Acne

What Is Acne?

• Acne, known as Acne Vulgaris, is one of the commonest dermatological complaints.
• Acne is especially prevalent during puberty and young adulthood, although some people may still suffer from it into their middle years. Acne is known in the general population as "pimples."
• Acne occurs when skin pores are blocked by excess sebum (natural oil produced by the skin) and by dead skin cells. As the sebum builds up, it causes inflammation of the surrounding skin. The lump that forms under the skin because of this blockage is called a comedo. A group of lumps is called comedones.
• If not treated properly acne can lead to permanent scarring. Acne also has important psychological implications such as low self-esteem, anxiety, and depression, especially in youths.    

What Are The Symptoms Of Acne?

• Acne starts out as comedones. People with acne present with blackheads, whiteheads, cysts, pustules (commonly known as “pimples”) or nodules (lumps that form under the skin). Often people with acne suffer from an oily skin complexion.
• Acne is classified as either inflammatory or non-inflammatory acne.
• Comedones are non-inflammatory acne. They can either be closed (whiteheads) or open (blackheads). The color of a blackhead is not debris or an indication of bad skin hygiene, but melanin (the skin’s surface pigment).
• Inflammatory acne occurs when bacteria invade the skin, causing papules or pustules (pimples). Nodules and cysts are also inflammatory lesions. Nodules are deeper skin lesions, while cysts are fluid-filled lumps. 
• Acne usually presents in common areas of increased oil production such as the forehead, nose, chin, chest and upper back.
• Acne can be classified as mild, moderate or severe, depending on the amount and type of lesions. 

What Are The Causes Of Acne?

• Causes of acne are multifactorial. There are many myths surrounding causes and home remedies.
• Genetics play the largest role (estimated in 80%) of acne cases.
• Hormones, especially increased testosterone during puberty, play the second biggest role. Androgens increase the production of sebum by the skin’s oil glands as well as an increased production of cells found in the skin’s epidermis (top layer).
• Hormonal changes during normal menstrual cycles, as well as pregnancy also play a role in women.
• The bacteria, Propionibacterium Acnes, which is usually found on the skin, is another important role player. The areas of inflamed skin surrounding comedones make it easier for bacteria to accumulate and grow.
• Although there are many myths surrounding diet in acne, there are few scientific conclusions around its actual role. Carbohydrates and milk products have shown some suggested links, but none are definitive.
• Facial hygiene is important, but plays a small role, especially in severe acne.    

What Are The Things One Should Do To Manage Acne?

• Consult your doctor sooner rather than later. Early treatment is important, especially for moderate to severe acne, to prevent scarring
• Sunlight has some anti-inflammatory effects. Moderate sunlight exposure may help curb the inflammation, but be sure to use a non-comedogenic sunscreen    

What Are The Things One Should Avoid To Manage Acne?

• Skin moisture balance is essential. Do not over dry your skin with cleaning products. Over drying will cause the skin to produce more sebum, creating a vicious circle.
• Do not use facial scrubs too often, as the exfoliation may worsen the skin’s irritation
• Although it can be very tempting, do not "squeeze" the acne as it causes a spread of bacteria, that can lead to more acne, and may result in scarring.

What Are The Best Foods For Acne?

• According to an article published in 2009 in the Dermato-endocrinology journal, research to date," does not prove that diet causes acne but rather influences it to some degree which is still difficult to quantify."
• Although studies are inconclusive on the effects of diet on acne, maintaining a healthy balanced diet is important.
• Acne is an inflammatory reaction, so following a diet with lots of fresh fruits and vegetables is important, as it contains antioxidants that help your body to fight inflammation.
• Refined sugar causes your body’s insulin to spike. Insulin has been linked to increased sebum production in the skin’s sebaceous glands.
• Zinc, Vitamin A, and E, as well as Omega 3 fatty acids, are strong anti-inflammatory sources.
• Foods that contain Zinc: Cashews, Pumpkin seeds, Flax seeds, Peanuts, Lentils, Soya, Spinach, Beef
• Foods containing Vitamin A: Carrots, Sweet Potatoes, Paprika, Cod liver oil, Kale, Mangoes, Peas, Spinach
• Foods containing Vitamin E:  Tomatoes, Butternut, Mangoes, Almonds, Spinach, Hazelnuts, Kale, Paprika
• Low glycemic index carbohydrates: Brown rice, whole-wheat bread and cereals, Steel Cut Oats, Peas and leafy greens. Certain fruits- apples, oranges, grapefruit, plums, strawberries
• Omega 3 containing foods: Walnuts, Flax Seed, Tuna, Kale, Spinach, Chia Seeds 

What Are The Worst Foods For Acne?

• Avoid foods with a high-glycaemia component (simple sugars/carbohydrates)
• White rice, Rice cakes, Potatoes, Puffed cereals, White Bread, Pasta, Sugar in any form- Honey, and fructose (bananas, mangoes, apricots, pineapples)
• Some studies have linked dairy to acne, although the response is based on the individual
• If you have excluded both carbohydrates and dairy from your diet, and you still struggle with acne, it is advised to consult your doctor for treatment
• If you are already on treatment for acne, eliminating these foods may be complementary.    

What Are The Medicines For Acne?

• There are different treatment options for acne, depending on the severity.
• Retinoids (Vitamin A related molecules), Antibiotics (Tetracyclines) and Benzoyl Peroxide (bactericidal effect on P. acnes bacteria) are usually the mainstays of treatment.
• Mild acne is usually treated with topical retinoids. If this alone does not improve, topical antibiotics (clindamycin, erythromycin) usually in combination with benzoyl peroxide (to prevent antibiotic resistance) is used. Usually, the response is reviewed after six weeks.
• Mild acne not responding to topical agents alone, as well as moderate acne is treated with combination therapy- Topical ointment with an oral antibiotic such as Doxycycline can be used for three months. In females, low-dose estrogen containing combined oral contraceptives can also be used for 3-6 months.
• Moderate to severe acne can be treated with oral retinoids.
• Other treatment options for treatment of acne:

                      1. Laser treatment- for active acne as well as the treatment of acne scarring.

                      2. Chemical peels specifically designed for skin rejuvenation

What Are The Tips To Manage Acne?

• Zinc and Omega 3 supplementation can be added to maintain normal skin function. Increase water intake (2 liters per day) to help your body detoxify.
• Natural oils, such as tea tree oil, applied topically oil has shown some benefit in mild acne. It is always best to consult your physician first before using any complementary products, as it may interfere with other medications that you are on.