What is acne?

It is a skin disease caused by both internal and external factors. It usually affects teenagers, because it is at this age that the production of androgens regulating the function of sebaceous glands starts; other internal factors include most importantly heredity. With regard to external factors, the appearance of acne can be induced by increased humidity, medical treatments or exposure to chemicals, as well as inappropriate cosmetic formulas.

There are three major disorders that lead to the appearance of acne. Hyperseborrhoea, occlusion of the sebaceous gland ducts by keratin and, consequently, pronounced proliferation of microorganisms living in the skin (mostly the P. Aeruginosa bacteria strain of the acne) and inflammation. Clinically, we first observe increased skin oiliness and blackheads or whiteheads (open or closed comedons respectively). In the next stage, we observe red purulent spots (papulopustules) and, in more severe acne with larger inflammation, painful pimples that are anchored beneath the skin (cysts or nodules).

Depending on the prevalent lesions, acne can be characterized as comedogenic, papulopustular or nodulocystic. Also, depending on the number of existing lesions, it is characterized as mild, moderate or severe. Acne is not only manifested on the face, but also on the chest, back, shoulders and neck. In recent years, we have increasingly seen post-puberty acne that affects mostly women.

This is attributed to hormonal factors and modern lifestyle (stress, environmental pollution, poor diet, excessive or inappropriate use of cosmetic formulas). Finally, adult women often experience pre-menstruation acne breakouts.

The good news is that there are plenty of ways to keep acne under control if not eliminate it (that depends largely on its type). Early diagnosis plays a key role, especially in cases where marks are left; it is therefore advisable to consult your dermatologist, who will suggest the appropriate treatment.

Can I avoid it?

There are now ways to avoid it, mainly because its appearance depends largely on heredity, which means that if one of your parents had severe acne, it is quite likely that you will have it too. The risk of developing acne is particularly high in puberty, when hormones, such as androgens, start to be secreted. Remember that the factors that can exacerbate acne – or tendency for acne- are:

  • Wearing or using objects that rub against the skin (e.g. violin, helmet, head scarves, turtle-neck, etc.) and irritate it
  • Using cosmetic formulas and haircare products that contain irritants
  • Washing your face with harsh soaps and hot water or rubbing it firmly
  • Hectic and stressful lifestyle
  • Touching your face without washing your hands
  • Pressing zits and mistreating your skin
  • Exposure to heat and humidity
  • Excessive sun exposure
  • Taking specific medications that cause acne
  • Consuming large amount of foods containing white sugar or a lot of fat

(Until recently, it was believed that acne is not influenced by food. Recent studies though have shown that foods causing sudden increase in blood glucose (e.g. foods containing white sugar and a lot of fat) play an aggravating role, forcing the body to secrete large quantities of insulin. Hyperinsulinemia makes acne more inflammatory, namely it causes more pimples and more severe ones.)

Pimples on the face, back and chest are the most common dermatological condition. They are due to the enlargement and excessive function of the sebaceous glands, which produce sebum. Sebum is blocked in the skin and causes inflammation (redness – pus) with the involvement of microbes. Acne is not a problem occurring only during puberty, but also in older people and especially women. Post-puberty acne is a common problem, which is difficult to treat in adult women. Acne is exacerbated by stress, menstruation and other factors, often leading to the formation of scars.

To treat acne, various topical or oral medications are administered. Where there is medical indication, the most efficient is isotretinoin, which decreases sebaceous glands size and makes them less active.

Anti-acne LASER treatments constitute another medically approved solution instead of medications but cannot always substitute them. We use pulse-dye (V-beam Candela) in order to reduce the appearance of spots and the red marks they leave behind. LASERs are used more and more for the treatment of acne. In active acne, i.e. when there are purulent spots, V-beam LASER decreases redness and inflammation of the face from the very first session. Usually it takes 4-8 sessions, one every 10-15 days, to achieve remission. A topical treatment is advised, to maintain results.

Red marks left after medication treatments can be significantly improved with V-beam LASER. 4 sessions are required, one per month.

In cases of scars, CO2 fractional laser has very good results. Usually 4 sessions are required, one per month, to achieve improvement of scars and of the skin texture overall (pore tightening, smoother and more even skin).

The acne-causing bacterium (P. Acnes) secretes red pigments called porphyrins. Blue light targets these pigments, thus eliminating bacteria indirectly. It is equivalent to oral antibiotics. It is advisable for those who do not want or cannot take medications. 4 sessions are performed once weekly followed by maintenance treatment once every two months if necessary.

How is it treated?

In case of mild acne, try to keep your skin as clean as possible. Avoid products that clog pores and choose formulas labelled as “non comedogenic”. Wash your face once or twice a day with a specialized cleanser containing salicylic acid or fruit acids and then use a sebo-regulating dermocosmetic product in the morning and a medical cream for acne at night, suggested by your dermatologist (usually containing salicylic or azelaic acid, benzoyl peroxide, retinoids, local antibiotics or combinations of the above).

Depending on the severity and cause of the problem, your doctor may suggest a specialized medical treatment with antibiotics or contraceptives when there is also a hormonal problem. In severe acne, we suggest a more intensive and efficacious treatment with isotretinoin (Vitamin A derivative) in the form of a pill. It should be administered with special caution, as it causes adverse effects, which are however dose-dependent and cease when the dose is reduced or the treatment discontinued.

Therefore, when a dermatologist subscribes it, monthly laboratory and clinical tests are required. Also, during therapy a contraceptive treatment is advised, since the medication can cause abnormalities in the fetal development, while alcohol is strictly prohibited.

In-practice acne treatment

In comedogenic acne, we usually open comedons and clear their content. In this way the trapped serum is released and the formation of inflammatory lesions (i.e. purulent spots) is prevented. The result is even better when cleansing is combined with peeling (TCA, AHA, BHA).

In cases of papulopustules, peeling with AHA or a combination of ΑHA and BHA has very good results either as monotherapy or in combination with medical treatment.

For cases that fail to respond to conventional treatments or cannot receive such treatments, new technologies offer a solution. Thus, light-emitting devices, such as blue light, and laser systems, such as V-beam, often have good results in the clinical improvement of acne.

Improvement may also be noticed in case of acne scars. Red marks fade away significantly with V-beam laser. Shallow scars can be improved with deep chemical peeling (TCA). (A dark eschar is formed on the face, which subsides within approximately 7 days and the epidermis is fully regenerated). For deeper scars, the most modern and promising treatment is fractional laser (CO2 fractional has been proven to be the most efficient). Again, the whole epidermis is damaged and regenerated – patient is required to stay in for the first two or three days because of the intense erythema and oedema of the face. Then a scab is formed that falls off in a few days. Also, microneedling can be successfully applied to scars.

All these treatments can be combined with autologous mesotherapy (PRP, platelet rich plasma), which speeds up recovery and optimizes the final result.

Acne – Isotretinoin

Isotretinoin, a synthetic derivative of Vitamin Α, has been used in the last 30 years for the treatment of acne with spectacular results. This medication treats acne etiopathogenesis (controls hyperseborrhoea, restores disruption of the keratinization process, controls inflammation) and usually patients treated with it forget they ever suffered from acne.

Caution is required, because although it is a very safe treatment when administered under medical supervision, it can be dangerous if taken without medical tests and dermatologist supervision.