Acne the most common skin disease, afflicts at least 80% of the population at some point in life. It can cause anxiety and frustration because it almost always coincides with the life stage during which we most prioritize our outward appearance – adolescence. Typically, acne begins and peaks during adolescence, gradually resolving by adulthood. However, the severity and duration of acne varies significantly from person to person. While one individual may experience an occasional, isolated outbreak during adolescence, another suffers from chronic and severe acne that negatively impacts his/her psychological and emotional well-being into adulthood.
Understanding and educating patients about the etiology (cause) of acne greatly increases the success of treating acne. The stratum corneum is a layer of tightly packed dead skin cells that form the outermost part of the skin and also line the wall the follicle (pore). The process goes awry in acne as the keratinocytes (dead cells) are being produced at an abnormally rapid rate, at least 4-5 times that of the normal follicle. There is an overproduction of dead skin cells sticking together with the sebum (oil), being retained in the follicle and on the surface of the skin. In both sexes, testosterone is secreted into the body and enters into the sebaceous gland, where the enzyme 5-alpha reductase converts the testosterone into di-hydrotestosterone; this in turn stimulates sebum formation in the sebaceous glands. Because 5-alpha reductase is sensitive to hormone levels, it goes into overdrive, causing an excess production of sebum when testosterone levels escalate. This is very noticeable during puberty and times of increased stress. It is the accumulation of skin cells and sebum that form a plug known as a comedone or “blackhead”. Propioni Bacterium acne or P. Acnes also plays a part in the development of acne particularly with inflamed lesions. This bacteria lives anaerobically(without oxygen) at the base of the follicle and feeds on sebum. When the follicle becomes blocked there is no air and plenty of food. This process is how a pimple or acne lesion develops.
The process of treating acne is based on each patient’s skin type. Not all people with acne have excessively oily skin, acne occurs in people with dry skin and combination skin as well. The key to the successful treatment of acne is customized professional skin treatments and home care regimen that includes cleansing, exfoliation, moisturizing and the use of broad spectrum physical sunscreen. In addition, maintaining good sleeping and dietary habits are critical to obtaining clear skin.