This is a common skin disease characterized by areas of scaly red skin, blackheads and whiteheads, pinheads, large papules and possible scarring. It affects mostly skin with the densest population of sebaceous (oil) follicles .Acne forms when hair follicles under your skin clog up on the face, neck, back, chest and shoulders. Anyone can get acne, but it is common in teenagers and young adults. It occurs most commonly during adolescence and often continues into adulthood. In adolescence, acne is usually caused by an increase in testosterone which accrues during puberty regardless of sex.

CAUSES

Nobody is completely sure what causes acne. Experts believe the primary cause is a rise in androgen levels – androgen is a type of hormone. Androgen levels rise when a human becomes an adolescent. Rising androgen levels make the oil glands under your skin grow; the enlarged gland produces more oil. Excessive sebum can break down cellular walls in your pores, causing bacteria to grow.

Some studies indicate that susceptibility to acne could also be;

1. Genetic: The predisposition for specific individuals to acne is likely explained by a genetic component, which has been supported by studies that have looked at rates of acne among first degree relatives
2.  Some medications which contain androgen and lithium may cause acne.
3. Greasy cosmetics may cause acne in some susceptible people.
4. Hormones: hormonal activity such as menstrual cycles and puberty, may contribute to the formation of acne. Hormone changes during pregnancy may cause acne to either develop for the first time, or recur.
5. Psychological: while connection between acne and stress has been debated, scientific research indicates that increased acne severity is significantly associated with increased stress levels.
6. Infections:Propionibacterium acnes (P.acnes) is the anaerobic bacterium species that is widely concluded to cause acne, though Staphylococcus epidermis has been universally discovered to play some role since normal pores appear colonized only by P.acnes.
7. Diet: the relationship between diet and acne is not very clear as there is no good quality evidence. However, a high glycemic load diet is associated with worsening acne. There is also a positive association between the consumption of milk and a greater rate and severity of acne.

MANAGEMENT

For most people, acne diminishes over time and tends to disappear or at the very least decreases by age 25. There is however, no way to predict how long it will take to disappear entirely and some individuals will carry this condition well into their 30s, 40s and beyond.

Treatment may depend on how severe and persistent it is. Many different treatments exist for acne, they are believed to work in at least four (4) different ways; normalizing shedding into the pore to prevent blockage, killing Propionibacterium acnes (P.acnes), anti-inflammatory effects or hormonal manipulation.

MEDICATIONS

Benzoyl Peroxide: is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects. It kills bacteria and slows down your glands’ production of oil as well as works as a peeling agent, accelerating skin turnover and clearing pores, which in turn reduces the bacterial count in the affected area.

Salicylic Acid – helps break down blackheads and whiteheads, also reduces shedding of cells which line the follicles of the oil glands, effective in treating inflammation and swelling.

Resorcinol – helps break down blackheads and whiteheads e.g Clearasil Stayclear Acne Treatment Cream, Sulfur Resorcinol

Antibiotics –Oral antibiotics are frequently prescribed for patients with severe acne and some patients with moderate acne too. The aim of such oral antibiotics is to lower the population of Propionibacterium acnes (P. acnes). The dosage will be initially high, and then as the acne reduces so will the dosage. Antibiotics are not taken for more than six months. As time passes the P. acnes can become resistant to the antibiotic and another antibiotic is needed. Some American studies have indicated that it is better to use oral broad-spectrum antibiotics.

Commonly used antibiotics, either applied topically or taken orally, include erythromycin, clindamycin and tetracyclines such as minocycline.

Clindamycin gel

Hormones – In females, acne can be improved with hormonal treatments. The majority of women with acne find that taking certain oral contraceptives clears it up. Oral contraceptives suppress the overactive gland and are commonly used as long-term treatments for acne in women. If the woman has a blood-clotting disorder, smokes, has a history of migraines, or is over 35, she should not take this medication without checking with a gynecologist first.

Topical retinoids – Topical retinoids are medications that normalize the follicle cell life cycle. This class includes tretinoin, adapalene and tazarotene. Like isotretinoin, they are related to vitamin A, but they are administered topically and they generally have much milder side effects. They can, however, cause significant irritation of the skin.

Oral retinoids – Isotretinoin is very effective for severe acne as well as moderate acne that does not improve with other treatments. Improvement is typically seen after one to two months of use.

REFERENCES

1.  http://www.medicalnewstoday.com/articles/107146.php
2. https://en.wikipedia.org/wiki/Acne_vulgaris