Acne is a disorder that affects the skin, causing the formation of pimples, papules and pustules.
Mistakenly considered, sometimes, a problem only of an aesthetic type, it is instead a real inflammatory disease.
Acne occurs mainly in adolescence, starting from puberty until the age of 25 or 30. For this reason, the disease has also been given the name of juvenile acne. In addition to adolescence, acne can appear in adulthood, especially in women after the age of 40. In this case we speak of late acne.
Acne has a cyclical pattern, with healing phases alternating with others of worsening, as happens after the summer season. In addition, it can reappear in adulthood, stressed by physical and environmental factors.
Acne manifestations appear mainly in areas rich in sebaceous glands such as the face, in particular in the so-called “T zone” composed of nose-forehead-chin, and on the cheeks; but it can also affect the trunk, back, shoulders and chest. Especially during adolescence, acne can even appear on the scalp.
At the base of the disease there is the excessive production of sebum, or fat, by the sebaceous glands. Sebum tends to accumulate in the follicles and to favor the colonization of bacteria physiologically present on the skin, in particular Propionibacterium acnes, the pathogen most involved in the genesis of the disease. In other cases it can occur as a result of hormonal imbalances.
Papulo-pustular acne: what is it
There are various forms of acne characterized, depending on the severity, by inflammatory and non-inflammatory lesions. In addition to the papulo-pustular form, the most frequent and which is configured as a form of intermediate gravity, there are comedonic acne, milder, nodule-cystic acne and conglomerate acne, the most severe forms.
Papulo-pustular acne presents with the formation of many reddened pustules of various sizes, containing pus. In the most advanced forms, the manifestations of the disease can give rise, in the affected areas, to scar lesions of various sizes, sometimes deep, which will tend to change the appearance of the skin.
This form is quite noticeable; Precisely because it occurs mainly at the level of the face, papulo-pustular acne is the cause of important psychological discomfort in young people and adolescents, and represents a frequent reason for dermatological consultation.
In milder forms of acne, such as comedonic acne, there are non-inflammatory lesions, called comedones, caused by the accumulation of sebum and dead skin cells inside the hair duct. There are two types: open comedones (also called blackheads) and closed comedones (white dots). When whiteheads become inflamed, due to the proliferation of bacteria inside the follicle, papules appear; Inflammation of the follicle causes swelling and redness. The pustule is an evolution of the papule, with the presence of pus inside it. In the most severe forms, inflammation may be accompanied by burning.
Nodule-cystic acne is a form of greater severity; It affects less than 10% of cases and is manifested by subcutaneous nodules and cysts.
Acne conglobata is considered the most serious form of acne: it manifests itself with nodules and cysts of variable size, sometimes joined together. This form lasts until the age of 30. Both the nodular and conglobate forms can lead to the formation of scarring.
Each form of acne can manifest itself with different levels of severity; Generally, the greater the amount of excess sebum, the greater the extent of the disorders.
Papulo-pustular acne: the most common causes
Acne has a multifactorial origin. Sebaceous hyper-secretion is in fact only one aspect of the disease. The process of formation of acne lesions is also characterized by the alteration of the keratinization process, ie the formation of the stratum corneum of the epidermis, which acts as a protective barrier against external agents and which covers the follicular duct. Excessive keratinization can cause obstruction and, as already mentioned, do not allow sebum to escape on the skin surface, thus favoring the proliferation of bacteria.
Among the possible causes of acne manifestations there are also, in women, conditions such as polycystic ovary syndrome and adrenal dysfunctions, such as Cushing’s syndrome. These conditions are characterized by an excess of androgen hormones, so hirsutism (excessive hair growth in some areas of women’s bodies, such as the face) and / or androgenetic alopecia (a typically male form of baldness) are also present.
The appearance of acne can also be linked, in some cases, to the intake of medications; In this case we speak of iatrogenic acne. The drugs involved in this process possess androgenic properties. These include: hormones, antineoplastics, drugs for the central nervous system (for example, antiepileptics), immunosuppressants, corticosteroids, antivirals.
In women, acne may worsen as the menstrual cycle approaches. The hormonal alterations of this phase of the cycle lead to a greater production of sebum.
Finally, the appearance of acne may also depend on genetic predisposition.
Papulo-pustular acne: most effective remedies
Acne must be diagnosed by the dermatologist who, based on the type of lesions, the degree of severity and the presence of any other coexisting conditions, determines which form it is. Sometimes acne can be confused with rosacea, a chronic inflammatory disease that affects adults causing redness of the central part of the face, which is associated with a sense of heat and burning.
In the treatment of acne, a “do-it-yourself” attitude often prevails, so that the majority of those concerned do not consult the dermatologist, nor the family doctor. However, “home” remedies not only have no therapeutic value, but can also be harmful and cause worsening of lesions.
On the contrary, an accurate diagnosis and a personalized treatment path are essential to treat the disease, which involves a long therapy, with results that are not immediately visible.
The treatment of acne is mainly based on retinoids, compounds derived from vitamin A, and antibiotics (such as clindamycin), to be taken individually or in combination depending on the type of disease.
As far as papulo-pustular acne is concerned, the association of retinoids that perform an anti-inflammatory and lesion reduction function with others that prevent the proliferation of the bacterium Propionibacterium acnes is indicated.
Depending on the case, an antibiotic (belonging to the class of tetracicilins) may be added to be taken orally; However, antibiotics for the treatment of acne should be used with caution and only in the most severe forms of the disease. The simultaneous use of oral and topical antibiotics, especially if of different types, should be avoided.
Whatever medication is taken, therapy should not be stopped without the doctor’s indication, even when improvement seems to be expected.
In women, when acne is associated with seborrhea, hirsutism and alopecia, with papules and nodules located on the lower part of the face, neck and in the area around the mouth, or when the disease does not respond to conventional therapies, hormone therapy based on oestro-progestogens (the “pill“) or with antiandrogen drugs is indicated.
In addition to indications about the dosage and mode of taking drugs, whether topical or systemic, it is important that the necessary precautions for adequate skin cleansing are also explained to the patient.
It is necessary, for example, to avoid too aggressive cleansations that would remove the hydrolipidic film of the skin, making it drier and more sensitive. Cosmetics and moisturizers are allowed, but must be prescribed by your doctor. Care must be taken, for example, not to clog the pores with so-called “comedogenic” products, making the situation worse.
Another thing not to do absolutely is touch, squeeze or cut the pimples: the risk is to cause the formation of permanent scars.
Papulo-pustular acne: how to prevent it
Acne prevention passes from the adoption of a healthy lifestyle. Especially in adulthood, in fact, the possible appearance of acne is the indicator of unhealthy behavior or excessive stress. Let’s see some useful tips and tricks.
As for nutrition, even if there are no foods that can cause acne, it is better to prefer foods with a low glycemic index and low sugar intake, which help limit the production of sebum.
The sun can help, but excessive sun exposure can aggravate the disease. It is also necessary to apply a protective sunscreen suitable for acneic skin.
Stress is one of the external factors that can accentuate the phases of worsening: in fact, the production of hormones is activated that “awakens” some receptors present on the sebaceous glands, which are thus stimulated to produce more sebum, with an increase in the possibility of bacterial proliferation and inflammation of the follicle.
Smog and pollution can also cause acne to worsen, because sulfur oxide and carbon monoxide reduce oxygen supply, “choking” the epidermis.
Beware of cigarette smoke, which prevents the elimination of waste in the skin and causes clogging of pores. In fact, not smoking is also good for the skin.
Green light instead to physical activity, which keeps stress under control and helps to regulate hormone production.
In the case of male acne, special attention should be paid to shaving and the presence of lesions under the beard. In fact, it is not necessary to shave inflamed or, worse, infected areas. If it is necessary to do so, it is better to use specific products recommended by dermatologists to increase skin disinfection.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.