Dr. Sandra Cabrera, Dermatologist. Dermatology Unit of the General Hospital of the Plaza de la Salud.
At some point we have heard "acne is a thing of age, it will pass!", That "it is normal" to appear "in youth" and that over time the pimples will disappear from the face, forgetting a bit of their importance.
But what we really need to know is that it is a pathology (disease) of the skin, which can last for many years and if it does not treat in time it leaves both physical sequelae, as in the case of post-acne scars, as well as psychological (low self-esteem and loss of confidence).
While it is true that it appears more in adolescence, it can be seen from birth to adulthood and affects 80 % of the population in some of its forms, without predilection of race.
Acne is defined as an inflammatory disease of multifactorial cause. It affects the sebaceous pilo unit, which is made up of the hair root, hair follicle, sebaceous gland and erector hair muscle. This explains its distribution especially in the face, chest and back, since these are the areas with the highest number of sebaceous glands.
There is also a disease of inflammatory origin similar to acne, which causes acne-like lesions, but without comedones and the disease is more common in adulthood, especially in the female sex appearing persistent redness and difficult management.
Within the pathology of acne, the following aspects should be considered:
1. Increase in sebaceous production. This is the initial lesion where there is an increase in sebum or fat by the sebaceous gland.
In early acne they are located in the facial center area such as the forehead, nose and cheeks, later they will extend to: back, ears, chest.
2. Ductal hyperkeratosis, together with excess sebum or fat, desquamated epithelial cells that obstruct the opening of the sebaceous pilo follicle or pore. Then open comedones (black dots) and closed comedones begin to form.
Open comedones, which are characterized because they are easy to squeeze, have a large dilated orifice, while closed comedones (white dots) appear as white papules of 1 to 2 mm with a pedrusco appearance, which is best seen when stretching the skin .
3. Bacterial proliferation or multiplication that, due to excess sebum and hyperkeratinization, forms an adequate environment for certain bacteria such as Cutibacteriumacnes and Propionibacterium acnes to grow, which causes the inflammatory response in this pathology.
There are other factors that contribute to the development of acne, such as genetic, emotional, hormonal, certain medications, some cosmetics and physiological processes, such as the premenstrual period, as well as pregnancy.
When examining the patient with acne it is important to know that the dermatologist is the specialist doctor in charge of treating this disease.
This specialist will take into account the following points:
- Type of injury. If many pustular lesions (pus) appear.
- Gravity of the picture. It will assess the intensity and stage of the lesions.
- Extension. The involvement of the face, chest and back is evaluated.