Acne is a common chronic dermatological disorder affecting both males and females of all races and ethnicities all over the world, it is more common among adolescents and young adults (over 80% of 16 to 20-year-olds are affected).

Occasionally it can happen in children and adults of all ages that might need further investigation in case of underlying conditions.

Acne affecting the hair follicle and sebaceous gland, in which there is a blockage of the hair follicle and inflammation. It mainly comes in the face but can be seen in neck, chest, and back.

Acne is due to a combination of multiple factors. The exact mechanisms are not fully understood. It tends to improve by age of 25 and if after improvement it comes back after 25 in life it needs further assessment and investigation for exclusion underlying conditions.

Factors such as families tendency, internal and external male hormones, inflammatory mediators inside the body, acne related bacteria (lives on our skin) and blockage and distension of hair follicles due to over-activation of sebaceous glands (especially in puberty).

Also, acne is much more common in polycystic ovarian syndrome (PCOS), medications (steroids, hormones, anti-seizure medications and others, application of oily products over the skin, high humidity (tropical areas, kitchen and etc), a diet high in carbohydrates (sugar).

Acne is often confined to the face but it may involve neck, chest and back.

It has 3 different types: mild, moderate and severe.

Mild acne treatment:

  • Topical medications such as benzoyl peroxide and/or tretinoin or adapalene gel.
  • Low-dose combined oral contraceptive
  • Chemical peel
  • Light or Laser therapy
  • Micro-needling

Moderate acne treatment:

  • Similar to mild acne treatment plus:
  • Antibiotics such as doxycycline with a dose of 50 to 200 mg daily for up to 6 months or sometimes more
    If tolerant or allergic to tetracycline family then antibiotics such as erythromycin or trimethoprim
  • Anti-androgen (male hormone) medication such as cyproterone acetate + ethylestradiol (for example Diane-35) and/or spironolactone might be considered in women not responding to low-dose combined oral contraceptive, especially in PCOS.
  • If all persistent oral isotretinoin can be tried which needs dermatology review.

Severe acne treatment:

Usually needs to be referred to a dermatologist.
Treatment usually includes higher doses of oral antibiotics and oral isotretinoin (Ruacutane), topical agents usually do not work for this type of acne.

References:

  1. https://www.dermnetnz.org/
  2. Clinical Dermatology by Thomas Habif
  3. https://www.betterhealth.vic.gov.au/