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What IS Acne?
Acne is the most frequent cause of what we all recognise as 'spots'. It is a verycommon skin condition that affects most young people, especially in teenageyears. It appears in males and females equally. It is usually at its worst between16 and 19 years of age. Most people find that the condition goes away by thetime they reach their mid-twenties. Some people, however, continue to haveacne into their 30s and 40s.Acne is characterized by the presence of 'comedones' (whiteheads andblackheads) and spots filled with pus (pustules). Inflamed nodules and cysts canalso be present in more severe forms. The effects of acne can be mild, includinga few spots on the face, upper chest and upper back. More seriously, it cancause scarring of the skin, cause embarrassment and reduce self confidence.In normal skin, small sebaceous (oil-producing) glands lie just under the skin'ssurface. The oil keeps the skin smooth and supple. Small holes (pores) on theskin allow the sebum (oil) to travel to the skin surface, and hairs also growthrough these pores. Some people produce more sebum than others, and as ageneral rule, the more sebum you produce, the more greasy your skin appears.During puberty, the production of male sex hormones (androgens) increases inboth boys and girls, and this stimulates the sebaceous glands to produce moresebum. At the same time, the dead skin cells lining the pores are not shedproperly, and these therefore plug the exit to the skin surface. This results in abuilding up of oil, producing blackheads (where you can see a darkened plug of oil) and also whiteheads. Note: The black coloured tip to a blackhead is not dirt,as people used to think. It is due to the shade of the skin pigment.Additionally, the acne bacterium (propionbacterium) exists on all skin surfaces,usually without causing any problems. However, for people who have a tendencyto get acne, the excess oil creates a perfect environment where the bacteria canmultiply. The bacterium produces waste products and fatty acids that irritate thesebaceous glands and causes them to become inflamed as well as forming pus-filled or red spots.Although acne is easily recognised by the existence of spots and their distributionon the face, neck, back or chest, there are several varieties of acne. Your doctor will be able to tell you which sort you have by looking at your skin.In rare circumstances, some diseases in females can cause acne - or make itworse if it already exists. These conditions include polycystic ovary syndromeand other conditions that that produce excess male hormone to be formed in theadrenal gland or the ovary
Types of acne
 Acne vulgaris
This incorporates a variety of spots ranging from blackheads and whiteheads toinflamed nodules and cysts, depending on the severity.
 
 Acne conglobata
This is the most severe form; it is characterised by large nodules and cystsrupturing under the skin, producing scars.
 Acne cosmetica
This is a mild non-inflammatory form of acne, often triggered by thick, greasymake up.
 Actinic acne
This rare form of acne can follow exposure to sunlight.
Some acne myths
Acne is NOT caused by the following:
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Bad hygiene. On the contrary, too much washing (and especially scrubbing)can aggravate the condition
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Stress
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Poor diet. There is no evidence that chocolate, sweets or fatty foods causeacne or make it worse. However, a healthy diet will promote good healthgenerally.Acne cannot be cured by:
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Sunbeds or sunbathing
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Drinking large quantities of water in an attempt to flush one's system.Other myths include the belief that acne is contagious ('catching'). This isbecause its cause is an interaction between hormones, oil, and the overgrowth of a normally harmless bacterium, inflammation - so it is not possible to catch thecondition by touching the skin of someone with acne.Acne can appear a lot in the same families, but this does not mean that you arebound to get acne if your parents had the condition.
What are the symptoms?
First symptoms are small red spots that are tender to the touch that later becomepimples containing fatty acids. Depending the severity, the inflammation willdisappear over a few days or weeks.Severe acne can cause scars on the skin. People with severe acnePsychological stress and/or loss of self esteem and therefore, early treatmentand management is important.What worsens acne?
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For a female, having a menstrual period will exacerbate the spots. Theprogestogen-only contraceptive pill may contribute to worsening symptomstoo.
 
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Being in a place where there are chemicals and grease - or in a damp or hotenvironment that causes sweating
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Rubbing, picking at or squeezing pimples
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Wearing thick, greasy make up can make acne worse, although most makeup products do not have this effect
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Wearing tight clothes that may rub the skin eg. shirt collars, bra straps,headbands
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A small number of drugs can worsen the symptoms eg. phenytoin (prescribedfor epilepsy) and steroid creams (prescribed for eczema), anabolic steroids(taken illegally for body-building purposes).
Skin care for individuals with acne
Wash twice a day with mild soap and lukewarm water. Avoid exfoliatingsubstances or abrasive soaps. Scrubbing can produce more inflammation, so begentle. Do not allow the hair to fall onto the face regularly.Avoid oil-rich face creams which may clog pores. Instead, use a water-basedmoisturizer.Although there appears to be no direct link between certain foods and acne,avoid any foods that you think may be affecting your acne.Cases of mild acne can be treated with over-the-counter acne skin care products.Follow the instructions for usage carefully. Consult a doctor if these do not workwithin two months or if the acne is producing scars or large pimples.If you wear make up, choose brands that are oil-free and water-based so thatpores do not become clogged. Opt for products labelled 'non-comedogenic'. Thismeans that they do not specifically cause blackheads or whiteheads.
Acne Treatment
Effective treatment depends on the type and extent of the acne. Your doctor willeither offer treatment or refer you to a dermatologist (a consultant doctor specializing in skin conditions). Treatment is generally focused on factors thattrigger acne. These are:
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Increased amount of sebum, leading to the plugging of the sebaceous glands
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Bacteria that cause acneTreatment may take up to eight weeks to take effect. It can fall into thefollowing categories:
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Topical treatments. These are applied directly to the skin
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Oral contraceptive pills (OCP)
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Oral antibiotics (tablets taken by mouth)
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