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Acne

Understanding Acne and Treatment Options

Acne is a common chronic inflammatory skin condition affecting the pilosebaceous unit, the hair follicle and associated sebaceous gland. Although commonly associated with adolescence, acne can affect people at any age and may persist into adulthood or develop later in life. The severity and type of acne can vary significantly, from mild congestion and blackheads to inflammatory acne, nodules and cysts. Appropriate treatment depends on the underlying causes, severity and risk of scarring.

Pathogenesis

Acne develops through several interacting mechanisms:

  • Follicular hyperkeratinisation: an abnormal accumulation of skin cells within the hair follicle, which can contribute to blocked pores.
  • Increased sebum production: excess oil production from the sebaceous glands.
  • Changes involving Cutibacterium acnes: a normal skin bacterium that can contribute to inflammation in acne-prone skin.
  • Inflammation: within and around the pilosebaceous unit.

These mechanisms can result in the development of comedones, papules, pustules, nodules and cysts.

Types of Acne

Acne can present in several different forms, including:

  • Comedonal acne
  • Inflammatory acne
  • Nodulocystic acne
  • Acne conglobata
  • Acne fulminans
  • Hormonal acne

Contributing Factors

A number of factors can contribute to or aggravate acne, including:

  • Genetics
  • Hormonal changes
  • Increased sebum production
  • Occlusive skincare or cosmetic products
  • Certain medications
  • Stress
  • Friction or pressure on the skin
  • High-glycaemic dietary patterns in some individuals

Grading

Acne may be clinically assessed according to its severity and extent, including:

  • Mild
  • Moderate
  • Moderate to severe
  • Severe
The presence of inflammation, nodules, cysts and scarring may also influence treatment decisions.

Contributing Factors

Topical skincare treatment for mild acne including retinoids and azelaic acid

Mild acne

Topical retinoids, benzoyl peroxide, azelaic acid, supportive skincare.

LED light therapy and chemical peel treatment for moderate acne

Moderate acne

combination topicals, short-course oral antibiotics, peels, LED.

Dermatology clinic treatment for moderate to severe acne with hormonal therapy

Moderate–Severe acne

Oral antibiotics + retinoid + BPO, hormonal therapy, clinic treatments.

Dermatologist-led treatment for severe acne including isotretinoin and scar management

Severe acne

Isotretinoin, intralesional steroids, scar management.