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A nice article about acne & pimples, aka comedo or microcomedo.

Essentially treatments are grouped in two categories:

Topical Agents
Topical medications include benzoyl peroxides, antibiotics, and vitamin A derivatives.

• Benzoyl peroxide is an anti-oxidant and bacteriostatic agent
• Clindamycin 1-4% and erythromycin 1-2% are most commonly prescribed topical antibiotics.
• Tretinoin is a vitamin A derivative that increases the turn-over of cells. The medication is available in creams, gels, or lotions. Dryness is a common side effect.

Systemic Agents
Systemic medications consist of antibiotics. Examples are tetracycline, erythromycin, minocycline, isotretinoin (Accutane), and some of the newer oral contraceptive agents.

Some patients develop acne for the first time as adults. The incidence of acne in the 25- to 34-year-old age group is eight per cent; it drops to three per cent in 35- to 44-year-olds. Some women experience acne flare-ups during their premenstrual cycles.

Although it is not life-threatening, acne has the potential to cause a number of psychological and social challenges including poor self-esteem, social withdrawal, embarrassment, frustration, anger and getting rejected.

Scar formation is variable and hard to predict, according to the American Academy of Dermatology.

The early onset of acne may also be a predictor of later severity. If a girl gets acne at 10, she is much more likely to experience severe acne within the next five years.

What Causes Acne

The mechanism behind the formation of acne is centred on the concept of plugged skin pores.

The scientific name for a blocked pore is a microcomedo. Essentially, a comedo is an inflamed and plugged follicle in the area where there is a lot of sebum production (usually the face, neck, chest, shoulders and upper back). Sebum is an oily secretion from the sebaceous glands that lubricates and protects the skin and hair.

The skin normally carries bacteria known as Propionibacterium acnes. When this bacterium produces an enzyme that interacts with the sebum, inflammation results; the degree and intensity of this inflammation determines the appearance and severity of the acne. The worst cases of acne present as deep cysts, often painful and deeply troubling to most adolescents.

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The term “whitehead” refers to a closed comedo; “blackhead” refers to an open comedo where oxidation of the sebum colours the plug; cysts, known as “papules” and “nodules” indicate a more severe situation, often requiring the opinion of a skilled dermatologist. (See aad.org for typical photographs of these various forms of acne.)

Cosmetics, especially oil-based products as opposed to water-based products, may contribute to acne formation. The same is true for hair gels and sprays. Occlusive clothing such as turtlenecks, bra straps and shoulder pads as well as sports helmets also play a role.

Treating Acne

The treatment of acne has improved over the past decade. According to an article in Pediatrics in September, an expert committee working together as the Global Alliance to Improve Outcomes in Acne states the foundation of treatment for most patients should be topical retinoid therapy.

Retinoids, drugs chemically related to Vitamin A, come in creams, gels and solutions. The lowest strength is 0.025 per cent, the recommended starting dose, since one of the common side-effects is burning of the skin.

This skin irritation is less common when retinoids administered at night are combined with a topical anti-acne treatment such as benzoyl peroxide, applied in the morning.

Oral antibiotics were first used to combat acne in the late 1930s and early ’40s, and people are right to worry about growing resistance to them. The rate of antibiotic resistance was 20 per cent in 1978; by 1996 the rate had climbed as high as 62 per cent. It continues to escalate.

Three main antibiotics are used: tetracycline, which should not be used in patients under 12 years of age because of the risk of discolouring the enamel of developing teeth; minocycline often required in lower dosages than tetracycline; and, erythromycin, an antibiotic with fewer anti-inflammatory qualities than tetracycline and one that’s more likely to cause resistance.

Newer topical products contain clindamycin combined with benzoyl peroxide. Combining benzoyl peroxide with an antibiotic may reduce the risk of resistance.

Oral antibiotics should not be used alone for longer than eight to 12 weeks at a time.

And then there’s the big gun: Accutane, a Vitamin A derivative introduced in 1982. It’s expensive, but 80 per cent of users experience positive changes with it. However, it comes with potential risks: liver damage, elevated triglycerides, joint and muscle pain, reduced night vision and, more recently documented, a possible association with depression and suicide.

Accutane is highly damaging to a fetus and, before girls are started on it, pregnancy testing must be done and contraception methods must be in place. The majority of experts consider the prescription of Accutane to be appropriate only in the hands of a dermatologist.

Accutane is recommended only when conventional therapies have failed over a six-month period, or when the risk of scars runs high.

Should scarring occur, it’s important to note there are two types: depressed scars and raised scars. Dermabrasion is still considered the most effective treatment of scars due to acne.

Read more on: canada.com

Additional info on acne (what it is, when to treat, when to see dermatologists,…etc) can be found at American Academy of Dermatology.

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