Acne

• Symptoms: Skin discolouration, redness, hyperpigmentation, dark patches, inflammation, scarring, swelling, tenderness, and pain when touching skin
• Causes: Extreme oil or sebum production, bacteria, clogged hair follicles due to dead skin, hormonal changes, a carbohydrate-rich diet, stress; specific medications like testosterone, corticosteroids, and lithium
• Risk factors: Young teenage years, hormonal changes during pregnancy or puberty, family genetics, contact with oily or greasy creams and lotions, friction against the skin
• Severity: Mild to severe; usually chronic
• Which doctor to consult: Dermatologist

Overview

Sometimes, the pores in skin get blocked by dirt, dead skin, bacteria, and oil, causing breakouts. This leads to pimples called a blemish or zit. An individual might suffer from acne if he/she gets such spots very often or if these happen in a bunch at once.

It's quite a common skin condition and around 9.4% of people worldwide deal with acne. 
This skin condition doesn't pose any severe health risk, although it is extremely painful, especially if one suffers from severe acne. Besides, it might leave some scarring, which can also cause emotional distress.

Acne and its scars contribute to low self-confidence and self-esteem, mainly if these occur at visible parts of the body.

Though it is a treatable condition, healing takes a long time. It might take months or even years for the scarring to lighten.

Acne can manifest on the skin as the following:

• Whiteheads: These pimples are closed comedones and occur as raised bumps within the skin surface. The tip of the bump is white, giving it its name.
• Blackheads: These are called open comedones and usually appear on top of the skin's surface. Due to contact with oxygen, the pimples get a darker appearance.

Besides pimples, an individual might also get inflammatory lesions which are the primary cause of scarring:

• Cysts: These cysts are big lumps which form underneath the skin. These contain pus and are painful to touch.
• Nodules: These lumps are pretty solid and painful to touch. Like cysts, these also occur underneath the skin.
• Pustules: If an individual gets tiny red pimples with pus and a pointed tip, it is likely a pustule.
• Papules: If hair follicles get infected or inflamed, these can cause small, raised, and red bumps called papules.

When to Consult a Doctor?

Pimples and acne are quite common and may usually resolve themselves with time without any medication. But some circumstances require necessary medical attention, such as:

• If the acne gets very severe
• If any over-the-counter medications like a retinoid gel, salicylic acid and lactic acid fail to clear the acne
• If an individual is struggling with acne due to medications for depression and anxiety 
• If an individual has acne scars 
• If acne is making a person lose confidence

Diagnosis

If an individual feels that his/her pimples and acne situation is recurring and getting out of control, he/she should make sure to get a proper diagnosis from a good, board-certified dermatologist.

The doctor will likely examine the skin to determine what kind of lesions the individual is suffering from and the intensity of it.

The doctor will ask the patient if he/she is undergoing any stress, has a previous family history, has hormonal changes due to menstruation, etc. Sometimes acne may happen due to an underlying medical condition; further testing may be required.

Treatment

Home Care

Certain nonprescription products can help control moderate or mild acne.

1. Wash the face twice daily with a gentle cleanser, mild soap, and warm water. 
2. Try not to use masks, astringents and facial scrubs, which might irritate the affected areas and worsen the acne.
3. Get some safe over-the-counter products for acne to promote drying out of excess oil. These products may take some time to show improvement.
4. Steer clear of greasy or oily cosmetics, hairstyling products, sunscreens, acne concealers or any other product that may exacerbate acne.
5. Non-comedogenic or water-based products and non-oily moisturisers may help lessen acne formation.
6. Avoid touching or picking on the acne. It may cause scarring or infection.
7. Apply sunscreen to protect acne from harmful UV rays.
8. Change bedsheets and pillow covers regularly to prevent germs from seeping into the skin at night. 
9. Have adequate water to help the skin flush toxins out.

Medication

Doctors may prescribe the following topical and oral medications which may help alleviate acne:

1. Dapsone gel: This gel works best in case of inflammatory acne. 
2. Salicylic acid and azelaic acid: Salicylic acid is available in leave-on and wash-off products and can help avoid clogged hair follicles. Besides that, azelaic acid gel or cream has antibacterial properties, which can help cure skin discolouration after acne. 
3. Antibiotics: Antibiotics help in reducing inflammation and redness by killing skin bacteria. These topical antibiotics are not recommended alone and are combined with benzoyl peroxide. Some oral antibiotics can help assuage acne. But these should only be consumed for the shortest duration possible to avoid antibiotic resistance. 
4. Retinoids: Moderate acne can be solved with gels, lotions and creams containing tretinoin or retinoic acids. 
Isotretinoin: It is another form of vitamin A prescribed for patients with mild or severe acne. It is to be consumed as oral medication.
5. Anti-androgen agents: If oral antibiotics don't help, drugs like aldactone are prescribed. It helps in blocking the impact of androgen hormones occurring on oil-producing glands.

Surgery

Surgical options can also be considered when acne becomes serious. These include:

• Drainage & incision: If topical medications do not work on acne, doctors may drain them with special surgical tools. 
• Blemish extraction: This surgical treatment is performed with sterilised equipment by applying pressure on the blemish to extract the content from the follicle.

Alternative Management

If home remedies, topical and oral medications fail, and an individual doesn’t want to turn to surgical treatments, then he/she can opt for a few alternative management or therapies like:

1. Steroid injections: If an individual has cystic and nodular lesions, he/she can be treated with steroid injections which can accelerate improvement and lessen pain. 
2. Light therapy: Certain light therapies have shown decent success with acne. Doctors will determine the ideal dose, light source and method for accurate results.
3. Tea tree oil: Try using a gel that comprises tea tree oil. These show slow outcomes but are as helpful as benzoyl peroxide lotions.
4. Chemical peel: It involves continually applying unique chemical solutions like retinoic acid, glycolic acid, or salicylic acid. 
5. Cryotherapy: This procedure involves the application of cold liquid, such as liquid nitrogen, to the skin area affected by acne. The length of liquid application depends on the size and type of acne. It prompts superficial skin peeling that will reduce blemish inflammation.

Risks & Complications if Left Untreated

Acne can lead to certain complications if an individual doesn’t receive medical treatment. These complications include:

Acne scars such as rolling, boxcars, and ice pick spots leave round craters or narrow, small, deep holes in the skin. Other than these, there are hypertrophic and keloid scars that are prominent in appearance.

Skin damage, such as hyperpigmentation or hypopigmentation, may make the affected skin look lighter or darker than before.

Additional information

What are the most common places for acne to appear

Some of the most common spots for acne are the face, forehead, shoulders, upper back, and chest.

What are the causes of acne?

Acne is a skin condition which usually happens due to hormonal changes, primarily due to conditions that involve androgen hormones. These hormones generally become active during young teenage and adult years. 
Sensitivity towards hormones, fatty acids, oil clogging, and surface bacteria can lead to acne. But some other conditions may make this situation worse, such as:

• Changes in hormones during a woman's menstrual cycle
• Weather conditions like high humidity
• Headgear and clothing that may cause friction on the skin
• Specific medications for other conditions that might aggravate the situation
• Usage of greasy or oily skincare products like wax, creams, and heavy lotions
• Increased levels of  stress 
• Family genetics

Does acne lead to scarring?

There are some occasions where acne might lead to scarring. When inflammation occurs, it causes the acne pores to swell and eventually break down the pore wall. This can cause scarring.

Before suggesting any treatment, a dermatologist will try to determine the specific kind of acne an individual is struggling with. Certain treatments will help lighten the scars such as chemical peel, laser resurfacing, dermabrasion and micro-needling.