ACNE and OILY

SKIN
Acne Vulgaris
Acne is classified as non-inflammatory lesions and inflammatory lesions.
• Non-inflammatory lesions
1) Open comedones (blackheads)
2) Closed comedones (whiteheads)
• Inflammatory lesions
1) Papules
2) Pustules
3) Cyst
4) Nodules
Acne can also be classified based on terms of severity
A) Mild A) Moderate A) Severe
- Non -inflammatory lesions - More number of established - Deep pustules and papules
in minor facial area. papules, pustules. develop.
- Less superficial papules, - Some scar development is - Non-inflammatory lesions are
pustules. observed. observed over face.
- No visible scar formation - Cystic lesions are less. - Cystic lesions are more.
- Appearance of skin is - Severe scar development.
normal.
Acne progresses from normal follicular stage to comedone stage and further leads to inflamed papule and pustule
condition.
Acne vulgaris is a result of sebum overproduction, sebaceous follicle epithelium degradation, growth of Propionibacterium
acnes (P. acnes) and an inflammatory reaction. Comedogenesis is process in which sebum is metabolised into irritating
glycerides and fatty acids by lipases produced by P.acnes and provide conditions to promote the growth of comedones.
Sebum is the mixture of sterols, triglycerides and sterol esters. Level of sebum may get increased due to changes in the size
of sebaceous gland or by increased hormonal levels (mostly testosterone).
Other reasons that lead to onset of acne are related to occupation or other environmental exposure that is exposure to
chemicals, air contaminants, high humidity. Changes in diet may not directly affect in development of acne but can lead to
hormonal initiation of acne cycle. Other causes are seasonal effects, excessive sexual activity, stress, skin surface
modulation, drugs such as corticosteroids that are responsible for onset of acne.
 Approaches for treatment of acne:
 Different treatment approaches are currently used to treat acne. Treatment consist of use of topical
therapy, systemic therapy, hormonal therapy. Depending upon the severity of acne different
treatment approaches are used. In mild acne condition topical therapy is sufficient for treatment but
severe and moderate acne conditions will require systemic therapy or combination of treatment.
Procedural therapies are also used that are comedone extraction, laser therapy.
• Topical therapy: Topical therapy includes use of different topical active agents -benzoyl peroxide, salicylic acid,
sulfur, resorcinol, sulphones, retinoids.
 Benzoyl peroxide (BPO) –
Benzoyl peroxide is an antibacterial and also an irritant. It reduces the growth of P.acnes by release of free radicals. It
is effective in inflammatory as well as non-inflammatory acne. It is a bactericidal agent and also has comedolytic action
but does not have any effect on sebum secretion. Concentration range of benzoyl peroxide that can be used in
formulation is 2.5% -10%. It can be formulated in the form of gels, foams, cleansers, creams, lotions. It can also be used
in combination with retinoids, antibiotics which will enhance the activity.
 Sulphur-
Sulphur is observed to act as an antimicrobial and also as a keratolytic agent. Concentration range is 3-10%
and can be used in colloidal or precipitated form.it is found to have dose dependent activity.
 Salicylic acid-
Salicylic acid acts as a keratolytic agent and concentration range is 0.5-2%. At low pH (<3) it shows
maximum activity.it is more soluble in alcohol containing vehicles. Disadvantage of salicylic acid is that it
causes severe irritation and therefore to be used carefully.
 Resorcinol –
Resorcinol is used in combination with sulfur and also enhances its activity. It acts as antimicrobial as well as
keratolytic agent. Concentration range to be used is 2-3% and 3-8% with sulfur.
 Systemic therapy-
Oral antibiotics such as tetracyclines, trimethoprim, sulfamethoxazole, macrolides can be used and found to be
effective. It is found to be more effective for inflammatory acne. Adverse effects of antibiotics differ based on
individual antibiotic used. Tetracycline are teratogenic, macrolides increase GI disturbances.
 Hormonal therapy –
Hormonal therapy is mostly used for treating acne in women. In this therapy, the levels of androgenic hormones
such as testosterone is reduced. Oral contraceptives and androgen-receptor blocker (spironolactone, flutamide)
are used.
 Herbal therapy in Acne –
Herbal therapy is used nowadays to treat acne. Use of herbal ingredients in formulation are increasing as they
are obtained from natural source and have fewer side effects as compare to conventional. Herbal active agents
are extracted from plants that have anti-bacterial and anti-inflammatory effect. They are used against antibiotic
resistant P. acnes.
Herbal ingredients that can be used in anti-acne formulations are aloe, green tea, neem, nutmeg, basil (tulsi),
copaiba oil, rose water, jojoba oil, coriander, orange peel, lemon peel, rhubarb, turmeric, tea tree, thyme, walnut,
asparagus.