either. The entire body is affected by air and water pollution. Sadly, the damage pollution can cause to the face is something expectable. Dust can clog the pores even faster which can lead to skin eruptions.[10]
  4. Pregnancy and menopause: two of the most important stages in a woman’s life can prove to be nerve-wracking in regards to skin’s aspect. Progesterone levels increase during pregnancy. Menopause registers a decrease in estrogen quantity. When this happens, even the smallest testosterone levels can affect the sebaceous glands’ oil production.[11][12]
  5. Improper hygiene: most people, especially the adolescents, squeeze pimples. In order to avoid inflammation and further complications, the individual should make a conscious decision to stop touching the pustules. The hands should be washed before touching the face because they make contact to a multitude of things on a daily basis. Excessive face washing can dry the skin as well. As a response, the glands produce more oil than needed. Pimples appear as a consequence. Cleaning the skin numerous times a day is not only unnecessary but can also cause inflammation. This way, a whitehead can become a cyst in no time.[13]
  6. Wrong beauty products: no matter the brand, smell or texture, a beauty product designed for facial use should be bought in accordance to one’s skin type. Soap and water should be avoided if the skin is rather dry because they can lead to an even drier Cleansing creams or night creams enriched with cholesterol are a better alternative. On the other hand, soap and warm water are much more appropriate than greasy creams if the skin is oily. Too much make-up can alter the skin’s aspect because it blocks the pores. Daily cleansing is recommended.
  7. Diet: sweets, saturated fats or chips are foods that should be consumed in Fried foods and dairy should be kept to a minimum. There are no scientific proofs in regards to sugar’s or milk’s influence on the skin. Some people have confessed their skin becomes irritated following an excess consumption of sweets. On the other hand, iodine should be avoided by anyone. In comparison to more common foods, it has the disadvantage to building up inside the body even months before showing its effects.[14][15]

Adult Acne

Adult acne is somehow different from its teen counterpart.  It affects around 15% of the women over 25 and is less common in men. Most women who suffer from acne are over 40 and going through menopause. Specialists call this medical condition “adult-onset acne”. The causes behind adult acne are largely the same as with teenagers. Many of them revolve around hormonal changes. Acne in adolescents means blackheads and pimples. Adult acne is more severe. The skin’s inflammation is more visible, with pustules, red spots and larger pores as primary symptoms. Permanent scars can appear if not treated in time. The chin, forehead and back are the most affected areas.  The treatment for adult acne can prove to be more challenging. Mainly due to the aging process, the skin becomes drier and the collagen production decreases.  Many of the present day acne treatments are designed for teenagers with oily skin so they are not exactly appropriate for adult use. In addition, the tissues need longer to heal when faced with wounds. They can quickly become beneficial environments for bacteria development in the absence of scars to heal them. Adult acne can only be alleviated by means of medical treatment because it is not a simple skin infection. Dermatologists use the ones listed below to treat their patients.  A specialist’s advice is essential in establishing the proper medication for the patient’s skin type and the issue’s severity.[16]

  1. Benzoyl peroxide is a popular topical treatment used for mild acne. It is efficient in reducing skin inflammation and unblocking the pores. It reduces the number of damaging bacteria after being applied and clears both blackheads and whiteheads. There are several products on the market containing benzoyl peroxide. Some can have additional helping ingredients. Regular cleansing solutions can be bought without a medical People should consult a specialist before using it. Benzoyl peroxide is used on a washed and dried skin. The areas of the eyes, nose and mouth are to be avoided. The solution must not come in contact with wounds and should be used for at least a month in order for results to be visible. It ‘s advisable to continue the treatment if the skin reacts positively to it. Most people have a higher tolerance to the solution’s water-based preparation. One must stop the treatment if it causes irritation. Other alternatives are available at drug stores.
  2. Retinoids are a class of chemical compounds related to vitamin A. scientific studies have shown their role in cell growth process. They reduce inflammation, unblock pores and treat a broad range of mild acne symptoms. Retinoids act by removing the dead skin cells so that the pores can remain unclogged. The compounds also prevent collagen breakdown. From this point of view, they are beneficial for adults over 40 who face acne and slowed down collagen production. Retinoids can be used only according to a medical prescription. Some of their chemical constituents can cause irritation and dryness. Pregnant women should avoid the product.
  3. Antibiotics work by destroying the harmful bacteria. Some of them only stop their growth. They are also beneficial in reducing skin inflammation. Usually, a doctor prescribes antibiotics only if the patient has visible surface damages so that the medication can have an application area. That is why antibiotics are not helpful in treating mild acne. Blackheads and whiteheads are the result of blocked pores and only affect a superficial skin layer. For this reason, antibiotics are more effective in adults rather than teenagers.
  4. Blue light therapy: mild acne patients are usually treated with topical cleansers. More severe cases need antibiotics. Recent studies have shown an increased resistance of Propionibacterium acnes bacteria to antibiotics. Specialists have come up with another method as a solution. It is called blue light therapy. As the name suggests it, the treatment uses narrow bands of high-intensity blue light on the damaged area. The acne causing bacteria releases porphyrins. When they come in contact with the blue light, a sudden release of free radicals takes place, leading to the bacteria’s destruction. Blue light therapy is available only in a dermatologist’s room. The patient sits in front of a lamp for 20 minutes, twice a week. Results are visible in about a month. A research project followed the evolution of a self-administrated blue light therapy treatment under medical supervision. The treatment took place twice a week, for 8 weeks in a row. The results showed a high efficacy rate with overall skin improvement in terms of redness and inflammation. Also, the participants confessed they felt safe during the study, in spite of self-administration.
  5. Tea tree oil is found in a multitude of skin designed beauty products and represents a more secure alternative to toxic Less irritating than many of them, it has antiseptic and anti-inflammatory properties. More and more specialists have started prescribing it, aware of its effectiveness. In regards to acne inflammation, it appears to be just as productive as benzoyl peroxide, but without its side effects. It should be applied twice a day for a month. People have reported a decrease in acne severity after using it.[17][18]

People suffering from acne also try home-made remedies in addition to these treatments. Most of them include ingredients casually found in one’s kitchen. The following are some remedies that are likely safe for anyone. In terms of severity, they are efficient especially in mild acne cases. It is not safe to use any of them if the skin presents cysts or any kind of damage:

  • Baking soda: good for exfoliation, it removes dead skin cells and dirt in order to prevent pores’ blockage. One should avoid baking soda if the skin is sensitive.
  • Oatmeal: similar to the baking soda’s mechanism of action, oatmeal is good at both removing dead skin cells and absorbing excess oil. It is good for oily skin.
  • Lemon juice: due to its astringent properties, it can help the process of cell growth if used on the clean skin for several weeks in a row. It also removes the excess oil
  • Milk and yogurt: these two products can work wonders on the skin. Milk alleviates irritation and redness while yogurt softens and moisturizes the skin
  • Egg whites: while they can cause a bit of dryness following their use, egg whites have proven efficacy in terms of mild acne reduction. They absorb the excess sebum and provide the skin with proteins beneficial for cell renewal. After applying and then removing a mask made of egg whites, one can use a moisturizer.

Other home-made remedies include aloe vera, apple cider juice, garlic, sugar or avocado. They are available in complementary and alternative medicine books or on the internet.[19]

Currently, acne is regarded as both a physical and psychological problem. Most of one’s teenage years are spent in embarrassment and social anxiety because of it. The condition, either a mild or severe one, leads to negative emotions. Adolescents experience low self-esteem so parents must take them to psychotherapists if the teenager shows signs of depression. Acne is common in adults as well, with little over 45 million cases reported annually. Adults may seem less sensitive to it, but acne  is just as upsetting for them too. Appearance is crucial in today’s society and even more so when it comes to people in higher positions. Fortunately, there are many remedies and treatments available on the market. Even when we talk about more serious situations, the issue can still be fixed, either with a dermatologist’s help or through surgery.[20]