Acne is a very common chronic disorder that affects the sebaceous gland and hair follicle leading to expansion and blockage of the follicle and inflammation. There are different variants of acne.

Acne equally affects males and females. It has the highest prevalence among adolescents and young adults. According to recent statistical reports, 85% of 16-18-year-olds are affected. However, children and adults of all ages can be affected as well.

The exact mechanism of acne remains unknown. However, multiple factors that can trigger this disorder have been outlined. Acne can be triggered due to acne bacteria, endogenous and exogenous androgenic hormones, distension and occlusion of the hair follicles, familial tendency, and/or innate immune activation with inflammatory mediators. 

Flares of acne can be caused due to different drugs (e.g. hormones, steroids, epidermal growth factor receptor inhibitors, and anticonvulsants), application of occlusive cosmetic products, high environmental humid conditions,  and a diet rich in high glycemic foods and dairy products. Moreover, individuals diagnosed with the polycystic ovarian disease are prone to flares of acne.

Acne mainly occurs on the face, but can also affect the neck, chest, and back.

The condition of acne has several distinct clinical features. Its characteristics include inflamed papules and pustules, open and closed uninflamed comedones (blackheads and whiteheads), and post-inflammatory erythematous or pigmented scars and macules. In cases of severe acne, patients have modules and pseudocysts. Acne is also associated with adverse psychological and social effects.

The severity of acne is classified as mild, moderate, or severe. For mild acne classification, the total lesion count should be less than 30. For moderate acne, the total lesion count should be in the range between 30 and 125. In cases of severe acne, the total lesion count should exceed 125.

During the majority of consultations, tests are not necessary for acne. However, if features appear atypical, skin swabs for culture and microscopy may be performed. Hormonal tests may be administrated to female patients, but it is rarely necessary.

Mild acne is typically treated with topical antiacne agents like tretinoin or adapalene gel and/or benzoyl peroxide. Low dose combined oral contraceptive may also be administered. Antiseptic or keratolytic washes with salicylic acid are recommended to use. Lastly, laser therapy treatment may help to reduce acne.

For moderate acne, tetracycline (e.g. doxycycline 50-200 mg daily) may be prescribed for 3 months or so. If the patient is intolerant to doxycycline, alternatives like erythromycin or trimethoprim would be prescribed instead.

Severe acne is mainly treated with oral antibiotics or oral isotretinoin. If the patient experiences bone pain, fever, ulcerated or extensive skin lesions, a blood count should be arranged.

Overall, acne cases tend to show improvement after the age of 25. However, it can persist for a longer period of time, especially in females.

A daily skincare routine is essential for maintaining the overall health of the skin and improving conditions like acne and dark spots.

Centre for Medical and Surgical Dermatology offers various acne treatment options that are individual for each patient.

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