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Introduction.

Acne can be a truly disfiguring problem. From daily anguish to lifelong emotional disturbance, the problem is much more than a simple skin blemish. I will present relevant medical information that may provide a better understanding of the problem and what to do about it.

What is Acne. source

The medical name of the condition is Acne Vulgaris. It results from either blocked and/ or inflamed hair follicles and the sebaceous glands.
Areas most commonly affected are the face, chest and back.
Merriam- Webster’s dictionary defines it as:

a disorder of the skin caused by inflammation of the skin glands and hair follicles.

hair follicle with sebaceous gland

What causes Acne?

• You may be surprised to know that genetics plays a part in Acne development. source
• Skin inflammation is an early event. source
• Increase in keratin in follicles and decrease in shedding of these cells leads to keratin and sebum plugs causing comedones. source
• A bacteria called cutibacterium acnes forms colonies in the comedones and causes further inflammation.source
• Sebum production is regulated by hormones. Excess sebum plays a role in Acne development. source

Who gets Acne?

Practically anyone can get Acne. 80% of Americans will suffer from Acne at some point in their lives. source
Even at age 45, 5% of men and women have Acne. source
Mediterraneans are more prone to Cystic Acne. I could have told you that from personal experience but here is the source.

Coffee break.

I can imagine the reader by now wanting this post actually talk about what to do about Acne. We shall commence that section after a beautiful random picture from pixabay.com.

What to do about Acne. source foe the entire section

This area of discussion is very complex and I will present some complexities in the discussion. The purpose here is to present limited medical information leading to my most important suggestion:
Acne treatment is a highly complex topic and all treatments should be undertaken under the guidance of a Dermatologist or any other physician with expertise in the field. Misadventures in treatments and self treatments may cause more lifelong damage that could have been prevented by proper medical care.
The current treatment consensus recommends a combination therapy of retinoids and antimicrobial agents. source

Retinoids

Retinoids normalize the excess cell production and breakup comedones. Can cause photosensitivity, rash and possible initial mild worsening.

Antimirobials

This line of therapy consists of antibiotics such as clindamycin, erythromycin or dapsone applied locally. These are active against the bacteria in a comedone. Benzoyl peroxide is also used as an antimicrobial. Some complications include allergic reactions and bacterial resistance. Duration of therapy needs to be appropriately limited to prevent resistance.
Realize that these regimens, their intensity, duration of each component etc can be decided by a physician only. Note that Benzoyl peroxide alone is not a recommendation.

If Acne is moderate to severe..

Oral antibiotics, steroids and retinoids, hormonal therapies and spironolactone are very effective.
Minor surgery can be done for very large lesions.

Photodynamic therapy. PDT.

PDT is a process where a photosensitizer applied to the skin is allowed to be absorbed and activated by light. A cochrane review was unable to come up with firm recommendations but individual studies have reported success. It appears that in good hands, it may be a helpful option.

Laser treatments.

There remains a lack of adequate scientific body of knowledge. Limited studies have suggested benefits.

I have hopefully stressed enough enough by now that even for mild acne, the treatment is with prescription regimens and if you want your acne treated well, then seek medical guidance from a Physician. Dermatologists are experts in this field.