ACNE

Acne is a skin condition that manifests itself through different types of injuries. It may be pimples or blackheads, whiteheads or cysts. The small holes in the skin are called pores and are connected below the sebaceous glands of the skin. These glands produce an oily substance called sebum. The pores are connected to these glands through a channel called a follicle and, within the follicles; the sebum transports dead cells to the surface of the skin. If there is excess sebum and too many dead skin cells the pores will clog. Then, the bacteria (especially the species Propionibacterium acnes) can become trapped inside the pores and multiply, causing the skin to swell and redden: the start of acne.

These are the most common causes that can lead to the appearance of acne:

• Age: Acne is most common among girls between 10-17 years and boys between 14-19 years. It may appear for the first time at age 25 or older.
• Sex: More severe in males than females.
• Race: Less frequent in Asians and Blacks; rare in China.
• Occupation: Exposure to mineral oils.
• Drugs: Lithium, hydantoin, topical and systemic corticosteroids can worsen inflammation.
• Genetics: Multi factor (multiple genes involved).
• Endocrine Factors: Emotional stress is one of the main causes. The occlusion pressure on the skin (skin being covered) is a factor that aggravates acne. For example, continuously supporting your face with your hands.
• Food: Milk consumption has been linked to greater increase in acne.

The type of acne that many teenagers have is called Acne Vulgaris. It usually occurs on the face, neck, shoulders, upper back and chest.

A pore that clogs and closes but exits into the surface of the skin is called a white point. If a pore becomes clogged but stays open, the top surface can darken, in this case it becomes a pimple or a black head. Sometimes the wall of the pore opens, allowing sebum, bacteria and dead skin cells break through under the skin and pimples are formed (sometimes these pimples form pus on the tips due to the reaction of the body against bacterial infection).

Clogged pores that open to a deeper level of the skin can lead to nodules or cysts larger than pimples and can be painful.

Diagnosis is made clinically through the presence of one or more lesions. In some patients whose acne is associated with other disorders such as menstrual disorders, hair loss, seborrhea or overgrowth of hair, the patient needs to take an additional hormone analysis to rule out hormonal disturbances and better target treatment.

Acne treatment is treated in two different ways: Topical and Systemic. Treatment guidelines are:

• Mild Acne: Topical treatment: exfoliants (elemental sulfur, salicylic acid, glycolic acid), benzoyl peroxide 4% 5-% and 10% azelaic acid and retinoids (tretinoin, isotretinoin and adapalene).
• Moderate Acne: Topical treatment: benzoyl peroxide, retinoids and antibiotics (clindamycin phosphate and hydrochloride, tetracycline hydrochloride, and erythromycin base).
• Severe Acne: Systemic treatment. Systemic antibiotics (tetracycline, erythromycin, minocycline and clindamycin) for 3-6 months. Systemic retinoids (isotretinoin) administered at doses of 0.5 to 1 mg / kg / day for 5 months. This treatment is effective in almost all patients.
• Extremely Severe Acne:
  • Surgical treatment: in some patients the drainage of cysts is needed or the removal of comedones as a complementary treatment.
  • Systemic treatment: Isotretinoin associated with systemic or intralesional corticosteroids.
• Photodynamic Therapy: Treatment indicated for pregnant women and for those patients that are resistant to oral treatments (Accutane).
• Aftermath: There are corrective treatments for those patients left with acne scars provided that there are no active lesions. Among others we have chemical peels with glycolic acid or other more aggressive methods such as dermabrasion, dermaroller or laser CO2, which allow us to improve the overall appearance of the skin. Those patients who have hormonal abnormalities may benefit from anti-androgen treatments or by estrogen associated with progesterone. It is important that patients avoid touching lesions and are consistent in performing the treatment as instructed.
• EACH TREATMENT MUST BE PERSONALIZED. A PERSONALIZED FORMULA IS PRESCRIBED BY YOUR DERMATOLOGIST AND IS SPECIFICALLY MADE FOR THE PATIENTS TREATMENT BY THE PHARMACY.

Acne is one of the most common problems in young people. In fact, it affects 85% between of people between 12 and 24 years. Generally, juvenile acne disappears spontaneously with age. However in 12% of women and 3% of men acne may persist up until 45 years of age.Doctor Pablo Umbert is a Professor for the Department of Dermatology of theSacred Heart Hospital. He also directs the Pablo Umbert Institute of Dermatology located in the Clinic of Corachan Dr. Pablo tells us why and how these severe and persistent acnes are treated..

With acne, the problem is that the pores become clogged, many times due to cosmetic products, but there are other factors such as environmental problems, mechanical and internal factors that may be genetic.

Acne is as if a pipe is clogged. This pipe will swell, break and produce an inflammation, which becomes a cyst.It is an anatomical and functional problem, which in many cases has much to do with hormonal factors.

There are many types of acnes that Dr. Pablo will explain to us along with the following questions:

- How many types of acne are there Dr. Pablo Umbert?

There are various types of acne such as the black pore (obstruction), the pustules, the cystic (swells and breaks), the shape of hematoma, which happens when these substances are broken they, produce an edema that can sometimes be distinguished from cellulites. The excoriated acne (some people continuously touch and scrape their face), puberty acne, chloracne (caused by chlorinated aromatic products found in electrical conductors, fungicides and pesticides, etc.) Lastly, acne due to certain drugs such as lithium and corticosteroids. Acne is not simple, but with the right type of acne it can be successfully treated.

- So, it is extremely important to find the source of the acne and not confuse it with other types of skin disease.

Usually, in children it is easier to differentiate, for example, acne from a yeast (candida infection). Sometimes folliculitis occurs (inflammation of the follicles). The problem is that people confuse rosacea with acne where rosacea is a vascular disease. There are many other diseases that may be confused with acne, therefore it is vital for the dermatologist to diagnose it correctly.

- Is it true that taking birth control pills is a solution for acne in women?

Especially in women with androgenic symptoms.For example, in girls who have a lot of hair on their skin. Or girls that have androgenic alopecia.These patients do benefit from birth control pills.However, if they stop taking the pills it is very likely that they will develop acne. So, regardless of taking the pills, these patients must be treated independently from their hormonal problem using other alternatives.

- There are situations in which there will be a mother of a young man or woman who will say “I have done everything to try to cure my son or daughters acne and it always comes back. There is no cure”. What causes these continued failures in the treatment of acne?

First we will let the mother know that we will find a solution. 99.9% of acne cases are treatable. The causes of such failures are a misdiagnosis or the type of acne has not been treated correctly. It may take up to 3 months to find out the type of acne. Then the correct treatment can be used.

- Patience comes with patience?

Exactly.The answer is to see the aggravating factors. Sometimes even after the treatment is finished; maintenance is key. And above all, with rebellious acnes, we must anticipate, and let the patient understand that the treatment will last for a period of 4 to 5 years.

- Is it less common among young people today than 20 years ago?

Of course.Today there are fewer acne patients than 20 years ago.

- Why is it thatin the last 10 years, their have been important advances?

Yes, especially vitamin A, and a drug called Accutane has made a big difference.We also do special formulas tailored to each patients needs.

- What is the role of laser?

Laser is not the treatment for acne. It may be used in exceptional cases.If there are scars due to acne, laser is recommended to diminish scars and improve overall appearance.

- So, scars are going to stay? Even if the patient follows treatment as directed and does not touch his/her face?

This is why it is of utmost importance to follow treatment as instructed, and to continue with the treatment. With time, overall appearance will get better.

- What is your protocol Dr. Pablo facing a severe acne?

First we must go over the patient’s clinical history to see what kind of acne it is and what has been the trigger. For instance, if it is a woman with androgenic signs we must know what medications are taken. (Antidepressants or medications for seizures can produce acne). Next we will customize the treatment for the patient’s specific needs. Last, but not least is to create a maintenance protocol. Patients should NEVER touch their face.Stress also plays a big role in this skin condition. Exercise is always recommended to reduce stress. Usually there are only a few analytics done. Getting to know the patient along with a thorough clinical study is key.

- Is visiting with a Psychologist sometimes needed?

Often the dermatologist serves as a psychologist by asking questions and getting to know the patient.

Dr. Pablo Umbert, a hug and thank you for being with us. For having spoken of acne. Dr. Pablo Umbert, Chief of Dermatology of l'Hospital Sagrat cor, teaching unit of the University of Barcelona and head of the Institute Pau Umbert at Clínica Corachàn of Barcelona.