Acne Vulgaris

Acne Vulgaris

Acne Vulgaris,is the medical term for what you know as acne. Pimples, zits, breakouts its all the same face heartache.

Acne Vulgaris is the most common skin disease in the United States, affecting up to 50 million people a year. In fact, the Latin word Vulgaris means “common.” Approximately 85% of people between the ages of 12 and 24 experience at least mild cases, and many adults continue to struggle with it as they age. With so many treatment options available, it can be difficult to know how to manage this complex condition. Following a tiered plan is the most effective way to discover the best course of treatment for your skin.


Acne Vulgaris: What Is It?

It is generally agreed that multiple molecular pathways are involved in acne, with four primary pathophysiologic mechanisms []:

  • Abnormal desquamation within the sebaceous follicles that leads to obstruction of the pilosebaceous canal.

  • Androgen-driven excess sebum production.

  • Proliferation within the follicle by Propionibacterium acnes, which generates proinflammatory stimuli.

  • Altered immune system activity and inflammation.

Pilosebaceous unit

The pilosebaceous unit (PSU), with but few exceptions, consists of both a piliary and a sebaceous component.464 Androgens are a prerequisite for the growth and development of PSUs in their characteristic pattern. Androgens exert their effects both on the dermal papilla, which regulates the hair growth cycle, and on PSU epithelium. Before puberty, the androgen-dependent PSU consists of a prepubertal vellus follicle in which the hair and sebaceous gland components are virtually invisible to the naked eye (Figure 15-30). Under the influence of androgens, in the sexual hair areas the PSU switches to producing a medullated terminal hair follicle that expresses a unique type of keratin that is androgen responsive.465 The difference in the apparent density of sexual hair between men and women is due to differences in the density of terminal hairs that develop in response to androgen. In the balding-prone area of scalp in individuals genetically predisposed to pattern alopecia, androgens weakly attenuate the hair growth cycle, so that the PSU gradually generates only vellus follicles.466 In acne-prone areas, androgen causes the prepubertal vellus follicle to develop into a sebaceous follicle, in which the sebaceous epithelium develops and the hair remains vellus. Adrenarchal levels of androgens suffice to successively initiate sebaceous gland development and the growth of pubic hair. Progressively greater amounts of androgen are in general required to stimulate terminal hair development along a pubic to cranial gradient. All these effects of androgen are to some extent reversible by antiandrogens.

Estrogens modestly stimulate hair growth, probably by inhibiting the catagen (resting) phase of the hair cycle467; this may well be due to induction of androgen receptors by estrogen. Estrogens also directly inhibit sebum secretion. GH synergizes with androgen action on the PSU, in part by acting through IGF-1. Retinoic acid receptor agonists antagonize the effects of androgen on the sebaceous gland by inhibiting sebocyte proliferation and differentiation. Insulin, prolactinglucocorticoidsthyroxine, and catecholamines also play roles in PSU growth, development, and function.

Why Breakouts Happen

Acne develops when hair follicles under the skin get clogged. Dead skin cells and sebum, an oily and waxy substance produced in the oil glands that serve to naturally moisturize skin, collect around the hair in the follicle. Normally sebum exits our skin through our pores, which are tiny openings in the hair follicles. 


Breakouts happen when a pore gets clogged. The sebum and skin cells can’t exit through the pore, so the follicle becomes inflamed. That leads to the redness, swelling, and tenderness many people experience when lesions form. Whiteheads, blackheads, and cysts can all result, depending on how clogged the pore becomes.


Who Is Affected

It is well-known that teenagers are most often likely to develop A. Vulgaris. During puberty, the hormones go into overdrive. Hormones cause the oil glands to be especially active, so more sebum is produced. The more sebum, the more likely some of it will become clogged in pores, leading to breakouts. 


For most people, the condition disappears or becomes much less likely to appear after age 30. However, some adults continue to experience it. Women especially can be prone to adult breakouts as hormones shift throughout the menstrual cycle. Additionally, acne can be genetic. If your parents experienced it, you are more likely to develop it. Poor diets and stress don’t cause acne, but they can make it worse.


Physical, Psychological, and Social Consequences

Acne can be mildly irritating, all the way through to very painful. This is especially true in the case of Cystic Acne when an infection results under the skin in the irritated hair follicle. In addition to physical discomfort, breakouts most often appear on the most visible of places on the body–face, neck, chest, shoulders, and upper back. 


This can lead to embarrassment and even low self-esteem on the part of the person suffering. Teenagers in particular may experience these negative emotions around acne right when appearance becomes a judgment yardstick. Along comes acne to make that 10 x more acute. Mother nature can be a cruel mistress.


How to Tackle Acne

Most of those who experience breakouts want to treat them in hopes of reducing or eliminating the blemishes and discomfort that are the hallmark signs of the condition. Unfortunately, the treatment of acne is not a one-size-fits-all matter. There are so many possible treatment plans! 


Making good decisions about treating it is also difficult because of the many over-the-counter and prescription products available. A tiered approach is best and most often recommended by dermatologists. You should look for ingredients rather than hype or marketing.


The First Step To Treating Acne

These are the common ingredients you want to look for, and always start with gentle products and work your way up. 

  • Benzoyl peroxide, which kills bacteria and may decrease the production of sebum
  • Salicylic acid, to help prevent pores from becoming clogged
  • Alpha hydroxy acids, including glycolic acid and lactic acid, to remove dead skin cells and reduce inflammation
  • Niacinamide, which helps remove excess oil and dead skin cells
  • Retinol, are vitamin A derivatives and have been shown to be fantastic at treating acne. They must be used with caution.


Dermatologists recommend starting with a product that includes benzoyl peroxide. To minimize redness and dryness, begin with the lowest over-the-counter strength, 2.5%, and move to higher-strength 10% products if necessary. If benzoyl peroxide doesn’t completely control your breakouts, try a product with retinoic acids.


When working your way through over-the-counter treatments, patience is key! It can take several weeks of using a product to see results. Constantly switching products or trying too many at a time is a recipe for skin irritation and dryness.


Keep It Clean

While working through over-the-counter products to find what works best, follow some basic rules to help the products work well. First, keep your skin clean. Using a gentle cleanser, wash the affected areas twice a day, but not more often. Avoid using abrasive scrubs or cloths; remember that gentle is best so that the skin is not further irritated.


Don’t use oily cosmetics, and be sure to spray hair products away from the skin. Look for makeup and skincare labelled “noncomedogenic,” which means that it doesn’t contain pore-clogging ingredients. Clean skin allows skincare products to penetrate well so that they can do their job. Don’t rest your hand or your phone on your face more often than is necessary. As tempting as it is, don’t “pop” or squeeze your blemishes. Doing so can lead to infections and scars.


Ask a Dermatologist

If over-the-counter products don’t work, it is time to see a doctor. A dermatologist is a doctor who has been specially trained to treat skin problems. The dermatologist will evaluate your skin, ask what has already been tried, and recommend treatments they feel will work best for you. Generally, dermatologists will recommend one of two, or both, types of treatment: topical and oral.


Topical prescriptions are those that are applied directly to the skin. Retinoids, derived from vitamin A, are often used. They work by removing oil and dead skin cells on top of the skin and stimulate the production of collagen and elastin below it. A common retinoid is tretinoin, sold under the brand name Retin-A. An additional benefit of retinoids is that they may reduce the signs of sun damage and skin ageing, leading to smoother skin. Other topical prescriptions are also available for dermatologists to recommend.


Oral medication may also be prescribed. Antibiotics can be taken to stop bacteria growth and reduce inflammation. For the most severe breakouts, isotretinoin may be prescribed. Isotretinoin, sold under the brand name Accutane as well as others, works by shrinking the oil glands in the skin, providing fewer places for sebum to form. It is a serious medication and can cause side effects for the patient or birth defects for a baby if taken when a woman is pregnant. Patients who take isotretinoin are closely monitored. Additional oral medications may be available, depending on your individual situation


Following Up

Once your skin clears, you may find you have acne scars or hyperpigmentation, dark spots that remain after blemishes go away. Many of these can be effectively treated with over-the-counter products that include spot-fading or bleaching ingredients as a hyperpigmentation acne treatment. Several other treatments, such as laser therapy, dermabrasion, and chemical peels are also effective. Your dermatologist can help you determine which treatments are best.