Acne

• Hormonal imbalance
• Polycystic ovarian disease
• genetic predisposition.
• Stress
• Use of cosmetics such as creams, oil based moisturizers, oil based foundations, etc
• Application of heavy oil or gel on the scalp leads to pimples on the back and forehead.
• People who work in chemical or oil industries and come in contact with hydrocarbons, heavy oils, cutting oil, wax, grease and coal tar derivatives can develop acne.
• Hot and humid climate.
• Diet- High glycemic load foods (sugar loaded and starchy foods), oily foods may aggravate acne
• Drugs such as oral contraceptives, steroids, isoniazid, lithium, phenytoin, iodides etc. can cause pimples.
• Sweat- sweating in a hot and humid environment causes deterioration in 15% of acne patients.
• Menstruation- Pre menstrual flare of acne occurs in 70% of female acne patients.
• Friction and pressure- Friction and pressure from helmets, backpacks and tight collars can induce blackheads and papules. Pressure from face massages or facials can aggravate acne.
• Pregnancy- Pregnancy has an unpredictable effect on acne. Pre-existing acne may aggravate or remit during pregnancy.

Do acne occur only in teenage?
Acne is more common in the age group of 13 – 30 years but it may occur or persist even beyond this age limit. Males are more frequently affected than females due to androgen activity. Females may get a pre-menstrual flare due to the increase in level of a hormone called Progesterone.

‘Do’s and Dont’s in acne?

• Wash your face with an anti-bacterial face wash at least 2-3 times a day.
• Increase the intake of citrus fruits such as oranges, grapes, lime and lemon and other food stuff which are high in vitamin C and zinc.
• Drink plenty of water.
• Do not pick or squeeze the pimples as this causes infection, pigmentation and scarring.
• Avoid the use of oily cosmetics, cleansing milk and gels.
• Avoid any parlour/Spa therapies.
• Do not apply excessive hair oil if you have acne over the forehead.
• Avoid stress factors.
• Be patient and give medicines some time to act. You may have to take medications for 8 – 10 weeks.
• You may require medical intervention in the form of comedone extraction, superficial chemical peel, MDA. These are best performed by a dermatologist.

Treatment Options

A combination of oral and topical treatment may be prescribed depending on the degree and severity of the condition.

Topical therapy (medicated creams)

• Benzoyl Peroxide
• Topical Antibiotics.
• Retinoids.
• Azelaic acid

Oral Medication

Antibiotics
These include Minocycline, Doxycycline, Azithromycin and Erythromycin. Antibiotics target bacteria and inflammation. They are administered for approximately 4-8 weeks till inflammatory lesions cease to erupt and in some cases for a longer time. Courses maybe repeated if necessary.

Isotretinoin
This is a synthetic derivative of Vitamin A. It reduces the sebum production from the sebaceous glands (oil glands).

Hormonal Treatment
Hormonal therapy is an excellent choice for female patients with acne who may have one or more of the following:

• Persistent or late onset Acne
• Acne with signs of hormonal imbalance like hirsutism , Frontal scalp hair thinning or Polycystic ovarian syndrome diagnosed on hormonal evaluation or ultrasonography of the pelvis.

Physical modalities in treatment of Acne
Chemical Peels
Chemical peels for acne work by removing the surface layers of the skin in order to expose the fresh and unaffected layers below. Done in a series of four to six sessions, these peels can improve mild to moderately severe cases of acne, and can be given over the face or other body area where acne is a problem. Chemical peels don’t really peel the skin, despite what the name implies. They rapidly exfoliate the skin, allowing dead skin cells to shed more effectively. By keeping dead skin cells and excess oil from clogging the hair follicle, pore blockages (comedones) and can drastically reduce breakouts of papules and pustules.
Chemical peels fall into a broad category of Alpha Hydroxy acids (AHAs) or Beta Hydroxy Acids (BHAs). Glycolic acid is the most commonly used AHA and Salicylic Acid is the most commonly used BHA in the treatment of acne.

Microdermabrasion
Microdermabrasion is done to reduce the oiliness in acne prone skins. It also helps reduce superficial acne scarring.

Intralesional Corticosteroids
A steroid injection is delivered into larger pimples ie nodules and cysts to reduce inflammation.

Blue Light and Photodynamic Therapy (PDT)
These are light and laser systems, which are used to treat acne.