PIMPLES (ACNE)

Pimples, medically known as acne vulgaris, are a common skin condition affecting millions worldwide at some point in their lives. It typically begins during puberty when the skin’s sebaceous glands produce excess oil, leading to plugged pores. If the pores remain open, they form blackheads, while closed pores result in whiteheads. These plugged pores can become inflamed, leading to the development of pimples, lumps, or nodules. Severe cases, known as cystic acne, involve firm swellings below the skin’s surface that can become tender and infected.

While acne is often associated with adolescence, about 20% of cases occur in adults. It commonly starts during puberty, lasting for five to 10 years and typically improving in the early 20s. Acne affects both sexes, with teenage boys often experiencing more severe cases. Women are more likely than men to have mild to moderate forms of acne into their 30s and beyond.

Acne lesions can appear on various parts of the body, including the face, neck, chest, back, shoulders, and upper arms.

Contrary to popular belief, acne is not caused by factors such as diet, hygiene, or sexual activity. Instead, genetics and hormonal changes play significant roles in its development. Avoiding certain foods or excessive scrubbing of the skin will not alter one’s predisposition to acne.

Causes of pimples

Acne is a complex skin condition with various contributing factors, though its exact cause is not fully understood. Here are some key factors involved in the development of acne:

1.Hormones:

During puberty, the surge in androgens (male hormones) stimulates the oil glands in the skin, leading to increased sebum production. This excess oil can clog pores and contribute to acne formation.

2. Genetics:

While not directly inherited, there may be a genetic predisposition to acne. Family history can play a role in determining an individual’s susceptibility to acne and their skin’s response to hormonal changes and environmental factors.

3. Excess Oil Production:

Sebum, the natural oil produced by the skin’s sebaceous glands, can become trapped in hair follicles and mix with dead skin cells, creating a favorable environment for acne-causing bacteria to thrive.

4. Bacteria:

Propionibacterium acnes, a type of bacteria commonly found on the skin, can proliferate within clogged pores, leading to inflammation and the formation of acne lesions.

5. Inflammation:

When bacteria multiply within blocked pores, the body’s immune response triggers inflammation, resulting in the characteristic redness, swelling, and tenderness associated with acne.

6. Dietary Factors:

While certain foods like chocolate and greasy foods were previously believed to worsen acne, current research suggests that high glycemic index foods and dairy products may contribute to acne development in some individuals.

7. Cosmetics and Skincare Products:

Certain cosmetics and skincare products containing comedogenic ingredients can clog pores and exacerbate acne. Opting for non-comedogenic products can help prevent pore blockage and minimize breakouts.

8. Environmental Factors:

Environmental factors such as pollution, humidity, and exposure to industrial substances like cutting oils can aggravate acne by increasing oil production and pore congestion.

Hormonal Fluctuations: Hormonal changes associated with menstrual cycles, pregnancy, or conditions like polycystic ovary syndrome (PCOS) can influence sebum production and contribute to acne flare-ups.

9. Medications:

Some medications, including corticosteroids, hormonal contraceptives, and certain anticonvulsants, may exacerbate acne or trigger acne-like eruptions as a side effect.

10. Other factors:

Acne can manifest in different subtypes, including acne neonatorum and acne infantum, which may affect newborns and infants. Additionally, some individuals may experience adult-onset acne later in life, even if they had relatively clear skin during their teenage years.

Overall, acne is a multifactorial condition influenced by hormonal changes, bacterial activity, genetic predisposition, and environmental factors. The interplay of these factors varies among individuals, leading to differences in the severity and persistence of acne outbreaks.

Prevalence

Acne is one of the most prevalent skin conditions globally, affecting approximately 9.4% of the global population.
It predominantly impacts adolescents, with around 85% of individuals aged 12-24 experiencing acne at some point.
However, acne can persist into adulthood, with approximately 40-55% of adults aged 20-40 experiencing some form of acne.

Symptoms of pimples (acne)

Pimples (acne) can manifest with a variety of symptoms, including:

Persistent red spots or swelling on the skin, commonly referred to as pimples. These may become inflamed and filled with pus, leading to a painful and tender sensation. Pimples often appear on the face, chest, shoulders, neck, or upper back.
Dark spots with open pores at the center, known as blackheads. These occur when the hair follicles become clogged with excess oil and dead skin cells, resulting in the oxidation of melanin, which gives them their characteristic dark color.
Tiny white bumps under the skin, known as whiteheads. Unlike blackheads, whiteheads do not have an obvious opening and may appear as small, flesh-colored bumps on the skin’s surface.
Red swellings or lumps, referred to as papules, that are visibly filled with pus. Papules are inflamed lesions that may be tender to the touch and can contribute to the overall redness and inflammation of the affected area.
Nodules or lumps under the skin that are inflamed, fluid-filled, and often tender. These nodules may become as large as an inch across and can be deeply embedded within the skin, causing significant discomfort and pain.

Risk Factors

Hormonal Fluctuations: Puberty, menstruation, pregnancy, and hormonal disorders.
Family History: Genetic predisposition to acne.
Certain Medications: Some medications, including corticosteroids and lithium, can exacerbate acne.
Environmental Factors: Exposure to pollutants and high humidity

Diagnosis

Diagnosing acne typically involves a visual examination by a dermatologist or healthcare provider. They may also inquire about the individual’s medical history and any medications they are taking. In some cases, additional tests, such as hormone level assessments, may be conducted to identify underlying hormonal imbalances contributing to acne.

Treatments for pimples (acne)

There are several treatments available for Pimples (acne), ranging from over-the-counter products to prescription medications and procedures. The choice of treatment depends on the severity of the acne, individual skin type, and response to previous treatments. Here are some common treatments for acne:

Topical treatments:

Benzoyl peroxide: Available over-the-counter and by prescription, benzoyl peroxide helps to kill acne-causing bacteria, reduce inflammation, and unclog pores.
Salicylic acid: Found in many over-the-counter acne products, salicylic acid helps to exfoliate the skin, remove dead skin cells, and prevent pores from becoming clogged.
Retinoids: Prescription-strength retinoid creams, gels, or lotions, such as tretinoin (Retin-A) or adapalene (Differin), help to unclog pores, prevent new acne lesions, and reduce inflammation.
Antibiotics: Topical antibiotics, such as clindamycin or erythromycin, can help to reduce acne-causing bacteria and inflammation when applied to the skin.

Oral medications:

Oral antibiotics: Antibiotics like doxycycline, minocycline, or tetracycline may be prescribed for moderate to severe acne to reduce bacteria and inflammation.
Oral contraceptives: Birth control pills containing estrogen and progestin can help regulate hormone levels in women and reduce acne by decreasing sebum production.
Isotretinoin (Accutane): Reserved for severe, cystic acne, isotretinoin is a powerful oral medication that reduces sebum production, shrinks oil glands, prevents clogged pores, and reduces inflammation. However, Isotretinoin is associated with potential side effects, including dry skin, lips, and eyes, as well as more serious complications such as birth defects, elevated cholesterol levels, and liver abnormalities. It requires close monitoring and stringent pregnancy prevention measures due to its teratogenic effects.

Procedures:

Chemical peels: Chemical peels containing alpha-hydroxy acids (AHAs) or beta-hydroxy acids (BHAs) are used to exfoliate the skin, unclog pores, and improve acne and acne scars.
Extraction: Dermatologists may perform manual extraction of blackheads and whiteheads using a sterile tool to remove the contents of clogged pores.
Laser therapy: Various laser and light-based treatments, such as photodynamic therapy (PDT) or laser resurfacing, can target acne-causing bacteria, reduce oil production, and improve skin texture and tone.

Other treatments:

Corticosteroid injections: Intralesional corticosteroid injections are used to reduce inflammation and rapidly shrink large, painful acne cysts or nodules.
Comedone extraction: A dermatologist may perform gentle extraction of comedones (blackheads and whiteheads) using a sterile tool to remove blockages from pores.

It’s important to consult a dermatologist for personalized treatment recommendations based on your individual acne type, severity, and medical history. They can help determine the most appropriate treatment plan to effectively manage your acne and minimize the risk of scarring or other complications.

Nonprescription treatments for acne can be effective for mild cases and can help prevent new breakouts. Here are some commonly used nonprescription treatments:

1. Soap and water:

Gentle cleansing of the face with soap and water, no more than twice a day, can help with pimples (acne). However, aggressive scrubbing can injure the skin and cause other problems.

2. Cleansers:

There are many cleansers and soaps advertised for treating acne. They often contain ingredients like benzoyl peroxide, glycolic acid, salicylic acid, or sulfur.

3.Benzoyl peroxide:

This compound works by destroying the bacteria associated with pimples (acne). It usually takes at least four weeks to work and must be used continuously to keep acne at bay. Benzoyl peroxide is available in various forms such as creams, lotions, washes, foams, and gels. It can cause dry skin and may bleach fabrics.

4. Salicylic acid:

Helps unclog pores to resolve and prevent lesions. It does not affect sebum production or kill bacteria and must be used continuously to maintain its effects.

5. Sulfur:

Helps prevent pores from being clogged and inhibits the growth of bacteria. It is often combined with other substances in over-the-counter acne medications.

6.Topical retinol gel or creams:

Retinol works to keep pimples from forming by affecting cell growth and turnover. It may take 8-12 weeks to see results and must be used continuously.

7. Alcohol and acetone:

These substances are mild antibacterial agents and can remove oils from the skin’s surface. However, they can dry out the skin and are generally not recommended by dermatologists.

8. Herbal, organic, and “natural” medications:

While marketed to treat or prevent acne, the effectiveness of these agents is not proven and they are unlikely to have much benefit.

It’s important to note that when dealing with pus-filled pimples, it’s best to let them break naturally or have them opened by a healthcare professional to avoid further inflammation and scarring. Squeezing pimples yourself can worsen the condition. Always consult with a dermatologist before starting any new acne treatment regimen, especially for persistent or severe acne.

Prescription treatments for acne are often necessary for more severe cases and may include the following:

1. Antibiotics:

Available in topical or oral forms, antibiotics work by clearing the skin of acne-causing bacteria and reducing inflammation. Topical antibiotics are applied directly to the skin, while oral antibiotics circulate throughout the body. Common options include clindamycin, erythromycin, doxycycline, minocycline, and tetracycline. Topical antibiotics are often used in combination with benzoyl peroxide or retinoids to reduce the risk of antibiotic resistance.

2. Retinoids:

Also known as vitamin A derivatives, retinoids are available as topical or oral medications. Topical retinoids affect the way the skin grows and sheds, helping to clear moderate-to-severe acne. Common topical retinoids include tretinoin, adapalene, and tazarotene. Oral retinoids like isotretinoin (Accutane) are reserved for severe cystic acne and can effectively clear acne that hasn’t responded to other treatments. However, they have significant side effects and must be used with caution, especially in women of childbearing age.

3. Azelaic acid:

Available in gel, cream, or foam formulations, azelaic acid has antibacterial and anti-inflammatory properties. While more commonly used for rosacea, it may also help mild acne.

4. Dapsone:

This topical gel has antibacterial and anti-inflammatory effects and can be used to treat acne.

5. Oral contraceptives:

Birth control pills containing female hormones can help counteract the effects of male hormones on acne. They are particularly beneficial for female patients with acne that worsens around menstruation or menopause.

6. Spironolactone (Aldactone):

This oral medication blocks the action of hormones on the skin’s oil glands and is especially helpful for women with hormonal acne.

7. Clascoterone (Winlevi):

A newly approved topical treatment for moderate to severe acne, clascoterone targets the hormones that cause acne. It has been found to reduce acne in both males and females over the age of 12. It works by blocking the effects of androgens on the skin, reducing sebum production, and preventing the development of acne lesions.

8. Corticosteroid injections:

Triamcinolone, a type of corticosteroid solution, may be injected directly into acne nodules to reduce inflammation and promote healing.

These prescription treatments address various factors contributing to acne, including bacterial overgrowth, inflammation, and hormonal imbalances. They are typically recommended for individuals with moderate to severe acne or those who haven’t responded to over-the-counter treatments. It’s essential to consult with a dermatologist to determine the most appropriate treatment plan based on your specific needs and medical history.

Pimples (acne)treatment Precautions

It’s important for patients undergoing acne treatment to be aware of potential side effects and interactions with other medications or herbal remedies. Here are some important considerations:

Topical retinoids and benzoyl peroxide:

These treatments can leave the skin reddened, dry, and sensitive to sunlight. It’s essential to use sunscreen and avoid excessive sun exposure when using these products.

Oral antibiotics:

Oral antibiotics may cause sensitivity to sunlight and stomach upset. Patients should take precautions to protect their skin from the sun and consider taking them with food to minimize stomach discomfort.

Interaction between benzoyl peroxide and topical retinoids:

Benzoyl peroxide may inhibit the effects of some topical retinoids, so it’s recommended not to apply them at the same time of day. Instead, they can be used at different times of the day or as directed by a healthcare professional.

Yeast infections:

Long-term use of oral antibiotics may increase the risk of yeast infections in women. Patients should be vigilant for symptoms and consult their healthcare provider if they experience any discomfort or unusual symptoms.

Allergic reactions:

Some over-the-counter acne products can cause rare but serious allergic reactions or severe irritation. Patients should seek immediate medical attention if they experience symptoms such as throat tightness, difficulty breathing, feeling faint, swelling of the face or tongue, hives, or itching after using these products.

Regarding acne scar treatments, various procedures can help improve the appearance of scars. These may include dermabrasion, laser therapy, chemical peels, microneedling, subcision, and fillers. It’s important to discuss these options with a dermatologist to determine the most suitable treatment based on individual needs and the type of scarring present. Additionally, patients should be aware of potential risks, necessary precautions, and expected results before undergoing any procedure.

It’s essential to follow your dermatologist’s recommendations and adhere to the prescribed treatment regimen for optimal results. Regular follow-up visits may be necessary to monitor progress and adjust treatment as needed.

Home Care Tips

Gentle Cleansing: Cleanse the face twice daily with a mild, non-comedogenic cleanser to remove excess oil, dirt, and impurities without stripping the skin’s natural oils.
Avoid Harsh Products: Steer clear of abrasive scrubs and harsh skincare products that can irritate the skin and exacerbate acne.
Moisturize: Use a lightweight, oil-free moisturizer to keep the skin hydrated without clogging pores.
Hands Off: Avoid picking, squeezing, or popping pimples, as this can lead to scarring and further inflammation.
Sun Protection: Apply a broad-spectrum sunscreen with an SPF of 30 or higher to protect the skin from harmful UV rays, which can worsen acne and cause hyperpigmentation.

Prevention of pimples (acne)

Preventing acne involves adopting a consistent skincare routine and making lifestyle changes to minimize factors that contribute to acne development. Here are some tips to help prevent acne:

1. Use a gentle cleanser:

Choose a mild, non-abrasive cleanser formulated specifically for acne-prone skin. Look for products containing salicylic acid or benzoyl peroxide, which can help unclog pores and prevent acne breakouts. Avoid harsh scrubbing or using abrasive materials that can irritate the skin and worsen acne.

2. Wash your face regularly:

Cleanse your face twice daily, in the morning and before bedtime, to remove excess oil, dirt, and impurities that can contribute to acne formation. Be gentle when washing your face. Using your fingertips or a soft washcloth, and avoid overwashing, which can strip the skin of its natural oils and lead to irritation.

3. Moisturize with non-comedogenic products:

Use lightweight, oil-free moisturizers and skincare products labeled as “non-comedogenic,” meaning they are less likely to clog pores and exacerbate acne. Hydrating the skin is essential to maintain its moisture balance without aggravating acne.

4. Avoid pore-clogging cosmetics:

Choose makeup and skincare products labeled as oil-free, non-comedogenic, and water-based to minimize the risk of pore blockage and acne breakouts. Remove makeup before bedtime and cleanse your skin thoroughly to prevent buildup and congestion.

5. Practice good hygiene:

Keep your hair clean and away from your face, as oils from the scalp can contribute to acne along the hairline and forehead. Avoid touching your face with dirty hands or resting your chin or cheeks on dirty surfaces to prevent transferring bacteria and dirt to the skin.

6. Maintain a healthy lifestyle:

Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit consumption of sugary, greasy, and processed foods, which may exacerbate acne. Stay hydrated by drinking plenty of water to keep the skin hydrated and flush out toxins.

7. Manage stress:

Stress can trigger hormonal changes that may exacerbate pimples (acne), so practice stress-reduction techniques such as deep breathing, meditation, yoga, or regular exercise to promote relaxation and overall well-being.

8. Protect your skin from the sun:

Use a broad-spectrum sunscreen with SPF 30 or higher daily to protect your skin from harmful UV rays, which can worsen pimples (acne) and increase the risk of post-inflammatory hyperpigmentation (dark spots). Opt for oil-free, non-comedogenic sunscreen formulations suitable for acne-prone skin.

9. Exercise regularly:

Regular exercise promotes overall health, including skin health. Shower or bathe after exercise to remove sweat and prevent skin irritation.

10. Manage stress:

Stress can exacerbate acne, so find ways to manage stress through relaxation techniques, exercise, and seeking support from friends and family.

When to See a Doctor

It’s important to seek medical attention if you experience any of the following concerning symptoms related to acne:

Your acne is causing emotional distress or affecting your quality of life.
Your acne is resulting in scarring or dark patches on the skin.
You have severe acne characterized by the presence of nodules, persistent pimples, or widespread inflammation.
Over-the-counter remedies have been ineffective in managing your acne, indicating the need for medical intervention or prescription medications.
You have concerns about your acne’s impact on your skin health and appearance, prompting you to consult a dermatologist for evaluation and treatment options.

Outlook/Prognosis

With proper treatment and skincare regimen, most cases of acne can be effectively managed, and the appearance of the skin can significantly improve over time. However, it may take several weeks to months to see noticeable results, and consistency with treatment and skincare practices is essential for long-term control of acne. In severe cases, pimples (acne) may leave behind scars or hyperpigmentation, but dermatological procedures can help improve the appearance of the skin.

Sources

American Academy of Dermatology Association. (n.d.). Acne.
Nguyen, Q. American Family Physician, 1994.
Chiu, A. Archives of Dermatology, 2003.
Teenagers Today.com website. Best Face Forward.
About.com web site: “Acne
FDA.
Mayo Clinic. (2023). Acne.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2022).
American Academy of Dermatology.
The Merck Manual, Seventeenth Edition.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.
News release, FDA.
Stathakis. V. Australasian Journal of Dermatology, 1997.

ACNE PIMPLES