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What causes you to get acne? risk factors, and therapy

Reflection in the mirror handsome dark haired male standing with naked upper body and looking at his face

 Acne predominantly occurs in adolescents during puberty. Between 80% and 90% of all boys and girls suffer from the characteristic blackheads and pimples of the skin disease. But adults are also often affected.

What is acne

Acne is one of the most common skin diseases in the world. It can be presented in different forms. Usually, the typical pustules, pimples and blackheads (comedones) appear on the face; especially on the chin and forehead. The back or cleavage are less often affected. Due to the hormonal changes during puberty, acne occurs in adolescents from the age of nine. As a rule, the symptoms subside in the course of the third decade of life. If the skin disease begins in adults over 25 years of age, doctors speak of what is known as adult acne or acne tarda (late acne).

Acne forms

The well-known acne is also referred to as acne vulgaris by doctors. It is usually triggered by hormonal changes during puberty. Boys are more often affected than girls. Acne vulgaris is divided into several types, which are characterized by the severity of the skin changes:

  • Acne comedogenic: This is the mildest form of common acne. Acne comedogenic (also acne comedogenic) only develops on the face due to the typical blackheads (comedones). The blackheads are closed or open. If you squeeze these out, they can ignite. They will then turn into red nodules in which pus can form.
  • Acne papulopustular: Blackheads and inflamed pimples characterize acne papulopustular. This moderate form of acne often affects the face and back. The term "papulopustular" is derived from papula = nodules and pustules = pus vesicles.
  • Acne conglobata: This is the most severe form of acne vulgaris. If you have acne conglobata, the pimples develop into large inflammatory nodules, abscesses, crusts and deep scars. It mainly affects men.

Other forms of acne

There are also numerous other forms of acne. Incidentally, the so-called Mallorca acne (Acne aestivalis) is not part of the clinical picture. It is only a short-term skin disease triggered by sunlight, with papules and pustules, without blackheads. It also often occurs in connection with certain sunscreens. Mallorca acne heals spontaneously. - Other forms of acne diseases include, for example:

  • Acne fulminans: This is a complication that can arise from acne Conglobata. Often there is a fever and death of affected areas of the skin (skin necrosis). Kidney inflammation and joint inflammation are also possible.
  • Acne Neonatorum: This form of acne can occur in newborns, but heals quickly after delivery. It arises from the transfer of male sex hormones from the mother to the embryo.
  • Acne Infantum: The disease, also known as infant acne, is more common in boys than in girls. It shows up between the third and sixth month of life. Small yellowish pimples, mainly on the forehead and cheeks, are typical. Scarring can occur. Congenital hormonal enzyme deficiency disorders or locally excessively fatty skincare are considered possible causes. Those affected often develop acne vulgaris later in life.
  • Acne Inversa: It usually occurs in the armpit and genital area. Acne Inversa (also called acne Inversa) is considered a severe form of acne. It can develop at any age but mostly occurs in adults at the beginning of their 20th year.
  • Acne Medicamentosa: This acne can be caused by certain medications. For example, with cortisone agents, vitamin B complex, iodine compounds, antidepressants or new (modern) anti-tumour preparations. The complexion shows up with pimples and pustules. This special form of an allergic reaction usually occurs when the drug in question is exchanged or discontinued.
  • Acne Venenata: This form, also known as occupational acne or contact acne, often affects people who work with oils or tar, who work in hot and humid air, for example in the melting furnace, or from a lack of heat. Acne Venenata can also be caused by blackhead-inducing ingredients in cosmetic products. This is also a special form of an allergic reaction and usually occurs when contact with the substance to which the skin is reacting is avoided.

Symptoms of acne

When suffering from acne, those affected suffer from pustules, pimples and blackheads (comedones). Initially, a small red point or nodule forms in the skin. A thickening is also noticeable at this point. The cause is the formation of a blackhead. This happens when the duct of a sebum gland in the skin is blocked by cornification. Most of the time, constipation is based on increased sebum production. The sebum now builds up and blackhead forms. A small white dot becomes visible on the skin, a closed blackhead. A black point in the middle shows up with so-called open blackheads. The black point is created by the reaction of the sebum with air and by the storage of the pigment melanin. As the disease progresses, the blackheads can become infected, fester and cause pain due to colonization with bacteria. Then one speaks of papules and pustules. - When patients manipulate these, i.e. squeeze the pimples, their contents are emptied outwards, but also into the neighbouring skin areas. This allows the inflammation to spread and scarring is possible after it has healed.
Pimples and blackheads form primarily on the face, usually in the so-called T-zone (forehead, chin and bridge of the nose). Severe acne can develop on the cheeks in some patients. This depends on the individual disposition and skin type. Acne on the back or chest is less common.

Causes of acne
Acne can be triggered by various factors. The most common form of acne, acne vulgaris, is mainly caused by hormonal changes, usually during puberty, but also in adults, including pregnancy or menopause. Genetic predisposition or external influences can also lead to acne. The following factors are involved in the development of acne:

  • Overactive sebum
  • Cornification disorder in the sebum duct
  • Overgrowth with bacteria
  • Inflammatory reactions

Overactive sebum and cornification disorder

The influence of male sex hormones, androgens, is often primarily responsible for the appearance of blemished skin with acne vulgaris in adolescents during puberty. Androgens and the growth factor (GH) cause the sebum glands to enlarge and produce more sebum. An overactive sebum gland develops. As a rule, sebum can easily reach the surface of the skin via the sebum canal. In the case of acne, however, the excretory duct becomes blocked so that the sebum can no longer drain away. The reason is an increased formation of the cells of horn material, which then hinders the unimpeded flow of sebum. As a result, precursors of blackheads now develop, which, however, cannot be seen with the naked eye. As a result, the skin symptoms characteristic of acne arise, including open and closed blackheads.

Acne vulgaris is usually much more pronounced in boys and men than in girls and women. This is because the production of fat and horn cells in the sebum glands is more strongly stimulated by male sex hormones. Women also produce male hormones such as testosterone, and men produce female hormones. However, the female sex hormone estrogen alleviates acne disease. Acne often occurs when there is a hormonal change, for example during puberty or after stopping the estrogen-containing birth control pill. Hormone fluctuations can also be seen during pregnancy or during menopause. During this time and also during menstruation, acne breakouts often occur.

Overgrowth with bacteria and inflammation

Overactivity of the gland leads to optimal growth conditions for bacteria in the sebum duct. The nests of bacteria (propionibacteria and Staphylococcus epidermidis) in the balloon-like inflated sebum glands lead to secondary, inflammatory manifestations of acne. The bacteria break down the sebum and produce breakdown products that stimulate these inflammatory reactions. As a result, pustules, papules, and nodules develop on the skin. The formation of new blackheads is also stimulated.

Other risk factors for acne

Hereditary predisposition and stress, for example, due to severe psychological stress, can also cause acne to develop.

Fats in cosmetic products, certain ingredients in medicines and some foods can also stimulate sebum production and thus block the ducts. The drugs that can trigger acne include cortisone, anabolic steroids, psychotropic drugs, adrenocorticotropin (ACTH), neuroleptics, halogens, antibiotics, vitamins B2, B6, B12 and drugs used to treat cancer.

In some sufferers, their diet promotes acne. Therefore, you should avoid eating high-fat foods.

Various factors make acne symptoms worse in some patients: moisture, cigarette smoke, or scratching the pimples.

Acne Diagnosis

The visible symptoms of acne on the skin - pustules, pimples and blackheads - allow a quick diagnosis. But only the dermatologist can rule out other possible diseases with similar symptoms, such as purulent hair follicle infections, fungal diseases or rosacea. Important information for the attending physician includes the time of the first symptoms, existing diseases or skin diseases or a familial accumulation of acne. Information on cosmetics, medicines and eating habits are also important. If the patient is prone to scarring, this should also be reported to the doctor.

In order to create a treatment plan, it is advisable, especially in severe cases or if an additional infection is suspected, to remove the purulent wound secretion from pustules, nasal secretions or blood and examine it.

Acne Therapy

The treatment of acne depends on the severity of the skin disease, but also on whether the inflammation is in the foreground or the excessive sebum production and clogging of the sebum glands.

Creams, gels or solutions are often used for external treatment. The aim is to contain the inflammation and to slow down or stop the further spread of acne. Patients with severe forms of acne are often prescribed medication in the form of tablets (systemic therapy). The doctor recommends the appropriate group of active ingredients according to the specific symptoms.

External acne treatment:

With mild forms of acne (acne comedogenic), antiseptic washing and care products from pharmacies or drugstores can often help. In addition, active ingredients are often used that suppress excessive sebum formation and dry out the skin in places. This prevents the formation of blackheads and bacterial colonization. Active ingredients are, for example, benzoyl peroxide and azelaic acid. Both also have anti-inflammatory effects. For severe acne, peeling agents such as benzoyl peroxide are not enough. Then vitamin A acid preparations or creams containing antibiotics (topical antibiotics) are more likely to be used. Various variants of vitamin A (so-called retinoids, mostly isotretinoin) also eliminate cornification disorders and stimulate the formation of new skin. Irritation and redness can occur, especially after the first few applications. For pregnant women, treatment with isotretinoin is by no means suitable because of the strong side effects, since drugs from the group of retinoids lead to severe malformations in the unborn child. - Especially in advanced forms of acne, the dermatologist often prescribes ointments or solutions with antibiotics such as erythromycin, clindamycin or tetracycline. If this does not help affected patients, antibiotics are also given as tablets for internal use.
Zinc can also inhibit bacterial growth on the skin and suppress inflammation. Adequate effectiveness has not yet been proven for external use. Over-the-counter ointments containing Ammonium Bituminosulfonate have similar effects. Salicylic acid can also be used to soften the keratinization of the skin. Local acne treatment can also be done by using skin-renewing peelings. Most of the peelings are based on natural fruit acids, the alpha-hydroxy acids (AHA). If you use them regularly, this can free the skin from annoying cornifications. Under no circumstances should the ointments, creams or solutions come into contact with the eyes or mucous membranes.

Internal treatment for acne:

Patients who suffer from more severe forms of acne usually also have to take tablets. Antibiotics usually bring about an improvement in symptoms after a few weeks. Antibiotic therapy can, however, damage the intestinal flora and limit the effectiveness of hormonal contraceptives such as the birth control pill. When taking an antibiotic with the active ingredient tetracycline, skin damage caused by light is also possible. As an alternative to antibiotics, retinoids (such as isotretinoin) can often be taken over a longer period of time. Since these drugs have a teratogenic effect, women should not become pregnant during therapy. For women of childbearing potential, retinoids (such as isotretinoin) are often combined with hormonal contraceptives. Isotretinoin is the most effective remedy for severe disease. Because of the damage that isotretinoin can cause to the unborn baby, women should not become pregnant for at least three months after stopping the drug.

Women who suffer from severe acne often experience an improvement in the symptoms of their skin through hormone therapy consisting of a female sex hormone and so-called antiandrogens. An agent that contains the anti-androgen cyproterone acetate in addition to estrogen can also act as a contraceptive. In the case of severe acne fulminans, additional acne therapy with medication containing cortisone is indicated. These suppress the strong inflammatory reaction.

More tips for acne:

Under no circumstances should you pinch or squeeze pimples. This can worsen the inflammation and damage the surrounding skin. Scarring is also promoted in this way. Anyone who suffers from acne should take good care of their skin and cleanse it regularly. Peelings and pH-neutral washing lotions are recommended for mild forms of acne. This allows clogged pores to be opened and sebum flows away more easily. Surfactant-free agents should be used to clean the skin. Lukewarm water is gentler than hot. Acne skin that has already reached an inflammatory stage should not be treated with scrubs. Those who tend to have oily skin and hair are better off avoiding oily ointments and cosmetics. Instead, products containing fruit acids can be used. A nourishing effect can be achieved with creams that are low in fat and at the same time donate moisture. Many acne sufferers find facial steam baths comfortable for their skin.

Foods that are high in saturated fat should only be consumed in small amounts. These are, for example, butter, cream, cheese, chicken yolks, meat, sausage, coconut fat and palm oil.

The sun or a visit to the tanning bed can sometimes alleviate acne vulgaris, but UVA radiation promotes the formation of blackheads (comedones). In addition, solar radiation contributes to accelerated skin ageing and is also involved in the development of skin cancer.

Homeopathy for acne

When treating acne, homoeopathic agents can also provide relief for some patients. Here it depends on the individual manifestation of the symptoms which medication the treating homoeopath recommends. The following remedies are often used for acne:

  • Belladonna: For acute, infectious inflammation with reddish and hot skin.
  • Pulsatilla: For acne during puberty. Especially in girls who have symptoms worse during their period.
  • Silicea: For blemished skin and acne pimples that develop slowly. If the pimples faster and heal slowly and if there is a tendency to scar.
  • Sulfur: For mild acne with lots of purulent and itchy pimples. If the skin is sore and the rash is itchy.

Acupuncture for acne

From the point of view of traditional Chinese medicine (TCM), the so-called functional circuit of the lungs is disturbed when suffering from acne. Moisturizing and excretion of the skin are assigned to it. Usually there is also a Qi weakness of the spleen, which means that the patient also suffers from a digestive disorder and/or eats incorrectly. In TCM, acne is treated with herbal medicines and ointments in addition to acupuncture. The therapy chosen depends on the patient's individual symptoms.

Acne - ICD Code

In medicine, each illness is assigned its own ICD code. The abbreviation ICD stands for International Statistical Classification of Diseases and Related Health Problems. The classification system is recognized worldwide and one of the most important for medical diagnoses. Acne is recorded under the ICD code "L70". Entering this code often helps with research on the Internet.

FAQ about acne

How often should you wash your face if you have acne?
The skin affected by acne vulgaris should be cleaned once a day with pH-neutral and fragrance-free soaps or washing lotions. Too frequent washing or the use of aggressive substances can destroy the bacterial environment of the skin and possibly worsen acne. After washing, it is recommended to use a water-based moisturizer. Anyone who uses make-up or sunscreen should make sure that the products are fat-free.

What helps against acne scars?
Acne scars can be covered with make-up, but they can also be removed. There are strong make-up options that can hide the scars. The dermatologist often uses peelings in the case of scars. The most effective ingredient is trichloroacetic acid, which can be used in different concentrations. The dermatologist can also surgically lift sunken scars (punch elevation). But collagen injections can also lift sunken scar skin. The doctor can flatten excessive raised scars. He usually uses local corticosteroid injections in combination with cold. Depending on the type of scar, laser treatment is also an option.

How long do you have acne?
Due to the hormonal changes with the onset of puberty, blemished skin with acne vulgaris can occur from the age of nine. In most cases, the skin disease subsides by the third decade of life. However, the disease can only develop into adulthood. How long the symptoms last depends on various factors, including the cause of the acne.

Which foods should you avoid if you have acne?
If patients notice that their skin reacts with more symptoms to eating certain foods, a change in diet is recommended. You should reduce the consumption of foods with a high proportion of saturated fatty acids, such as butter, cream, cheese, meat (with a few exceptions) and sausage, as well as with easily digestible carbohydrates such as chocolate bars or cornflakes. It is better to eat a diet rich in vegetables and fruits.

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