Causative & risk factors
The reason behind production of acne is not yet clearly known, but the following underlying mechanisms may be present:
- Increased production of hormones androgens
- Overactive sebaceous glands in response to androgens
- Hyperkeratinization within the intrafollicular ducts
- Colonization of the follicles with Propionibacterium acnes
Adolescents are highly prone to developing acne. Frequent use of oily cosmetics, hair gels etc. or friction of skin caused due to helmet straps or any other gear increase the risk of acne formation. People suffering from polycystic ovarian syndrome, congenital adrenal hyperplasia or other endocrine diseases are more prone to develop acne. Medications like lithium, isoniazid, phenytoin, corticosteroids, anabolic steroids, and oral contraceptives also raise the risk of acne formation.
Clinical presentation
Acne can occur on any body parts such as face, neck, shoulders, back, or chest. It may present as a combination of few or all of the following:
Whiteheads: These are very small lesions which remain under the skin
Blackheads: These are the black spots appearing on the surface of the skin
Papules: They are small, pink bumps
Pustules: They are red at their base and have pus at the top.
Nodules: They are large, solid, painful lesions embedded deep into the skin.
Cysts: They are the painful, pus-filled lesions.
Scarring
Investigations
Acne is a very common occurrence, especially in teenagers and young adults. Only when the doctor suspects an underlying endocrine disease, tests will be carried out to measure hormone levels. An ultrasonography may be advised to women to rule out PCOD.
Treatment
Usually topical medications are prescribed which may contain retinoids and steroids. Oral or topical antibiotics may be prescribed. Cases where there is persistent cyst are treated with interlesional corticosteroid injection. Cases of severe acne which does not respond to any other therapy are treated with isotretinoin. Oral contraceptive pills may be used in some cases. Cosmetic procedures may be used to lighten the scars.
