Acne is a chronic condition involving the sebaceous glands. It manifests as comedones and inflammatory lesions (red or white pimples), which mainly appear on the face, but sometimes also on the chest and back. Acne is extremely common during adolescence, but can last or reappear well into adulthood, particularly in women.
- How acne forms
• Oily skin
Each skin pore contains a hair and a sebaceous gland and the combination of these elements forms the pilosebaceous follicle. The role of the sebaceous gland is to produce sebum, an oily substance which protects the skin from external elements.
Acne is the result of an imbalance in the pilosebaceous follicles, due to increased levels of androgens (male hormones) in the body: the sebaceous gland expands and produces excess sebum, resulting in oily skin.
• The appearance of comedones
At the same time, skin cell renewal is disturbed and dead cells accumulate on the skin’s surface: this is called hyperkeratinisation.
The combination of sebum and dead cells obstructs the canal that connects the sebaceous gland to the skin. The sebum becomes trapped. It accumulates just below the surface of the skin, dilates the pores and forms bumps that are visible to the naked eye. These can take two forms:
– a whitehead, or closed comedone.
– or, when the sebum trapped at the surface oxidises through contact with air, a blackhead, also called open comedone. Comedones predominate in the least severe forms of acne: we call this non-inflammatory acne.
• Inflammatory lesions
Some comedones are then colonised by a bacterium whose presence is normal, but which proliferates excessively when acne is present: Propionibacterium acnes. The follicle becomes inflamed, the glandular sac ruptures and the surrounding tissue is affected. It swells and becomes painful, forming a bump that is either red (papule) or white (pustule or nodule).
When a large number of papules, pustules and/or nodules are present, we call this inflammatory acne. Its severity varies from one individual to another.
- Predisposing factors
• Touching or scratching the lesions should be avoided: squeezing the pimples spreads pus and bacteria on the skin, which leads to more lesions.
• The sun is a false friend: at first it dries out the pimples and this can give the illusion of an improvement. However, it also causes the skin to thicken. This promotes an increase in comedones and, in the medium term, causes a new outbreak of lesions. Consequently, acne sufferers should avoid sun exposure or systematically use a strong sunscreen.
• Stress alone might not be enough to trigger a bout of acne on healthy skin, but it can temporarily exacerbate acne-prone skin. As an example, this is evident in students during exam periods.
- Some misconceptions about acne
• Oily skin and acne are not caused by a lack of hygiene. Conversely, excessive cleansing or using abrasive products can be harsh on the skin and further increase sebum secretion. Cleansing in the morning and evening with a mild product suited to acne-prone skin is sufficient.
• Make-up is not contraindicated in acne sufferers, as long as the products used are oil-free and non-comedogenic.
• To date, no conclusive scientific correlation has been identified between diet and acne: this means that there is no evidence to suggest that chocolate and cured pork meats exacerbate acne.
- Managing and treating acne
Acne is often difficult to live with, especially during adolescence. It can have a social, psychological and emotional impact on sufferers. Moreover, if left untreated, acne can leave long-term scars. Early treatment is therefore essential to better protect the skin: see your skin specialist as soon as possible.
Depending on the type of acne and its severity, your doctor will decide on the best course of treatment: local (creams or lotions) and/or oral (antibiotics, zinc derivatives, isotretinoin, or hormonal treatments), often in combination with cosmetic skin treatments.
In any case, the treatment must be taken or applied regularly, for the entire period prescribed: even though acne treatments are very effective, they often take several months to reach their full effect, and the condition can worsen slightly in the first few weeks.