Development, Features and Treatment of Acne Vulgaris

Millions of people worldwide suffer from acne vulgaris. Acne vulgaris is classified as inflammation of the skin and the appearance of blemishes. With a large variety of acne treatments, it can be hard to know where to start. From home remedies to prescribed medications, it is common for individuals to have trouble with finding the right treatment. Acne vulgaris is treatable with a number of methods, but it is important to understand that the successful eradication of acne vulgaris is specific to the individual’s skin.

The development of acne is a disorder of the sebaceous glands. The development of acne begins at the cellar level where the hair follicle is blocked. The hair follicle is an opening in the skin which hair and sebum reach the skin’s surface. The hair follicle and the sebaceous gland is where acne begins to form. “This process may go wrong for those who have acne and the dead skin cells and oil are not cleared out of the pore properly.” (Mayo Clinic, 2015) The sebum and dead skin cells become trapped in the follicle. This debris that is trapped in the follicle blocks the pore opening. The blockage is a called a comedo, a clogged hair follicle in the skin. The blockage invites Propionibacterium acnes (P. acnes), a bacterium that causes the inflammation of acne breakouts. The comedo creates an environment that lacks oxygen in the follicle. This environment is favored by P. acnes that will thrive and grow out of control in the follicle. The follicle will continue to fill up with sebum, dead skin cells, and bacteria and it will start to swell up. White blood cells go to fight the bacteria in your pores. Redness, swelling, and pus is created forming a pimple.

There are multiple things that cause acne. First, there are overactive sebaceous glands. The sebaceous glands are responsible for creating sebum and oil that are needed for the skin’s surface. People who are prone to acne have sebaceous glands that create more sebum than what is needed. “The excess oil in the hair follicle will create a blockage in the pore and becomes a comedo.” (Web MD, 2015) This is what creates the environment that invites Propionibacterium acnes to grow. Second cause of acne is the abnormal shedding of the skin cells. The epidermis, the top layer of your skin, is always shedding dead skin cells. This natural process of exfoliation is called desquamation. Skin cells travel through the epidermis until they reach the stratum corneum, the outermost layer of the epidermis, where they will fall out and become replaced by newer skin cells below. Desquamation goes wrong with those who have acne and cells are produced faster than normal and the skin cells won’t shed and will get trapped in the follicle. The third cause is the proliferation of bacteria in your skin. The most common bacterium that is found in your skin is Propionibacterium. This bacterium grows out of control in those with acne. P. acnes thrives in your pores that are blocked because of the lack of oxygen. P. acnes digest the oil that is trapped in the pores of your skin and produces a fatty acid waste. The waste will irritate your skin that causes the redness and inflammation. P. acnes is antibiotic resistant and cannot be washed away. However, there are treatments available that can help you treat and get rid of the bacteria in your skin. There are other factors that cause acne outside of your body. For example, hormones enlarge the pores and increase the rate of sebum production that can cause clogging.

There are many different kinds of acne that you can get. These include: whiteheads, blackheads, papules, pustules, nodules, and cysts. Whiteheads, in appearance, are exactly how they are sound. This type of acne has a white head on the surface of your skin. This is caused by sebum and dead skin cells that are blocking your hair follicles. Sebum production and dead skin cell exfoliation is natural for your skin and is needed to keep your skin healthy. However, if this process goes wrong, then that is when you risk getting clogged pores because excess oil and dead skin cells will get trapped and accumulate. Blackheads are relatively similar to whiteheads and also look exactly how they sound. “Blackheads are also classified as comedones and look like black dots on the surface of your skin.” (Acne, 2015) However, whiteheads are closed in the pores of your skin and blackheads are open. This gives the blackhead’s appearance. Blackheads are formed when the blockage that is trapped inside the pore becomes oxidized. Papules are essentially a level higher than a whitehead that has been inflamed. A papule contains bacteria, sebum, and dead skin cells similar to the whitehead, but it does not contain pus. It is set apart from whiteheads by inflammation and redness. Pustules are similar to papules, but contain pus. Pustules are small round lesions appearing whitish on the center because of the pus. Nodes and cysts are similar to each other in terms of acne types. Nodules are severely inflamed and large lesions on the deep layers of the skin. Cysts are smaller and softer pus-filled lesions. These two types of acne can occur together, creating nodular cystic acne, or independently. These types of acne begin as papules and pustules and become nodes/cysts when they become irritated. This causes them to go deeper into the skin and produce pus.

Many treatments and medications to treat acne vulgaris can be bought over the counter. Over-the-counter medications and treatments are also known as OTCs. These medications and treatments do not require a prescription issued by a doctor. Treatments that can be readily obtained are known to treat mild to moderate acne. Common over the counter treatments can take the form of lotions, gels, and washes.  Common bases of over the counter acne vulgaris treatments include benzoyl peroxide, salicylic acid, and alpha hydroxy acids. Alpha hydroxy acids include glycolic acid and lactic acid.

“Benzoyl peroxide is the most common over the counter acne medication.” (Mayo Clinic Staff, 2015)  Benzoyl peroxide is found in a variety of gels, lotions, and soaps. Benzoyl peroxide has drying qualities, which removes excess oil and dirt. Benzoyl peroxide also is effective at eradicating bacteria, which often lead to the formation of acne vulgaris. Due to its drying and cleansing properties, benzoyl peroxide also unclogs pores. Side effects of benzoyl peroxide may include rare allergic reactions, redness, dryness, and scaling of the skin.

Salicylic acid is another over the counter acne medication that is used often. Salicylic acid is only available in concentrations of 0.5 to 5 percent. Salicylic acid is used primarily as a topical gel or cream that is applied to effected areas several times a day. Salicylic acid works by preventing the clogging of pores. “Side effects that may occur with the use of salicylic acid include redness, dryness, and irritation. The most popular alpha hydroxy acids include glycolic acid and lactic acid. Although there are other hydroxyl acids, those acids haven’t proven to be as effective. Alpha hydroxy acids are synthetic acids that would normally be derived from milk and fruit sugars. Hydroxy acids work by removing the dead layer of skin cells on the top of the epidermis. Hydroxy acids do not remove the epidermis, but they do remove the first layer. Hydroxy acids also stimulate the production of new skin, which then leads to smoother, calmer acne. The two side effects of hydroxyl acids are sun sensitivity and irritation.

Sulfur, another base of over the counter treatments, is especially effective at eradicating P. acnes bacterium. The P. acnes bacterium is known to have started developing antibacterial resistance. Sulfur is often combined with other acne-eradicating ingredients. Sulfur is known to dry the skin and cause it to peel off; this is helpful in terms of removing excess odor and preventing the clogging of pores.

When over the counter methods of treatment do not work well, it is recommended to then visit a dermatologist. Dermatologists will properly access acne and prescribe a treatment. The three main fields of prescription treatments include topical methods, oral methods, and treatment-based methods. There is a very large variety of prescription treatments available. Although these treatments cannot be readily obtained, they are proven to be more potent and concentrated than over the counter methods.

The most common topical treatments for prescription medications are retinoids, antibiotics, and dapzone. Retinoids come in the form of creams and gels. Retinoids work by preventing the plugging of hair follicles. Retinoids are derived from vitamin A and they come in many different types. Although they all serve the same purpose, retinoids include tazarotene, adapalene, and tretinoin. Antibiotics are used as topical ointments and creams to kill the bacteria inside of acne. Dapsone is also an effective topical treatment because in addition to an antibiotic, dapsone effectively works to kill bacteria and reduce inflammation.

Other prescribed treatment methods are oral drugs. Oral drugs include oral antibiotics, oral contraceptives, anti-androgen agents, and isotretinoin. “Oral antibiotics have a direct effect on acne by reducing inflammation and killing bacteria on the skin’s surface.” (Mayo Clinic, 2015) Some individuals cannot be treated with antibiotics because they may have built up a tolerance to antibiotics. Doctors may also be concerned with prescribing antibiotics to treat acne because the antibiotics may be used for months, or even years. The usage of antibiotics for a prolonged period of time is likely to develop antibiotic resistance in that individual. Common antibiotics prescribed for acne include doxycycline, limecycline, minocycline, erythromycin, trimethroprim, and cortimoxazalone. Oral contraceptives are also used in women to help reduce acne. Oral contraceptives include hormones, such as estrogen and progesterone, which balances out the amount of androgen produced in the body. Anti-androgen oral pills may also be prescribed to limit the amount of androgen produced in the body. Isotretinoin is often the last resort for acne treatments because it is a pill that may cause major side effects. Although isotretinoin is very effective, it does require close monitoring by the doctor. Isotretinoin is only prescribed when all other treatment methods have failed. Women that are prescribed this treatment are required to first take part in a Food and Drug Administration monitoring program.

Many other treatments prescribed by the doctor are therapies. Therapies include light therapy, which targets bacteria in the skin that cause inflammation. Chemical peels may also be conducted in a doctor’s office. Chemical peels are acids applied to the skin that help with the eradication of bacteria on skin.  Steroids can also be injected in to nodular and cystic acne to improve appearance. With the injection of steroids, extraction of the cysts and nodules is not necessary.

While treating acne, an emerging problem is antibiotic resistance in acnes. The Propoinibacterium found in P. acnes, is a slow growing, thick-walled bacteria that exhibits antibiotic resistance. To treat these types of acnes, doctors must turn to other methods of treatment besides antibiotics. Antibiotic resistance in P. acnes raises concern because it is quite possible that other bacterium may begin to show similar properties. “P. Acnes bacterial resistance is common in people treated with antibiotics for acne, and the resistance can spread to their family members and neighbors.” (Ngan, 2014)

As described above, many methods for acne suppression are available. Although many methods are available, it is important to note that not all treatments are equal in terms of effectiveness and that treatment is individualistic. When choosing an acne treatment method, it is important to know which kind of acne needs to be treated, and how severe it is. Mild to moderate cases of acne vulgaris are commonly successfully treated with over the counter treatments, and severe acne vulgaris is often treated with the help of a medical professional. According to dermatologists, all acne vulgaris is believed to be treatable after proper assessment and examination of the affected individual.


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