Acne treatments

Many people suffer from acne, a skin condition which occurs mainly in teenagers and adolescents but which can also affect adults. It occurs in both mild and very severe forms, and while it is not contagious, it can be cosmetically disruptive due to the acne marks it leaves, and have a considerable impact on the social and psychological wellbeing of those who suffer from it.

Acne is a skin condition in which the sebaceous gland follicle becomes inflamed. The condition manifests itself mainly where the most active sebaceous glands are located, namely on the face in the so-called T-zone (forehead, nose and chin), back, neck, throat and shoulders.

During puberty, the body produces more hormones, including androgens, which are responsible for the growth of the sebaceous glands and the production of more and thicker sebum. Every sebaceous gland has an opening called a pore, from which sebum can escape. Sebum, which keeps the skin and hair supple and oily, is water-repellent, protects against dehydration and moisture loss of the skin and increases its resistance.

Thicker sebum combined with dead skin cells can clog the pores, however, and this can cause blackheads. A blackhead, or comedo, can have a black or a white spot. Those with a white spot are deeper and can close off the entire pore. In addition, there is a keratosis (scaling over) of the excretory duct of the sebaceous gland, which further clogs up the pore. The sebaceous glands contain bacteria that convert the sebum into fatty acids. Due to the accumulated sebum and the irritating fatty acids, the clogged sebaceous gland follicle expands further and further and eventually bursts open. The irritants enter the adjacent skin and cause inflammation, resulting in acne, i.e. spots and pimples.

The occurrence of acne or its worsening can also be influenced by:

• Genetic factors (it runs in the family);
• Hormonal factors (menstruation and pregnancy);
• Polycystic ovarian syndrome or cysts on the ovaries;
• Stress;
• Cosmetics;
• Friction with clothing;
• Strong climate change.

Acne occurs in many different forms. Common ones include:

• Acne vulgaris (the most frequent):
  Comedones, spots and pustules occur simultaneously and to varying degrees.
• Acne comedonica:
  Mild acne in which comedones rather than inflammations or blackheads are the main focus.
• Acne conglobata:
  This type is accompanied by very severe inflammations with giant and double comedones, nodules and cysts, usually creating acne scars. This occurs mainly in young men and can continue into their adult lives.
• Acne excoriée:
  In this form, acne is exacerbated by scratching or squeezing out each pimple or comedo, resulting in acne scars on the face or back.
• Acne tarda:
  This is the same as acne vulgaris except that it affects adults and acne vulgaris does not go away after puberty.
• Acne ectopia or hidradenitis supperativa:
  A type in which pimples in the groin or armpits are caused by an inflammation of the hair follicles as opposed to the sebaceous glands.
• Acne fulminans:
  A rare severe and acute outbreak of acne accompanied by a general feeling of illness. It includes inflamed pustules that develop very quickly into open wounds and sores accompanied by fever, malaise, blood disorders and muscle and joint pains in the limbs.

Acne is usually found in the face in what is known as the T-zone (the forehead, around the nose and the chin), but also on the back, chest, shoulders, neck and throat. It can manifest itself as follows:

• Blackheads or comedones:
  Open black comedones with a black clot of dried secretion in the pore or closed white comedones with a white spot
• Pimples or spots:
  A sharply defined solid elevation of the skin.
• Pustules:
  A visible cavity in the skin with purulent moisture (pus).
• Subcutaneous inflammation, nodules and cysts:
  A nodule is a sharply limited tangible resistance in the skin or in the subcutaneous tissue, which may or may not be elevated above the skin and generally heals with scarring (an acne mark). A cyst is a closed cavity filled with fluid, cells or cell products.

These symptoms occur in varying combinations and in different degrees of severity depending on the form of acne. When acne is no longer actively present, side effects such as acne scars and stains may be visible.

If treated properly, acne can decrease or disappear. Clean your skin once or twice a day with lukewarm water – do not use soap, or rub or exfoliate your skin. Do not squeeze your blackheads, pimples or spots: this will only exacerbate the condition and may also cause acne scars. Do not smoke as this has a detrimental effect on your skin. Although healthy eating, drinking enough water and moderate alcohol consumption will not directly affect acne, it will certainly not exacerbate it. Be careful with make-up, as some products clog up the sebaceous glands and aggravate or cause acne. Take a lukewarm shower after exercise, as sweating combined with friction with clothing can exacerbate acne. Moisturising cream can also help.

Despite all of the measures mentioned above, more thorough acne treatment may be required. The treatment of acne depends on the severity of the condition.

A first possible step in the treatment of acne can be deep cleansing, where black and white comedones are removed using a thin, small needle. The purpose of deep cleansing is to reduce inflammation and prevent scarring.

In combination with medication, a microdermabrasion treatment – in which the top layer of skin is removed with crystals – can be considered. Acne treatment with medication and microdermabrasion is aimed at calming, counteracting and reducing the acne. It will not disappear overnight, but may eventually heal.

Acne scars

Any kind of acne can leave acne scars. They show that the body has repaired the damage to the skin in that place, but with a different structure to ordinary skin, which makes it stand out. Over time, acne scars become less visible, and there are several methods of treatment for acne scars:

• Chemical peeling:
  The epidermis is removed by an etching liquid.
• Laser treatment:
  The epidermis is burned off layer by layer.

Research the various acne treatments and find out the best place to have them carried out.

Having acne can greatly reduce the quality of life, as the resultant shame and grief that people feel can be enormous, making them insecure, lacking in self-confidence, dejected and even depressed. If these feelings prevail, do not hesitate to consult your doctor and if necessary, ask for a referral to a psychologist and/or dermatologist.

Always read the leaflet of the medicines you are prescribed. Do not use antibiotics to which you have previously had an allergic reaction. Always complete an antibiotic course, unless you have allergic reactions.

Acne vital (z.d.). Acne fulminans and acne congoblata. Consulted on 23 April 2019 from https://acnevitaal.nl/acne/soorten- acne/acne-fulminans/

Apotheek.nl (Last updated KNMP: 29-09-2017). What medications are used for acne? Consulted on 23 April 2019 from https://www.apotheek.nl/klachten-ziektes/acne#welke-medicijnen-worden-gebruikt-bij-acne

Dr. Njoo D (z.d.). Acne. Consulted on 23 April 2019 from https://www.huidarts.com/huidaandoeningen/acne/

Ear skin therapists (z.d.). What does acne look like? What forms of acne are there? Consulted on 23 April 2019 from https://www.thoord.nl/aandoening/acne/

NHG (z.d.). Acne summary map. Consulted on 23 April 2019 from https://www.nhg.org/standaarden/samenvatting/acne

Pharmacotherapeutic compass (z.d.). Treatment plan Acne. Consulted on 23 April 2019 from https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/acne_vulgaris#acne_vulgaris_treatment plan

Skin care Royale (z.d.). Acne and quality of life. Consulted on 23 April 2019 from https://huidzorgroyale.nl/huidproblemen/acne/acne-vulgaris/

Skin care Royale (z.d.). Acne ectopia. Consulted on 23 April 2019 from https://huidzorgroyale.nl/huidproblemen/acne/acne- ectopica/

The Blaak outpatient clinic (z.d.). Acne treatment. Consulted on 23 April 2019 from https://www.polikliniekdeblaak.nl/huidziekten/acne-behandeling/