Acne: Q & As

We are republishing the interesting Q & As of Mr. D. Ioannidis on the subject of acne hosted on the HDAS

Acne: Q & As

What is acne?

Acne is an inflammatory condition characterized clinically by polymorphic lesions of the sebaceous follicles, mainly on the face, but also on the shoulders and the upper part of the trunk. The lesions are the closed and open comedones (comedones, literally "pimples"), papules, pustules, nodules, cysts and in a percentage of 15-20% of the patient's scars.

How common is acne, and at what age does it appear?

75% of people develop some acne lesions during their lifetime. This particularly common skin disease is usually observed during adolescence. In fact, every teenager shows some mild form of acne, while in about 20% of them the acne activity is characterized as serious enough, so that the help of a specialist dermatologist becomes necessary. Acne, however, can also appear at an older age, such as during the third, fourth and, rarely, fifth decade of life, i.e. over 40 years, especially in women. The time shift in the onset of acne in older people has created an extremely demanding group of people who expect quick and spectacular improvement.

How long does acne last?

The tumor lasts for many years if left untreated and progresses with flare-ups and remissions. This observation is important for understanding the behavior of this condition, since a positive result of any therapeutic treatment should be maintained with the use of certain drugs for a long period of time.

What causes acne?

Acne usually appears in individuals with increased sebum production. The primary alteration concerns the disruption of the proliferation of the cells that line the excretory pores of the sebaceous glands, which, thus, become blocked and swollen. This is how the first lesions are created, the closed and open nipples. An anaerobic micro-organism, the acne proprioceptive bacteria, which normally lives deep in the hair follicles of all people and is responsible, most of the time, for its inflammatory forms, i.e. the development of papules, pustules, participates in the development of acne. and cysts. There is also an increased reaction of the cells of the sebaceous gland and its excretory duct to the stimuli of normal levels of androgenic hormones. In women, an important factor in the appearance of acne is the presence of hyperandrogenemia in the context or not of polycystic ovary syndrome, and in this case it can be accompanied by hypertrichosis of the face, trunk and extremities and thinning of the scalp.

What factors improve or worsen acne?

Diet: Most acne sufferers believe or have read that certain foods, such as animal fats or chocolate, cause or worsen acne. This opinion, however, does not seem to be confirmed by the study of a large number of patients, in whom no food is to blame for causing and aggravating acne. Therefore, the recommendation is, if identified, by the patient himself, a food that bothers him to limit it during the treatment.

Menstrual cycle: Factors related to certain hormones seem to affect the course of menstruation, since in 70% of women with acne, certain lesions appear or flare up about one week after menstruation. Contraceptive tablets should not contain hormonal derivatives with androgenic action.

Pregnancy and breast-feeding: The effect of pregnancy and breast-feeding on the development of lesions is different, i.e. in some cases no change is observed, in others there is a worsening and in others an improvement.

Solar radiation: Acne usually improves with exposure to solar activity, but the positive effect is maintained for a very short period of time. About 60% of the patients report that the sun had a positive effect, while 20% did not distinguish a significant change. In the remaining 20%, acne occurs during breaks, as the appearance of lesions seems to be favored by high humidity.

Use of cosmetic substances: Prolonged use of cosmetic substances is also likely to worsen or cause the appearance of acne lesions, mainly closed pores. Cosmetic products, in fact, in the U.S. they are checked for their food quality in a specific way in laboratory animals, and if they prove to be safe, the indication "non comedogenic" is included in their label. Make-up is preferably done with powder and not with make-up. If and when make-up is used it is best to apply oil-free make-up. Makeup removal must be done carefully and efficiently.

Medicines and chemicals: certain drugs, such as cortisone, and some chemicals, such as oils, have a two -folded non -inflammatory, as a result of Vosho, therefore, there is some acne, .

Heredity: Finally, heredity appears to play some, as yet unspecified, role, since the frequency of acne is significantly higher in some families than in others.

Assessment of acne severity

How a patient deals with their acne is subjective and should be treated as such. The psychological effects can be much more intense than the doctor and relatives have appreciated.

Are scars and residual lesions (red marks) always forming?

Scars form in about 20% of cases and their development is related to the time of starting the treatment. That is, the earlier the treatment begins, the less the chances of developing scars. Also, "red marks" are created when the lesions are inflamed and open before they subside, that is, when we "break the pimples". Their retreat is assisted by the application of special solutions and peeling.

Can acne be cured?

The treatment of acne is effective in almost all cases and depends on the shape, duration and location of the acne, the existence of inflammatory or non-inflammatory lesions, the age of the patient and the therapeutic methods previously applied. All these producers must be evaluated by a dermatologist, who will administer the appropriate treatment.

How long does the treatment take?

The patient's awareness and cooperation is a basic prerequisite for the success of the treatment, since the duration of the treatment is not about a few days or weeks, but several months, while for the maintenance of the positive result, the local use of the drug may be required for a long time colors . It should be noted that during the first month of the treatment the skin will remain in the condition it was in before the start of the treatment, while an improvement in volume will be observed in 2 months to 40% and in 6 months after the start of the treatment to About 80% of patients.

What drugs are used to treat acne?

The treatment includes the application of various topical preparations, such as retivoides, antibiotics, bezolium peroxide, azelaic acid, sulphur, resorkivol, salicylic acid, zinc, etc. In many cases, it is necessary to orally administer antibiotics, retivoides and mild antibiotics to women, or a combination of them. The therapeutic treatment of damaged cysts can be combined with local steroid injections and cryocoagulation, while the scars are treated with various surgical techniques by specially trained doctors.

When does acne treatment fail?

Treatment failure is most often due to the patient's non-compliance with the proposed treatment and sometimes to mental overstrain.

Dimitris Ioannidis

Hellenic Dermatology & Venereology Society (EDAE)