Acne is a common chronic inflammatory disorder which affects the hair follicle and its related sebaceous gland, acne is characterized by blackheads (comedones), papules, postules and cysts, mostly on the face, chest and upper back. Commencing at or about puberty, it affects adolescent and young adult males and females equally.
The cause of acne still not well understood. The hair follicle become blocked, forming a comedo, but continues to secrete sebum (an oily secretion at lubricates the skin) which is changed to pus. The normal skin organisms split the neutral fat in sebum into free fatty acids, which sets up an intense inflammatory reaction; this reaction can be aggravated by pressure caused by the patient trying to express the lesion which then heals with scar formation. Hormones and psychological factors seem to have some role; acne is often worse before menstrual periods and in times of stress, for example during school or university examinations.
Treatment begins with skin care; gentle washing with hot water and soap, scalp hygiene, and avoiding greasy cosmetics and cleansing lotions and picking and squeezing. Sunlight seems to improve the condition. There is little evidence that certain foods aggravate acne, but restriction of chocolate, cocoa- bean products and nuts may help.
Acne lotions and creams reduce bacteria or enhance peeling of the surface layer of the skin; there are many prescriptions available. Oral antibiotics have been the major advance in acne control. The tetracyclines are most often used; these inhibit the growth of normal skin organisms and thus decrease the amount of free fatty acids, which cause the irritation. Low doses can be used over a long term, but there are side effects in some people. Oral contraceptives may help some women, but some types can themselves aggravate acne. Doctors may use a comedo expressor, or drain cystic lesions by needle, or use ultraviolet light or superficial x-rays. Bad scarring may need specialist treatment.
