Acne

Acne (medically: acne vulgaris) is one of the most common skin diseases that primarily affects the sebaceous glands and hair follicles. It mainly occurs on the face, back and chest and can appear in various forms such as blackheads (comedones), papules, pustules or cysts. Acne affects people of all ages, but is particularly common during puberty.

How does acne develop?

Acne is caused by a combination of several factors:

• Overproduction of sebum: There are sebaceous glands in the skin that produce sebum (skin oil). Acne leads to overproduction, often triggered by hormonal changes.
• Blockage of the hair follicles: Excess sebum and dead skin cells block the follicle openings, leading to the formation of blackheads.
• Bacterial infections: The bacterium Cutibacterium acnes (formerly: Propionibacterium acnes) multiplies in the clogged follicles, triggering inflammation.
• Inflammatory reactions: The body reacts to bacterial activity with inflammation, which can lead to painful, red papules or purulent pustules.

Myths about acne

1. “Acne is caused by a lack of hygiene.”
   Wrong: Excessive washing can actually irritate the skin.
2. “Oily food causes acne.”
   Only partially true: diet plays a role, but fatty food alone is rarely the main cause.
3. “Acne disappears after puberty.”
   Acne can also affect adults, especially women.

Causes of acne

The exact causes of acne are complex and can vary from person to person. However, the most common triggers include:

1. hormonal factors

• Puberty: Hormonal fluctuations during puberty promote sebum production.
• Menstrual cycle: Many women experience acne breakouts before their period.
• Pregnancy or menopause: Hormonal changes also affect the skin here.

2. genetic predisposition

• A family history of acne increases the risk of developing acne.

3. lifestyle and nutrition

• High sugar consumption: Foods with a high glycemic index can promote acne.
• Stress: Can affect hormone production and worsen acne.
• Poor skin care: Oily cosmetics or irregular cleansing can clog the pores.

4. medication

• Certain medications such as steroids or lithium can promote acne.

Forms of acne

Acne occurs in various degrees of severity and forms:

Non-inflammatory acne

• Blackheads (comedones)
  • Open comedones: Black spots caused by oxidation of sebum and skin cells.
  • Closed comedones: White dots that are trapped under the skin.

Inflammatory acne

• Papules: Small, red, inflamed nodules without pus.
• Pustules: Pus-filled pimples with a red base.

Heavy forms

• Nodular acne: Large, painful lumps deep under the skin.
• Cystic acne: Purulent cysts that can leave scars.

Special shapes

• Acne inversa: Chronic inflammation in skin folds such as the armpits or groin.
• Acne mechanica: Triggered by mechanical friction, e.g. from sportswear or masks.

Diagnosis of acne

The diagnosis is usually made by a dermatologist who examines the skin condition. The type of acne (non-inflammatory, inflammatory, severe) and possible triggers such as medication or hormone fluctuations are determined.

Treatment options

The treatment of acne depends on its severity and the individual causes:

Topical treatments (local application)

• Retinoids: Promote skin renewal and prevent clogged pores.
• Benzoyl peroxide: Kills bacteria and reduces inflammation.
• Salicylic acid: Helps to remove dead skin cells and keep pores clear.

Systemic treatments (oral medication)

• Antibiotics: Reduce inflammation and bacterial infections.
• Hormone therapy: Antiandrogens or the contraceptive pill can improve hormonal acne.
• Isotretinoin: A strong retinoid that can treat severe acne permanently, but has side effects.

Additional procedures

• Chemical peels: Remove dead skin cells.
• Laser therapy: Fights acne bacteria and reduces scarring.
• Drainage and extraction: For particularly large cysts or lumps.

Acne scars

Untreated or severe acne can leave scars. There are different types of scars:

• Atrophic scars: depressions in the skin.
• Hypertrophic scars: raised, thick scars.
• Post-inflammatory hyperpigmentation: Dark spots that remain after healing.

Treatment of acne scars

• Microneedling: Promotes collagen production.
• Laser treatments: Smoothes the skin and removes pigmentation.
• Fillers: For the treatment of deep scars.

Prevention of acne

Although acne cannot always be prevented, these measures help to minimize breakouts:

• Regular cleansing: Use mild, non-comedogenic cleansing products.
• Avoid skin irritation: Avoid aggressive scrubbing or greasy cosmetics.
• Optimize your diet: Reduce sugar and dairy products, which can promote acne.
• Stress management: Techniques such as meditation or yoga can help to balance hormonal fluctuations.
• Do not scratch the skin: Squeezing pimples can aggravate inflammation and scarring.

Conclusion

Acne is a complex skin disease with a variety of causes and manifestations. With the right care, treatment tailored to individual needs and preventive measures, acne can be successfully controlled in most cases. In the case of severe acne, consultation with a dermatologist is crucial to avoid long-term skin damage.