Dr Sentila Longkumer, Consultant Have you ever had acne in your life? If not, you are one of the luckiest people. Acne , more commonly known as PIMPLES, is a skin disorder that occurs usually between the age group 12-25 years, sometimes even younger or older people may be affected. 8 out of 10 teenagers may develop acne at some point, usually mild and in 3 out of 10 teenagers, there can be moderate to severe acne that requires intervention in the form of topical or oral medications followed by cosmetic procedures to help alleviate the acne, marks and scars. Treatment may last a few months to many months. Untreated acne can last 4-5 years or even longer before healing with undesirable scarring. What causes acne? Small sebaceous glands lie just under the skin surface. These glands make the oil (sebum) that keeps the skin supple and smooth. Tiny holes (pores) on the skin allow the sebum to come on to the skin surface. During the teenage years, you make much more sebum than when you were a child due to the hormonal changes of puberty which stimulate the sebaceous glands. As a rule, the more sebum you make, the more greasy your skin feels and the worse acne is likely to be. This sebum, along with dead cells form a plug and block the pores which are seen as Blackheads and Whiteheads, also called comedones. An open comedone or blackhead is seen as a black bump due to the the skin pigment becoming oxidised, and not due to dirt as many people think it to be. A closed comedone as the name suggests is seen as a whitish bump over a closed pore. Often, the trapped sebum/oil may give room to a bacteria called Propionibacterium acnes to reside and multiply within, as a result of which there may be inflammation, whereby the surrounding skin becomes red and the bumps become larger with collection of pus. Sometimes, these pus filled pimples(pustules) can enlarge to form nodules and cysts. Rarely, conditions like Polycystic Ovarian Disease in girls/women and drugs (oral as well as topical), oily cosmetics, chemicals can cause or aggravate acne. Very often, we come across people who come with acne like eruptions on the face and arms due to topical steroid misuse. Let us discuss some Acne Myths and Misconceptions: Myth: Acne is a teenager's problem. Fact: a survey of more than 1,000 adults published in the Journal of the American Academy of Dermatology found that 50% of women between 20 and 29 years old, 35% of women between 30 and 39 years old, and 26% of women between 40 and 49 reported having acne. (Note: Adult acne is more common in women than men.). This is attributed to a surge in the hormone “Estrogen” at puberty and at the peri-menopausal periods, thereby explaining why acne is more common at puberty and again in later life. Myth: Diet has no role in acne Fact: Today, researchers are finding that diet indeed plays a role in acne. Studies have shown that people consuming food with a high glycemic index (food that increases sugar level in the blood), carbonated drinks, dairy products and unhealthy fat, and also less fish are most likely to have moderate to severe acne. Myth: If you suffer from acne you should never eat chocolate. Fact: Here's a good news- you can! Just make sure the cocoa content is higher than 70% (dark chocolate)..the more the cocoa, the less the glycemic index...so, chocolate lovers, take the plunge!! Myth: Washing the face frequently will reduce acne. Fact: Frequent and vigorous cleansing will rather exacerbate acne as the skin is stripped off its natural moisture. Dehydration follows and the skin compensates by producing more oil which will only clog the pores and increase your problem. Myth: Popping your pimple/zit makes it go away. Fact: NO! NO! As much as the temptation be, leave your pimples alone. A whitehead may disappear on its own in a week's time if left as it is. Squeezing it will introduce dirt and bacteria thereby causing inflammation and redness that will heal in a long time with scarring. Myth: You just have to let acne run its course. Fact: The truth is, acne needs treatment in order to be cleared up. . With the kind of treatment available today, there is no reason why anyone with moderate to severe acne should dwell in misery and wait for nature to take its own course. Acne needs at least 4-6 months of active treatment as it is a slow responding disorder and often needs a long period to produce reasonable improvement. Treatment should start as early as possible and reassessed every 2-3 months. Myth: Make-Up can cause acne. Fact: Today there are water based make up creams, which do not block the pores and are not comedogenic as were the previous oil based products. Powder foundation helps by absorbing oil and so can be recommended for use. Some cosmetic products also contain anti-acne medicaments such as benzoyl peroxide. Primarily all cosmetic products should be non- comedogenic, oil free and hypoallergenic. Myth: Sun exposure cures acne. Fact: This is yet another myth that needs to be laid to rest. Basking under the hot summer sun may create the appearance of improved skin and less acne, but looks can be deceiving. The sun’s powerful ultraviolet rays will turn your skin a darker tone, which subsequently masks the redness caused by acne. The acne will remain on your face; it’s just concealed somewhat by the sun. Long-term sun exposure can lead to a wide variety of other problems, fine lines, wrinkles, and an increased risk of skin cancer. Don’t be fooled by this myth. Protect your skin and health from the damaging effects of sun exposure by wearing a sunscreen, preferably a physical sunscreen containing zinc oxide. This article has been written with an aim to educate our people and throw some light into one of the most common skin conditions here and anywhere in the world. Being dermatologists and having to see countless number of patients with acne, both young and old, we have come across some whose personality and self image have been severely affected by it. One will not die of acne but the psychological impact can be immense, thus hampering one's performance in school, college, workplace, etc. Hence, intervention in the form of timely treatment and counselling is needed. And indeed, it is very rewarding to see such patients gain back their self confidence and coming out of their shell ensuing proper treatment and management. Very few people will generally outgrow acne. A larger chunk will need appropriate medications to help resolve it. Treatment protocol varies between different types of acne. Topical medications in the form of cream, gel and lotion are sufficient for mild acne whereas those with moderate or severe acne will need oral medications. Treatment duration on an average lasts 4-6 months, along with concurrent dermatosurgery procedures like comedone extraction, chemical peels and microdermabrasion which will aid in faster resolution. For residual scarring, microneedling and laser resurfacing of the skin with Fractional CO2 laser are available. This laser is one of the latest technologies introduced for skin rejuvenation and scar repair. Of course, the skin is not going to look the way it did before one had the scars but it will definitely improve to a vast extend. All these facilities can be availed at CIHSR, popularly known as Referral Hospital. Do's & Don'ts To end, here are a few advice for acne prone people:
- Wash the face with a mild cleanser twice a day, with a gentle massage.
- Get rid of bangs and side burns as the oil from the hair will clog the pores.
- Change the pillow covers on alternate days for the same reason as above.
- Do not use oil based cosmetics/foundation.
- Do no apply steroid creams like betnovate, elocon, lobate, clobetamil, to name a few on your face unless your dermatologist recommends them for other conditions.
- Adult onset acne tends to be confined on the lower face and neck areas, so avoid covering the neck with mufflers, collared shirts.
- Do NOT pick on acne/pimples.
- Visit a dermatologist for proper management of your pimples/acne.
