Understanding Acne

Acne is the most commonly diagnosed skin disorder in young adults. Although the problem can be more severe during our teenage years, it is not an adolescent only problem. In fact, recent studies have shown increase prevalence of adult acne, with up to 80% of acne cases persistent beyond puberty (1). The majority of those affected are ladies (82.1% in this study) but also possibly because ladies are more affected by their appearance.

Problems Acne Can Cause

Apart from the pain and irritation that happens during the active phase. Acne also results in:

1. Skin blemishes in the form of persistent red or brown marks. These frequently need cosmetics to conceal and some cosmetics can exacerbate the problem.
2. More severe lesions result in long term scarring because of the collagen destruction in the skin. Scarring is often difficult to conceal with cosmetics and was present in a majority (76.4%) of patients in one study (1).
3. Psychological stress is common (52.8% in the same study) and one study (2) even highlights three psychological aspects in patients with acne:
   – Acne causes disturbances in self esteem, social phobias and depression
   – Stressful conditions tend to worsen the patient conditions
   – Primary mental illnesses such as anankastic disorders, OCD and psychoses focus the patient’s attention on scratching acne lesions, which secondarily deteriorates the skin condition, leading to a ‘vicious circle’.

What Causes Acne?

Adult acne has similar mechanisms as pubertal acne: oversecretion of sebum (oil), excessive production/shedding of skin cells blocking the pores, bacterial growth (propionibacterium acnes) and finally inflammation over affected areas.

In adulthood, the causes are frequently related to stress, hormone stimulation, cosmetic and inappropriate skincare use. Tropical weather was also found to be an exacerbating factor, believed to be due to oxidative damage of sunlight and sweating from the increased humidity.

Being multifactorial, I personally believe that every patient suffering from acne needs a personalised and detailed medical consult to detail the potential causes, aggravating factors as well as any loopholes in their skincare regime.

Since there are multiple steps in the mechanism for acne formation, it also makes sense that a combination of treatments is sometimes required for any improvement especially in cases which are more severe.

Prevention and self care are important parts of many medical treatments and acne care is no different. In fact, as your acne improves with medical treatment, proper care during and after can help prevent an unscheduled visit back to the doctor’s.

• Decreasing sebum levels: the use of oral and topical medications like retinoids and hormonal pills (for ladies) are an effective way for reducing oil gland secretions. Almost all laser treatments also shrink the size of these oil glands, which can be felt from the first treatment.
• Normalising skin growth and shedding: this is usually achieved by topical retinoids (popular ones include Differin, Retacnyl) and oral options like Roaccutane. Salicylic acid (BHA), AHAs, Azelaic acid and Benzoyl peroxide (BPO) also possess mild comedolytic effects. These function clear out the pores, preventing the formation of new acne and allow the unplugged follicle better penetration by antibiotics. Medical peels like Araclear, certain resurfacing lasers and radiofrequency treatments such as the Venus Viva are also postulated to reset the skin growth cycle and normalise the growth and shedding of skin cells.
• Killing the P. Acnes bacteria: antibiotics are the obvious choice for some forms of inflammatory acne and they are sometimes needed in oral and topical combinations. BPO has antibacterial effects on top of providing mild comedolysis. However, recent research show increasing antibiotic resistance in up to as many as 60% of acne patients (4). Thankfully, most laser and light treatments have shown to have good effects on eliminating this troublesome bacteria, something that they have not yet developed resistance for!
• Reducing inflammation: the use of anti-inflammatory products such as salicylic acid, niacinamide and occasionally steroid injections are an effective approach to the most physically troublesome symptom of acne. Pulsed-dye lasers such as the Pro-Yellow laser have been shown by multiple research studies to reduce inflammation which can greatly reduce the number of inflammatory acne lesions. On top of this, the Pro-Yellow has also been found to be bactericidal, decrease oil secretion as well as stimulate dermal collagen production to even out scars. These features make it a powerful workhorse for treatment of acne and a convenient all-in-one treatment option.

Laser Treatments For Acne – Yay or Nay?

Oral and topical treatments are quite effective for acne but most of them take a few weeks to show its effects. Also, poor compliance to treatment, lack of long-lasting results and potential side effects from medications are common drawbacks to these treatments. As such, the use of laser and light treatments for acne has grown very popular recently because they effectively target multiple parts of the mechanism as shown above, do not need daily maintenance, has minimal side effects and predictable clinical efficacy.

Depending on your condition and your lifestyle, a combination of different laser and light treatments usually can speed up recovery from acne. My favourite part of laser treatments for acne is that it is almost always accompanied by other desirable effects such as skin rejuvenation, lightening of pigmentation and scar resurfacing. Consult your doctor early to find out how a combination of medical grade treatments can help you – early is better than late treatment otherwise much money and effort needs to be spent to treat its sequelae as well.

References

1. A clinico-epidemiological study of adult acne: is it different from adolescent acne. Khunger et al. Indian Journal of Dermatology, Venereology and Leprology, 05/2012, Volume 78, Issue 3

2. Psychologic aspects of acne. Koo, J.Y. and Smith, L.L. Pediatr. Dermatol. 8, 185–188 (1991).

3. The effects of cleansing in an acne treatment regimen. Jackson EM. Costmet Dermatol. 2000;12(suppl):9.

4. Treatment of acne with topical antibiotics: lessons from clinical studies. Simonart T et al. Cr J Dermatol. 2005; 153:395