Acne Vulgaris

Acne, also known as acne vulgaris, is a chronic or recurrent skin disease in which the pores (hair follicles) of the skin clog up and can become inflamed.

Depending on the degree of severity, this can lead to blackheads (comedones), pimples, knots, and scars occurring in groups. The face is most frequently affected, other localizations are back and chest.

Most people are affected for some time during their lives. The disease typically occurs between the ages of 10 and 30 and usually disappears with age. In adolescence, men are affected more frequently than women, while women suffer more frequently from acne in adulthood than men. It is the most common skin disease in adolescence and young adulthood.

The disease can lead to considerable psychological stress in those affected but usually does not cause long-term health problems. 1, 2, 3, 4

If you think that you might have acne, you can try using the Ada app to find out more about your symptoms.

Acne typically occurs for the first time at the beginning of puberty. Pimples are caused by a combination of four different factors. A group of hormones (known as androgens) trigger an increase in sebum production on the skin.

Dead skin cells and sebum can clog the pores of the skin. This forms blackheads, also known as comedones. Also, bacteria colonizing the pores, which are called Cutibacterium acne or propionibacteria, can cause an inflammatory reaction. The body's immune system gets activated by this, which leads to inflammatory cells migrating towards the affected area and increasing inflammation. Eventually, painful and swollen pimples can form. With a change in hormonal balance, acne often improves in early adulthood but can also last longer.

Ultimately, genetics is decisive for the development, course, and severity of acne. However, acne is not caused by a single gene, but instead by a series of genes that influence the probability of disease.

There are also a number of triggers that can make the development of acne more likely to happen or to affect its progression. These are: 1, 2, 3, 4

• Mechanical irritation of the affected skin area (e.g. by scratching, pressing, or pulling as well as wearing tight-fitting clothing such as headbands, bras, or backpacks)
• Application of cosmetics, hair products, and soaps
• Certain medications (creams and tablets containing cortisone, lithium, some antiepileptics, etc.)
• Certain metabolic diseases
• Menstrual cycle in women
• Sunlight can contribute to the improvement but also to the worsening of acne – in any case, it promotes skin aging
• Nutrition (worsening of acne through consumption of dairy products and sugary foods, particularly chocolate)
• Climatic conditions (worsening of acne in humid climate)
• Being overweight
• Stress

The typical symptoms of acne are blackheads (comedones), pimples, or nodes of the skin. The spots are often on the face, but other parts of the body can also be affected, such as shoulders, back, and chest. They usually occur in groups.

The skin around and above these spots is sometimes reddened and painful. Over time, the affected skin may become darker or scarred. Only in extremely rare and severe cases do symptoms such as fever, joint pain, and general fatigue occur. Since acne often represents a psychological burden for those affected, additional symptoms can occur, such as depression, anxiety, and social isolation.

Here you can find a description of the different skin symptoms of acne: 5, 1, 2, 3, 4

1) Noninflammatory: comedonal acne:

• closed comedones ("whiteheads"): small round lesions containing whitish material (sebum and dead skin cells).
• open comedones: small round lesions that look like dark spots on the surface

2) Inflammatory: Affected areas are red and can be painful) Mild/moderate acne:

• Small, reddish spots and bumps that may be filled with pus and have developed from comedones) Nodulocystic acne:
• Most severe form of acne
• Palpable hardenings and knots of the skin larger than 5 mm and usually lie in the area of the back and neck
• Scars may form during healing

If you think that you might have acne, you can try using the Ada app to find out more about your symptoms.

The diagnosis of acne is based on the medical history and the physical examination of the affected person. A doctor diagnoses acne by carrying out an extensive examination of the skin. The doctor will document where the acne is located and how severe it is. These factors are important in deciding which treatment measures to take.

It is also important to ask about current medications, as these could be potential triggers. Further tests or examinations are usually not necessary. In rare cases, if the treatment is unsuccessful, hormonal tests or bacterial cultures can sometimes be analyzed. 1, 2, 3, 4

The treatment of acne depends on the severity of the disease. The following information should be obtained before starting any treatment: 6

• Severity? (comedones, pimples, knots)
• Location?
• Skin type? (dry, greasy)
• Scarring present or not?
• Skin darkened by hyperpigmentation or not?
• Information pertaining to the menstrual cycle in women?
• Signs of masculine body hair in women present or not?
• Current skin care practices?
• Existing acne treatment?
• Eurrently used cosmetics?
• Eurrent medication?
• Internal psychological strain present or not?

In the case of very mild acne, it can sometimes be sufficient to carry out simple steps such as regular but not excessive face washing, eating a balanced diet, and avoiding cosmetics and greasy creams.

However, if the acne is severe or if the mild acne does not improve after implementing the steps described above, a number of different medications are available. These are either applied to the skin as a topical or taken as a tablet. Some are available over the counter, while others require a doctor's prescription.

In general, the drugs used to treat acne target one or more of these key factors: 6

• Excessive growth of hair follicles
• Abnormal amount of dead, rough skin layers
• Increased sebum production
• Bacterial overgrowth
• Inflammation

Some of the most common medications to be applied directly to the skin are: 7, 6

Retinoids:

• The so-called topical retinoids are beneficial for both comedonal (noninflammatory) and inflammatory acne
• They should be included in the initial treatment of most patients
• They have an anti-inflammatory effect and prevent the formation of further comedones (blackheads)

Benzoyl peroxide:

• This medication is available without prescription in pharmacies
• It effectively cleanses the skin from bacteria, loosens pores, and reduces inflammation
• In some cases, benzoyl peroxide can be used in combination with antibiotics, which are prescription only
• Always consult your doctor or pharmacist before starting any treatment

Topical antibiotics:

• This form of antibiotics should also be applied as an ointment to the affected skin areas
• With this treatment, the bacteria growing on the inside of the pores are killed
• This effectively reduces the inflammation caused by the bacteria
• However, antibiotics have limited effectiveness in combating comedones
• A prescription is required

Some of the most common medication taken in tablet form is: 3

Oral antibiotics:

• Systemic antibiotics are an important component in the treatment of moderate to severe inflammatory acne.
• They have an anti-inflammatory effect and are available only on prescription

Hormonal therapies:

• Some hormonal therapies may be effective in the treatment of acne
• Estrogen can be prescribed for women to reduce sebum production
• In addition, it reduces the production of androgens in the ovaries

Also, a drug called spironolactone can be used in the treatment of acne. It binds to the androgen receptor, which reduces androgen production.

Isotretinoin:

• Isotretinoin is a systemic retinoid that is highly effective in the treatment of severe acne.
• Isotretinoin is anti-inflammatory and reduces sebum secretion

The development of acne is predominantly genetic. However, there are some measures that can be taken to reduce the likelihood of acne occurring or to positively influence its course. These effective measures are among others: 5, 8

Keep your face clean:

• The face should be cleaned twice daily with warm water and mild soap to remove impurities and dead skin cells from the surface.
• However, you should avoid washing your face too often or using aggressive soaps. Washing frequently can lead to skin irritation and make symptoms worse

Diet and exercise:

• A balanced diet and regular exercise can have a beneficial effect on general health, stress levels, and consequently, acne.
• After exercising, you should wash off your sweat as soon as possible

Avoid cosmetics:

• Not wearing make-up or other cosmetics can help prevent an acne outbreak.
• Any make-up used should be oil-free and not comedogenic

Use shampoo:

• If the hair is particularly greasy, shower once daily with shampoo

Do not touch the acne:

• Avoid touching the acne all day long; this includes squeezing pimples or scratching the affected areas.
• This allows natural healing

Avoid excessive exposure to sunlight and sunbeds:

• Sunlight can contribute to the improvement but also to the worsening of acne. Too much sunlight and the use of solariums can damage the skin and is therefore not recommended

Acne typically improves when people grow out of puberty, but it can persist into adulthood. Around 3 percent of adults suffer from acne over the age of 35. For most people with acne, there are no long-term consequences. However, it is important to keep in mind that this condition can also have a psychological impact and even rarely, it can lead to mortality – due to suicide. Severe acne and lack of treatment can lead to permanent scarring in the affected skin areas. This can cause feelings of low self-esteem and anxiety that can impact one's social life and even employment. 5, 7, 2

Patients who are about to undergo treatment should follow the treatment plan discussed with their doctor for at least two to three months before deciding on the effectiveness and further course of action.Acne usually takes a long time to develop and typically repeats itself over many years, so maintenance therapy is an important part of the treatment. 6

Q: Is acne hereditary?A: Yes, genetics is crucial for the development, course, and severity of acne. However, acne is not caused by a single gene, but instead by a series of genes that influence the probability of disease. 1, 2, 3, 4

Q: Can acne ever pose a serious risk to your health?A: Acne does not pose a direct health risk, but in some cases, it can cause permanent scarring to the skin. If your acne does not respond to treatment, you may be referred to a hospital specialist to explore further options. 6, 2, 3

Q: What are the types of acne?A: There are different types or stages of acne. These include: 5, 1, 2, 3, 4

1) Noninflammatory:a) comedonal acne:

• Closed comedones ("whiteheads"): small white spots
• Open comedones: small dark spots

2) inflammatory:a) mild/moderate acne:

• Small, reddish spots and bumps that may be filled with pusb) nodulocystic acne:
• Palpable hardenings and knots of the skin larger than 5 mm
• Scars may form during healing

Q: What is hormonal acne?A: Sebaceous glands are at the center of acne formation. These glands are highly sensitive to hormonal influence. A group of hormones (known as androgens) trigger an increase in sebum production on the skin. These androgens are most active in puberty and young adulthood. That is why acne typically occurs between the ages of 10 and 30 and usually disappears with age. 1, 2, 3, 4