acne vulgaris

acne vulgaris
International Classification (ICD) L70.9

Basics

With the onset of puberty, many adolescents have problems with their skin. The often hated acne provides for one or the other eternal stay in the bathroom. With peelings, washing lotions, pimple sticks and special skin creams, people try to master the skin disease.

In medicine, acne vulgaris is understood to be a skin disease of the hair follicle triggered by several causes. As a result, the contents of the follicle are retained and can become inflamed, causing the typical pustules to form. It mainly affects adolescents in puberty. Usually the disease heals within a few years, but in some people it persists until the age of 30.

As it is a disease of the sebaceous glands, acne vulgaris mainly occurs in those areas of the skin which have many sebaceous glands. These are not only on the face, but also on the neck, chest and back.

The term "acne" is actually a collective term for all diseases of the sebaceous glands and hair follicles associated with nodule formation. What is commonly understood by acne is acne vulgaris, also called acne simplex.

Causes

The causes of acne are very multilayered and complex. Several criteria must coincide for the skin disease to form in the first place. Some of these factors are discussed below.

Hormonal factors

The exclusive occurrence of acne vulgaris during puberty up to the third decade of life can be explained by the fact that hormones play an extremely important role. It is mainly the hormonal changes that occur during puberty that trigger acne. The male sex hormones, the androgens, play a predominant role, which is why boys are usually more affected by acne than girls.

Genetic factors

In addition to the hormones, which are similar in all teenagers, genetic predisposition also plays a major role. While it is not the case that the disposition for acne vulgaris is directly passed on from parents to children, a familial clustering can be observed. This indicates that the predisposition to acne is inherited through a complex mechanism.

Follicular keratinization disorder

For acne vulgaris to develop, one must also suffer from follicular keratinization disorder. This ensures that the pores of the hair follicles become clogged, causing the material inside to become inflamed.

Enlargement of the sebaceous glands

In addition, the sebaceous glands must also be enlarged and thus produce more sebum.

Bacterial colonisation

Every inflammation also needs a pathogen. In the case of acne vulgaris, it is bacteria that live on our skin. This may sound repulsive at first glance, but we need the microorganisms that colonize our skin to stay healthy. The majority of these bacteria are completely harmless to us, at least as long as they remain on the skin. However, some produce substances that cause the sebaceous glands to become inflamed more easily. These promote the development of acne vulgaris.

Inflammation and immune reaction

Last but not least, the way the body reacts to inflammatory stimuli also plays a major role. Acne vulgaris is of course much more pronounced when the immune system tends to overreact. Then inflammations develop much more easily, which then become visible in the form of pus-filled pustules on the skin.

Symptoms

Due to the great prevalence of acne vulgaris in our population, it is probably clear to everyone at first glance if someone is suffering from the disease. However, in order to be able to carry out an effective treatment, it must be checked exactly whether it is really acne vulgaris or one of the other forms.

Formation of blackheads

In acne vulgaris, retention occurs at the openings of the sebaceous follicles. In medicine, retention refers to various mechanisms that cause fluids, tissues or other substances to be held back somewhere. In acne vulgaris, there is an occlusion of the sebaceous gland follicles, which occur mainly on the face, chest, back and neck.

These occlusions of the sebaceous follicles then become visible as blackish or whitish spots. The black discoloured follicles are those which are still open, whitish discoloured ones are completely closed.

Particularly affected skin areas

As already mentioned, acne vulgaris generally occurs on the face as well as on the neck, back and chest. However, there are still regions on the face that are particularly frequently affected by the blackheads. These include the forehead, the nasolabial folds, the nose and the region around the mouth.

Of course, it is particularly unpleasant that acne vulgaris very rarely occurs in isolation. Usually several skin areas are affected by the painful and cosmetically unfavourable inflammations.

Pustules and inflammatory papules

In addition to blackheads, pustules and papules are the main symptoms of acne vulgaris. Pustules are small pus-filled blisters located directly under the skin. These are also called pustules or whimperles. Papules are nodules under the skin that can be up to the size of a pea. If the papules are inflamed, they usually show a reddish discoloration and are sensitive to pain. Over time, they then develop into pustules.

Another defining feature of acne vulgaris is that all skin symptoms occur simultaneously. Thus, one finds both open and closed blackheads, as well as papules and pustules in different stages of healing.

Provocation of the symptoms

There are several factors that can cause acne to worsen. These include, for example, working in a moist environment, as well as skin contact with fats, oils and chlorinated water. In women, depending on the menstrual cycle, acne can worsen during menstruation because the skin secretes more sebum during this time.

As every teenager must hear frequently, squeezing out pimples also aggravates the skin's appearance. This promotes inflammation, making the acne worse overall.

Last but not least, medicines and chemicals play a major role in aggravating acne. Therefore, one should always mention that one suffers from severe acne when visiting the doctor when it comes to starting a long-term therapy.

Diagnosis

The diagnosis of acne vulgaris is made by evaluating the symptoms described. Further tests and examinations are not necessary, in most cases it is even a simple eye diagnosis.

Course of acne vulgaris

The course of acne can usually not be predicted. While some people heal within a few months, others are affected by the skin change for many years.

The inflammation can also lead to the formation of scars, which usually remain visible for the rest of the patient's life. It should be noted that the type of scarring can vary greatly from person to person.

Psychological burden

Nevertheless, the diagnosis by a specialist is of great importance. This is the only way to consider a therapy which has a positive influence on the skin condition. And this is not only of great importance with regard to the prevention of scarring. For many adolescents it is also a heavy psychological burden to be affected by severe acne vulgaris. This may not only lead to a reduced self-esteem but above all to a social withdrawal.

Therapy

The therapy of acne must always be adapted to the individual severity and the speed with which the disease develops. It is most effective when several therapeutic approaches are combined with each other.

A therapy should be considered especially if one suffers from large and highly inflamed pimples or if acne scars develop. A visit to the doctor is also indicated if dark spots appear after the pustules have healed, or if the skin changes cause severe psychological stress.

Local treatment of acne

For the treatment of acne, mainly soaps and lotions are used which should prevent the formation of blackheads or change the bacterial colonisation of the skin. For this purpose, the skin usually has to be cleaned twice a day with the medical products.

Mainly so-called topical retinoids are used. These mainly prevent the formation of blackheads, which also prevents inflammation. A small disadvantage of retinoids is that they often worsen the skin appearance at the beginning of treatment, as there is a short flare-up of acne vulgaris. However, this usually subsides within a few weeks.

Alternatively, benzoyl peroxide can be used as a wash suspension or gel. It convinces with a high efficacy, good combination possibilities with other agents and the absence of resistances.

Especially in cases of frequent papule formation, antibiotics can also be applied topically, i.e. directly on the skin. Especially clindamycin and erythromycin are frequently used.

Last but not least, azelaic acid is also used to prevent blackheads and inflammations. This however hardly has a positive effect on the increased sebum flow which is why it should definitely be combined with other preparations.

Systemic treatment

If the application of the above mentioned substances on the skin does not bring the desired effect, a systemic therapy can also be applied. In this case, the active ingredient is not only distributed in the affected region, but throughout the body via the bloodstream.

The systemic application of antibiotics has proven to be particularly effective. Tetracyclines are mainly used for this purpose. After two to three months there should be a marked improvement in the skin condition. Then the dosage can be reduced, but the preparation should not be discontinued prematurely.

Especially women with severe acne benefit from the administration of estrogens which prevent the sebum production. These are mostly combined with antiandrogens, i.e. substances which prevent the promoting effect of androgens on acne. However, the application should definitely be done in consultation with a gynecologist to prevent negative effects on the menstrual cycle.

The retinoids mentioned above can also be given systemically, which quickly leads to a significant improvement in appearance. However, these are not likely to be combined with the tetracyclines.

Supportive behaviour

In addition to drug treatment of acne, there are still some ways in which the development of pustules and papules can be prevented or their healing accelerated.

First and foremost, proper acne hygiene can be very helpful. This can be done by using medicated scrubs or other lotions once or twice a week. The use of skin care products containing fruit acids, salicylic acid or lactic acid can also improve the skin's appearance. However, it must be noted that its excessive facial hygiene usually leads to worsening of symptoms.

Improvement can also be achieved by frequent hair washing. In addition, one should make sure that the hair does not hang down on the face. This could irritate the skin and especially also spread sebum from the hair on the face, which then again leads to clogging of pores.

The removal of blackheads should not be done by yourself, but preferably by a trained beautician. Otherwise, the acne will only get worse.

For the main care should be used mainly products that are based on water. Oily or greasy products will only lead to increased clogging of the sebaceous follicles and thus worsen the symptoms.

The influence of diet has not yet been clearly demonstrated, however, many people experience that caffeine, chocolate, alcohol, nicotine or pork exacerbate the symptoms.

Treatment of acne scars

Early and aggressive treatment of acne vulgaris should be sought primarily because it is almost impossible to treat acne scars that already exist. Although there are several methods to improve them, these are only moderately successful overall.

Nevertheless, it is worth trying out one or the other treatment for acne scars, as it may consistently be possible to at least significantly reduce one's own scarring. The most effective methods for treating acne scars are laser therapy, dermabrasion, cryotherapy and collagen injections.

Forecast

Thanks to new therapeutic approaches, the prognosis for acne vulgaris is very good today. Particularly in severe cases, it is also useful to use a drug therapy, which improves the skin appearance quickly and effectively. By combining several active substances with sensible acne hygiene, the skin appearance can be considerably improved within a very short time. And this then also has a positive effect on the appearance and self-confidence of the adolescent.

In order to further optimize the prognosis, it is important that the therapy is started early and not discontinued prematurely. Otherwise, a relapse will quickly occur and the acne vulgaris will make a new attack.

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