ACNE VULGARIS (PIMPLES): Yes, it Could be Embarrassing!!!

Pimples is a common skin problem which affects young adults in their pubertal stage. Some times, it affects older adults even infants. For some people, it develops for the first time in their thirties.

CAUSES OF ACNE

For those with acne, their sebaceous gland is quite sensitive to testosterone (hormone present in both males and females). This feature of sebaceous gland makes them produce excess of oil. As the excess of oil builds up, the dead skin cells lining the skin pores cause blockage of the pilosebaceous follicle. These blocked pores form comedons which when opened are called “black-head” and when closed are call “white-head”.
Propionibacterium acnes is a bacterium which is a normal skin flora (that is, it ideally causes no harm as it lives on the skin), but in those prone to developing pimples, and with oily skin, the bacteria multiply and cause formation of red or pus-filled spots (abscess) which when healed results in scarring in severe case as seen in the image below:

A woman with scarred face secondary to acne (pimples)

TREATMENT

Treatment depends on the cause. However, you need to understand that acne (pimples) respond to treatment slowly. With many patients, little improvement is seen for 4 weeks after starting treatment; for some, as long as 2-12months.
For sebaceous skin blockage, use retinooids and benzoyl peroxidase.
For bacterial colonization, treat with antibiotics benzoyl peroxidase or azelaic acid.
For sebaceous gland sensitive to androgens, use anti-androgen and oral contraceptives.

ABOUT THE DRUGS

  1. Benzoyl peroxidase: It is usually available as a cream or gel. It works as an antiseptic to reduce the number of bacteria on the skin surface, white-head and black-head. It also has an anti-inflammatory property. Most people need a six week course to clear the acne. You might even need to continue using it less frequently to prevent acne returning.
  2. Azelaic acid: It works by getting rid of dead skin and bacteria.
  3. Combined Oral Contraceptive Pill (COCP): This is of benefit to women who have acne around menstrual period or associated with Polycystic Ovarian Syndrome.
  4. Topical retinoid: This works by removing dead skin from the surface of the skin. Topical retinoid should be avoided during pregnancy.