ACNE
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Acne is a malfunction of the pilosebaceous unit and an inflammation of the sebaceous glands characterised by many forms from blackheads, whiteheads, nodules, papules, pustules and cysts (Holmes, 2013). Acne also comes in different severity as you can view the severity in the photos down below (warning: some photos may be too graphic to view)
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To keep your hair and skin well lubricated, your body depends on sebaceous glands which sit just under your skin. These glands secrete an oily substance called sebum which coats your skin and hair to prevent them from drying out. Sebum travel up hair follicles and out through your pores onto the surface of your skin.
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Naturally, we produce million dead skin cells about every forty minutes. However, in acneic skin, we produce four to five times higher with the natural sloughing process is disturbed. This condition called retention hyperkeratosis. How does this happen?
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Well, when your body produces extra sebum (oil) and dead skin cells, they can stick together and clog your pores resulting in skin blemishes. acne skins lack tiny particles called lamellar granules which important in stimulating the natural release of dead skin cells. The average sebum secretion rate is three times greater than in normal skin. It is also different in composition with higher levels of squalene and wax esters while lower levels of linoleic acid makes sebum thicker and stickier.
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CAUSES
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What causes three times the amount of sebum produced? HORMONES! The sebaceous glands largely under the influence of androgens also called the 'male hormones' that are present in men and women. It secreted by adrenal glands, the testes and the ovaries. Testosterone, is one of the androgens and this hormones converted to dihydrotestosterone by an enzyme called 5-alpha reductase enzyme which directly stimulates the cells to produce more sebum. Sebum is rich in waxes and that provides a favourable environment for bacteria to flourish and these bacterias play a part in the development of acne particularly the inflamed lesions. These type of bacteria live in our skin and they are anaerobic means they don't need oxygen to survive plus they feed on sebum .
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When the hair follicle become blocked and there is no air and plenty of food, then bacteria that normally exists in small amount on your skin called Propionibacterium acne or known as p. acnes, thrives. They begins to break down sebum composition to produce fatty acids which irritate the lining of the hair follicle which leads to inflammation in the skin (Chang & Choi, 2020).
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Acne is the most common skin condition worldwide, affecting approximately 85 percent of people at some time during their life. Although acne is often considered a problem of teenage years, acne persists into adulthood in up to 50 percent of patients. In addition, there is also growing evidence that acne can have significant effects on psychological well-being from feeling embarrassed, frustrated, angry and more likely to suffer depression, anxiety and social phobia compared with people without acne.
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Why is this important to know?
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To help control acne, we need to slow down the sebum production. Acne treatment aims to address some or all of these factors mentioned above and usually begins with the least invasive options.
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At Skinderm Aesthetics, most acne can be treated with range of chemical peels (O'Connor et al., 2017). Other than that, skin resurfacing and various treatments available for acne are:
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In conjunction with the treatments, homecare product is play the key to success when treating acne. Ingredients such as retinol, salicylic acid, lactic acid, mandelic acid, niacinamide, zinc glycinate, ascorbic acid and benzoyl peroxide have been clinically proven to regulate the sebum production and prevent future acne formation (Kolli et al., 2019; Oon et al., 2019).
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Patients with severe acne that has not responded to other treatments, more likely might be refer to see medical specialist such as dermatologists to further treat the condition with highly effective topical and oral prescriptions. In Australia, medication such as oral isotretinoin, oral antibiotics or other hormonal medications can only be prescribed by board certified dermatologists (Cho et al., 2023; Leung et al., 2021; Villani et al., 2022).
At Skinderm Aesthetics, we are working interprofessionally with appropriate medical authorities (Adamski et al., 2021) and our patients mostly required to use retinoids such as Tretinoin cream which prescribed from patient's medical practitioners to prep their skin prior dermal procedures and this also accelerate the patient's wound healing process for faster downtime (Kolli et al., 2019).
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For acne during pregnancy and lactating, low percentage of chemical peel solutions consider safe to be use (Ly et al., 2023).
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REFERENCES
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Adamski, Z., Gornowicz-Porowska, J., Sobkowska, D., Kaszuba, K., & Czajkowski, R. (2021). Acne - therapeutic challenges to the cooperation between a dermatologist and a cosmetologist. Postepy dermatologii i alergologii, 38(2), 21-31. doi:https://doi.org/10.5114/ada.2021.104273
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Chang, J. E., & Choi, M. S. (2020). A Molecular Perspective on the Potential Benefits of Metformin for the Treatment of Inflammatory Skin Disorders. International journal of molecular sciences, 21(23), 8960. https://doi.org/10.3390/ijms21238960
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Cho, M., Woo, Y. R., Cho, S. H., Lee, J. D., & Kim, H. S. (2023). Metformin: A Potential Treatment for Acne, Hidradenitis Suppurativa and Rosacea. Acta dermato-venereologica, 103, adv18392. https://doi.org/10.2340/actadv.v103.18392
Holmes, S. (2013). Acne, Rosacea, and Related Disorders. In C. Soutor, & M. Hordinsky, Clinical Dermatology (1st ed., pp. 128-140). McGraw-Hill Education, LLC.
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Kolli, S. S., Pecone, D., Pona, A., Cline, A., & Feldman, S. R. (2019). Topical Retinoids in Acne Vulgaris: A Systematic Review. American journal of clinical dermatology, 20(3), 345-365. doi:https://doi.org/10.1007/s40257-019-00423-z
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Leung, A. K., Barankin, B., Lam, J. M., Leong, K. F., & Hon, K. L. (2021). Dermatology: how to manage acne vulgaris. Drugs in context, 10. doi:https://doi.org/10.7573/dic.2021-8-6
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Ly, S., Kamal, K., Manjaly, P., Barbieri, J. S., & Mostaghimi, A. (2023). Treatment of Acne Vulgaris During Pregnancy and Lactation: A Narrative Review. Dermatology and therapy, 13(1), 115-130. doi:https://doi.org/10.1007/s13555-022-00854-3
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O'Connor, A., Lowe, P., Shumack, S., & Lim, A. (2017). Chemical peels: A review of current practice. Australasian Journal of Dermatology, 59(3), 171-181. doi:https://doi.org/10.1111/ajd.12715
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Oon, H. H., Wong, S. N., Aw, D., Cheong, W. K., Goh, C. L., & Tan, H. H. (2019). Acne Management Guidelines by the Dermatological Society of Singapore. The Journal of clinical and aesthetic dermatology, 12(7), 34-50. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31531161/
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Villani, A., Nastro, F., Di Vico, F., Fabbrocini, G., Annunziata, M. C., & Genco, L. (2022). Oral isotretinoin for acne: a complete overview. Expert opinion on drug safety, 21(8), 1027-1037. doi:https://doi.org/10.1080/14740338.2022.2102605
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DermNet NZ (n.d.). Retrieved from https://dermnetnz.org
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