Medically reviewed by Minimalist Health Specialist - Written by Shreya Singh (Pharmacist) on 22nd Aug 2020
What is Acne Vulgaris? Causes, Symptoms & Treatment of Most Common Acne Type
Acne Vulgaris is the medical term for one of the most common skin diseases out there known as Acne. Acne is known to affect almost 90% of people of all races worldwide and is something that we all experience at a certain point in our lives.
A wide majority of teenagers, young adults(especially between the ages of 12-24 years), suffer from acne ranging from mild or moderate types to all the way up to the severe ones, which can cause stubborn scarring.
Dr.Davin Lim, Board-certified Dermatologist, Lasers and Lifts, Australia quotes:
“Acne is a part of life. Most patients would grow out of this condition in their early 20’s without requiring any serious treatments and procedures; however, some patients can experience persistent acne that recurs and may need to see a dermatologist for the proper treatment.”
This article gives an insight into the topic of Acne Vulgaris, how it is caused, and the treatments and tips required for its cure.
What is Acne Vulgaris?
Acne vulgaris is the medical name of most common acne, a chronic skin disease presenting with non-inflammatory or inflammatory lesions that occur due to the blockage of our pilosebaceous units (sebaceous glands at the base of hair follicles) with keratin, dead skin cells, bacteria, and sebum.
It most commonly occurs in people when they hit their puberty because that is the time when our sebaceous glands are hyperactive, usually due to hormonal changes and produces an excess amount of oils causing acne.
According to a recent research article by AAD (American Academy of Dermatology), “Acne vulgaris is the most prevalent chronic skin disease in the United States, affecting nearly 50 million people. It is most common in adolescents and young adults but may persist into the 30s and 40s.”
Acne is most commonly found on your face; however, it is not only restricted to the face but also occur on the chest, upper back, neck and upper arms. The reason is the abundance of sebaceous follicles in these areas.
Acne can be characterized into Non-inflammatory lesions and Inflammatory lesions.
Non-Inflammatory lesions: It consists of open or closed comedones, which are blackheads & whiteheads, and there is no inflammation yet.
- Whitehead: Whenever the blockage plug is under the skin's surface, it develops into a lump under the skin called closed comedones or Whiteheads. These comedones are not open to the surface.
- Blackhead: When the blockage plug is on the skin's surface, it is called open comedones or blackheads. Since it is open to the skin's surface, there is a black discoloration at the tip, which is due to melanin interacting with oxygen and getting oxidized.
Inflammatory lesions: It consists of Nodules, Papules, and Pustules.
- Papules: These are tender to touch and are small pink-ish bumps.
- Pustules: Bumps which are filled with pus having white/yellow tip
- Nodules: These are painful and large lesions and are the most severe ones. They are known to give aggressive scarrings on the skin.
What causes Acne Vulgaris?
Four main factors that can contribute to the formation of acne:
1. Follicular epidermal hyperproliferation: It is the fancy term for irregular shedding of the dead skin cells.
2. Overproduction of Sebum: Excess oil production by the sebaceous glands.
3. Overgrowth of bacteria: Infection with basically Propionibacterium acnes, popularly known as C. acnes.
Any of these four factors can trigger a chain reaction, which leads to the formation of acne. A typical acne journey looks like below.
Sebum production is regulated by hormones such as Androgens, which can stimulate the enlargement of the sebaceous glands and increase oil production.
When left unchecked, increased oil production allows for a rich environment for the overgrowth of the bacteria called P.acnes or C.acnes.
This bacteria then secretes a protein or enzyme that breaks down the sebum. This triggers the sebaceous follicles and develops into bumps called comedones, a plug of dead skin cells and sebum.
These triggered sebaceous follicles release inflammatory substances and chemotactic factors that allow white blood cells to come to these areas to fight and kill these bacteria.
When these bacterial cells die off and are not flushed out by skin automatically, they combine with oil and dead skin cells and form pus & swellings, which leads to the formation of those Pustules and Nodules.
Acne Vulgaris Treatments and Home Remedies
There are some OTC products and home remedies that can treat acne. These treatments help keep your acne at bay and effectively fading post-acne scars.
Over-The-Counter-Treatments for Acne Vulgaris
Topical therapy of many over the counter products can be beneficial in treating mild to moderate acne. They are more effective and provide rapid results as compared to home remedies.
According to the guidelines released by The American Academy of Dermatology (AAD) for managing and treating acne vulgaris in adolescents and adults,
“First-line treatment for mild to moderate acne vulgaris includes benzoyl peroxide or a topical retinoid, or a combination of topical medications consisting of benzoyl peroxide and a topical antibiotic (erythromycin or clindamycin), retinoid, or both.”
Some of the active ingredients used are:
1. Benzoyl Peroxide
It is an antibacterial agent and is well known to treat acne effectively. Its antibiotic properties have no risk of developing bacterial resistance. Its anti-inflammatory activities are beneficial in treating inflammatory acne. It boosts the process of skin cell renewal and limits the overproduction of sebum.
A 2% Benzoyl peroxide serum, when applied regularly, is proven effective for reducing acne.
2. Topical Retinoids
It is useful in treating acne by accelerating cell turnover and unclogging pores.
Retinols are best for dealing with acne and anti-aging signs after the mid-20s. Choose for a Retinol derivative-based formula that is soothing and effective.
3. Salicylic Acid
It is a powerful exfoliant that causes chemical peeling and helps in unclogging pores and fading acne scars. It is known to assist the breakdown of blackheads and whiteheads and helps suppress inflammation and swelling.
2% Salicylic acid face serum is effective in keeping your pore clean. You can also use salicylic acid-based cleansers, but it will be less effective than serum. Cleaners are best for sensitive skin that cannot tolerate serum.
Assists in the breakdown of blackheads and whiteheads.
5. Azelaic Acid
It is used as the anti-acne treatment of choice because of its well known anti-bacterial properties, limiting bacterial growth.
It has anti-inflammatory properties and can be used even by people with sensitive skin and in conditions such as rosacea.
Prescription-based Treatments for severe acne
Dermatologists' prescription based ointments are used to treat severe and recurring forms of acne. These are effective in treating severe acne types, such as Nodules and Pustules, but there are also many risk factors and side effects associated with them. Therefore a dermatologist’s recommendation is highly required.
Prescription treatments include:
1. Oral Antibiotics
An oral form of antibiotics such as erythromycin and tetracycline are prescribed for treating severe acne build-ups. These are effective in reducing the population of P.acnes and suppressing inflammation.
2. Oral Isotretinoin
These are potent oral Retinoids which are prescribed for the treatment of very severe Nodulo-cystic acne, which is likely to cause aggressive scarring. This treatment is usually prescribed to the patients in which other conventional therapies don’t work effectively.
ccording to The American Academy of Dermatology(AAD), “About 85% of patients see permanent clearing after one course of isotretinoin.”
3. Oral Contraceptives
A Oral contraceptive pills, combined with an antibiotic or a drug called spironolactone, can be prescribed for female patients.
Home Remedies for Common Acne
Some home remedies are known to treat and prevent acne; however, not all are well researched and may not work for everyone.
People should first know how to use these home remedies and at what concentrations.
1. Applying Apple Cider Vinegar
The Anti-bacterial properties in apple cider vinegar are well researched to treat acne by killing P.acnes, the acne-causing bacteria, and preventing further breakouts from occurring.
ACV contains organic acids such as malic acid and lactic acid, which is known for clearing up post-acne scars. It is also known to suppress inflammation and keep your oil production in check. Since it is a pretty strong acid, it should be diluted before use.
Raw ACV might contain some allergens not suitable for some skin type, so consider using ACV based skincare products.
2. Spot Treatment with Tea Tree Oil
Tea tree oil is well researched to treat acne by fighting acne-causing bacteria and suppressing skin inflammation.
According to a research study of 60 patients, published in the Indian Journal of Dermatology, Venereology, and Leprology, “Topical 5% tea tree oil is an effective treatment for mild to moderate acne vulgaris.”
Tea tree oil is an essential oil, and many essential oils can cause skin allergies, so we recommend a patch test. Also, use it only as a spot treatment. Long term use of essential oils can develop sensitive skin.
3. Dietary Changes
Although there is no well-researched link between diet and acne taking Vitamin A, E and Zinc supplements are known to treat and reduce acne.
This may be because people with acne tend to have lower levels of these vitamins and supplements than individuals with clear skin.
4. Applying Green Tea
There is some slight evidence that the topical application of green tea may limit excess sebum production and, therefore, treat acne.
It is likely due to polyphenols, flavonoids, and tannins in green tea, which have been shown to combat and prevent bacterial buildup on the skin.
Tips to prevent Acne Vulgaris
When it comes to acne, everyone has some or other advice. Some of the tips are helpful, and many are myths or just hit and trial.
We have listed just 4 things that are scientifically proven to reduce acne-causing factors.
- Using Non-Comedogenic products: Comedogenic Products may clog our pores and trigger the sebaceous follicles to develop acne.
Using products and makeups labeled as “non-Comedogenic” may reduce the risk of acne as they don’t clog pores.
If you are suffering from severe acne, staying away from makeup can be the best choice.
- Avoid Pricking or Popping: Pricking or touching acne lesions can make them more severe and cause scarring.
It is one of those things which sounds easy but difficult to do. Stay away from that viral popping DIY.
Popping may help, but when performed by a medical professional, not at home.
- Exercising Daily & Healthy Diet: It is one of the most beneficial lifestyle changes that we can implement to reduce stress build-up, which is known for making our acne more severe.
Exercise plays a significant role in hormonal balance, followed by a healthy diet.
- Protecting yourself from the Sun: Acne treatments can increase photosensitivity and make your skin likely more prone to sun damage; therefore, Applying a broad-spectrum sunscreen is non-negotiable. But invest in a lightweight sunscreen that does not leave your skin oily.
- Follow a skin care routine: Preventing acne is more like a hygiene practice. When you do not sweep your house for three days the dirt covers everything with invisible bacteria.
Same thing happens with your skin if you do not regularly clean your skin (not just washing your face) from inside the skin debris accumulates leading to acne.
Follow a good skincare routine for acne prone skin.
Most cases of acne are short-termed and usually heals itself without requiring any serious treatments. A dermatologist’s help is necessary if your acne gets worse and persists.
This disease is likely to affect the patients both physically and mentally. There are many social and emotional stigma associated with this disease, which leads to anxiety, depression, and low self-esteem.
Therefore, people are advised to support the patients emotionally and provide them with proper medical help and treatment.