Your Health  -  A to Z of Common Medical Conditions

 Acne

Description  - Acne is so common as to be considered, by some, part of the normal process of growing up. It is a disorder of the sebaceous glands in the skin that produce sebum, the grease that keeps the skin soft and supple.
Basically, in acne, the glands produce too much sebum, the ducts from the sebaceous glands to the outside become blocked, the chemical nature of the sebum changes and there is bacterial invasion of the gland. All this results in inflammation and local swelling, to a lesser or greater degree. This might vary from a simple blackhead to a pustule to quite a large cystic swelling which might lead to life-long scarring. The commonest sites for acne lesions are the face, back, chest and anogenital regions. The condition is most common in the younger age groups.
The name “acne” derives from the Greek “acme” meaning “the prime of life” and it affects, most commonly, those in their late teens, who, by the very nature of things, want to look their best. The sebaceous glands are under the control of the male hormone testosterone (found in both males and females, more so in the former) and the condition is, therefore, a little more common in boys than girls.
Late onset acne affects about 5% of women aged 40 or more. Acne tends to be worse in winter, improved by sunlight and, in some cases, made worse by certain foods such as chocolate. People, who work in oily environments, or with coal, or with pesticides, seem to be more prone to acne than the norm. In some women, high oestrogen oral contraceptives can make acne worse. The individual’s response to acne is probably the most important factor. Some young people may have quite severe acne though it does not bother them too much, knowing that they will most likely grow out of it. Others are devastated by the appearance of one or two small spots. This does not seem to be a thing of vanity but more people’s perception of themselves.

Management -  In most cases reassurance that the condition is, almost always, self-limiting and that people do grow out of it, is very important. It is also true that the more concerned people are about their own acne the more other people notice it as well.
Simple home treatments include avoiding foods and circumstances that worsen the acne, and the use of over-the-counter local applications which contain benzoyl peroxide. Sunlight is helpful and judicious sunbathing can be tried. A hot (not scalding) flannel held to the face followed by washing with a non-scented, simple soap helps cleanse the skin.
The main treatment available from the doctor are antibiotics of the tetracycline family, taken by mouth, daily, for a prolonged period of 6 months or more. Local antibiotic preparations such as erythromycin may also be used. These forms of treatment are unlikely to clear the acne completely but do so sufficiently to dampen down the condition and make cyst formation and future scarring less likely.
Girls and young women may try mixed contraceptive pills containing anti-androgenic substances which will suppress the levels of testosterone. In the most severe cases hospital managed treatment with retinoids may be necessary.

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