ACNE Write For Us – We know that acne is a subject that affects and worries adolescents and their families a lot. Therefore, in this opportunity, we will seek to answer some frequently asked questions while providing relevant information on how to treat this disease.
What is acne?
It is a chronic inflammatory skin disease of the pilosebaceous unit of multifactorial aetiology. Increased sebaceous secretion, formation of comedones, colonization by Cutinebacterium Acnes, inflammatory lesions and risk of scarring characterize it.
It is one of the most frequent dermatological diseases, especially in adolescence, due to the action of androgens, with a heterogeneous and polymorphic form of clinical expression.
The maximum prevalence and intensity occur around 14-15 years of age in women and between 16 and 18 years of age in men. Although the incidence by sex is similar, more severe forms are observed in men.
This chronic disease impacts the quality of life of adolescents, especially in the psychosocial sphere, causing depression, anxiety and body image disorders. The role of the paediatrician or referring physician is relevant to carry out diagnostic guidance, early therapeutics, follow-up, and accompaniment, and to determine the timely referral to the specialist in Dermatology in case it is required.
How is the diagnosis made?
The clinical diagnosis confirms the presence of comedones and inflammatory lesions (papules, pustules and cysts). Scars may accompany them. These are present mainly on the face (90%) but can extend to the trunk (20%) and upper back (60%).
Within the anamnesis, it is essential to know: the age of onset, duration, changes in the lesions, previous treatments and their effectiveness, and the impact of this disease on their quality of life.
In its diagnostic approach, four fundamental aspects must be considered: type of lesion that predominates (inflammatory or non-inflammatory), intensity/severity (stage of the lesions), extension (facial, pectoral, back) and associated factors.
The classification is clinical: mild acne (comedones), moderate acne (inflammatory lesions plus papule and pustule) and severe acne (inflammatory lesions, nodules, cysts and scars predominate).
When to refer to Dermatology?
- Acne that presents in childhood.
- Moderate acne that has not responded to well-conducted treatments.
- severe acne
What are the factors that are related to episodes of acne exacerbation?
- Diets high in sugar and other carbohydrates stimulate serum insulin and insulin-like growth factors (IGF-1), leading to increased androgen production and subsequent acne development.
- Stress situations determine the increase in the adrenal secretion of androgens and stimulate the neuroendocrine regulation of sebocytes.
- Drugs: anabolic steroids or contraceptives with progestogens with androgenic action.
- Cosmetics with high-fat content, aggressive cleansers, and soaps with an alkaline pH alter the skin barrier, favour the formation of comedones and induce inflammation.
What advances are there in treatment?
The continuous advances in the pathogenesis of acne have allowed the development of new therapeutic guidelines. The gold standard continues to be the clinical interview and a correct physical examination to organize an appropriate and individualized therapeutic plan for each adolescent, always considering the impact it generates on their quality of life.
The approach is interdisciplinary and requires strengthening self-care, treatment adherence, and periodic evolution monitoring.
The basic guidelines for treatment
- Adequate hygiene, once or twice a day with neutral or acid, non-irritating pH soaps, before topical or systemic drug treatment.
- Photoprotection of the area is recommended to avoid marks and scars, if possible, with specific photoprotection for oily skin.
- It is recommended to discontinue topical treatment in the summer months.
- Do not manipulate the lesions.
- Treat from the beginning when the adolescent consults.
- Individualize and adapt the treatment to acne’s type, extent and severity.
- Clearly explain its efficacy and adverse effects.
The American Academy of Dermatology and European guidelines recommend:
Combination therapy in all forms of acne, and that topical retinoids alone or combined with benzoyl peroxide (PBO) or topical antibiotics are the initial treatment for mild/moderate conditions and the most widely used option for maintenance in all forms of acne.
What drugs do we have in Uruguay, and what are their indications?
Retinoids are comedolytic and anti-comedogenic, have an anti-inflammatory effect and normalize keratinization. Options: Adapalene 0.1 -0.3%, Tretinoin 0.025%, 0.05%.
PBO 5-10%: acts as an antibacterial, anti-inflammatory, comedolytic and keratolytic. Its use is recommended in combination with retinoids, not in monotherapy.
Topical antibiotics (ATB): They act due to their anti-inflammatory effect and inhibit the growth of Cutinebacterium acnes. It is recommended to use: Erythromycin 1-2% and Clindamycin 1-2% (not in monotherapy, always combined with retinoids).
Ac Azelaic 15%: Acts as an anti-inflammatory and decreases keratinization of the follicle and hyperpigmentation.
In Uruguay, topical commercial preparations combine these drugs: retinoid/PBO, retinoid/ATB, and PBO/ATB.
Oral antibiotics (ATB): doxycycline, minocycline and lymecycline. They are used in pulses of 15 days -1 month.
Hormone treatment l: oral contraceptives. Oral isotretinoin.
As adjuvant treatments, the following can be performed: removal of comedones, use of chemical peels or service of lasers.
Depending on the severity, the following may be recommended:
Mild acne: topical treatment: retinoid accompanied by topical PBO or ATB if there are inflammatory lesions.
Moderate acne: topical treatment combined with oral ATB in the pokes.
Severe acne: oral ATB, assess hormonal therapy (in women) and the use of isotretinoin.
Has your skin decided to live a second youth even though you left adolescence long ago? Don’t worry, it’s normal. Hormonal changes in women and that disease of this century called stress favour the appearance of pimples. But there is more…
Are hormones to blame?
Yes. 90% of women suffer from acne at some point in their lives. Occasionally on the days of menstruation or during pregnancy, when high levels of progesterone and testosterone cause the sebaceous glands to work excessively.
Do I get pimples from eating chocolate?
No. Acne appears due to hormonal or genetic factors, but perhaps the same hormonal disorder that makes you cry, be angry or eat chocolate is what causes you to get a pimple.
If I wash the skin a lot, won’t they come off?
No. Too aggressive cleansing leaves the skin unprotected, which can cause a reaction —rebound effect— with a consequent increase in sebum.
I get my period before my period; is it normal?
Yes, due to the aforementioned hormonal change. In these cases, it appears above all on the chin and jaw area and at the hairline.
I have pimples. Can I skip the moisturizer?
No. You can have dry skin and pimples. Use an oil-free moisturizer (without oils) with anti-irritant properties.
Acne is a skin ailment when hair follicles become clogged with oil and dead skin cells. It causes whiteheads, blackheads, or pimples. Acne is most ordinary among teenagers, although it affects people of all ages.
There are effective acne treatments, but acne can be persistent. Pimples and rashes heal slowly, and when one starts to fade, others appear to crop up.
When to see the doctor
See your primary care doctor if home remedies can’t clear up your acne. Your doctor may prescribe stronger medications. If acne persists or is severe, seek treatment from a doctor specializing in the hide (dermatologist or pediatric dermatologist).
Lousy skin can persist for decades for many women, with common outbreaks a week before menstruation. This type of acne tends to obvious up without treatment in women who use birth control.
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