Acne treatment

A lot of people suffer from acne. This skin condition occurs mainly in adolescents and young adults, but adults can also have acne. Acne occurs in both mild and very severe form. The condition is not contagious. Acne can be cosmetically disruptive and therefore have a considerable impact on the social and psychological wellbeing of those who have acne.

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What is acne? 

Acne is a skin condition in which the sebaceous follicle becomes inflamed. The condition manifests itself mainly where most and active sebaceous glands are located, namely on the face in the so-called T-zone (forehead, nose, chin), back, neck, throat and shoulders. The condition occurs mainly in puberty in young people and young adults between the ages of 12 and 24 (85%). It usually disappears before the age of 25. In later life it occurs more often in women than in men.  

What are the causes of acne? 

During puberty, the body produces more hormones. Including androgens. These hormones are responsible for the growth of the sebaceous glands and for the production of more and thicker sebum. Every sebaceous gland has an opening that we call a pore. Sebum can escape here. Sebum keeps the skin and hair supple and oily. Sebum is water-repellent, protects against dehydration and moisture loss of the skin and increases the resistance of the skin. However, a combination of dead skin cells and thicker sebum can clog the pores. This can cause blackheads. A blackhead or comedo can have a black dot or a white dot. The blackheads with a white tip are deeper and can close off the entire pore. In addition, there is a keratosis of the excretory duct of the sebaceous gland, which further clogs up the pore. The sebaceous glands contain bacteria that convert the sebum into fatty acids. Due to the accumulated sebum and the irritating fatty acids, the clogged sebaceous glandular follicle expands further and further and eventually tears open. The irritants enter the adjacent skin and cause inflammation, resulting in spots and pimples.  

The onset of acne or its worsening can also be influenced by: 

  • Genetic factors (other family members also have it)
  • Hormonal factors (menstruation and pregnancy)
  • Polycysteus ovarian syndrome or cysts on the ovaries
  • Stress
  • Cosmetics
  • Friction with clothing
  • Strong climate change

 

What forms of acne are there? 

Acne occurs in many different forms. Common forms include:  

  • Acne vulgaris, this is the most common form. Comedones, spots and pustules occur simultaneously and to varying degrees. 
  • Acne comedonica is a form of mild acne in which inflammation and blackheads are not the major issue, but rather the comedones.  
  • Acne conglobata, this form of acne is accompanied by very severe inflammations with giant and double comedones, nodules and cysts, usually followed by scarring. This acne occurs mainly in young men and can continue into their adult lives. 
  • Acne excoriée, with this form, the acne gets worse because every pimple or comedo is scratched or squeezed out, resulting in scarring on the face or back. 
  • Acne tarda is the same as acne vulgaris with the difference that the condition affects adults or that the acne vulgaris does not go away after puberty. 
  • Acne ectopia or hidradenitis supperativa, is a form where pimples in the groin or armpits are caused by an inflammation of the hair follicles (not of the sebaceous glands). 
  • Acne fulminans is a rare severe and acute outbreak of acne and is accompanied by a general feeling of illness. We see heavily inflamed pustules that develop very quickly into open wounds and sores accompanied by fever, malaise, blood disorders and muscle and joint pains in the limbs.  

 

How do you recognise acne? 

Acne is usually found in the face, the so-called T-zone (forehead, around the nose and chin), but also on the back, chest, shoulders, neck and throat. Acne can manifest itself as follows: 

  • Blackheads or comedones: open black comedones with a black clot of dried secretion in the pore or closed white comedones with a white dot.  
  • Pimples or spots: a sharply defined solid elevation of the skin.  
  • Pimples, spots or pustules: a visible cavity in the skin with purulent moisture (pus). 
  • Subcutaneous inflammation, nodules and cysts. A nodule is a sharply limited tangible resistance in the skin or in the subcutaneous tissue, whether or not elevated above the skin, generally healing with scarring. A cyst is a closed cavity filled with fluid, cells or cell products. 

These symptoms occur in varying combinations and in different degrees of severity, see the different forms of acne. When acne is no longer actively present, side effects such as acne scars and stains may be visible. 

Is there anything I can do myself about acne? 

If treated properly, the acne can disappear or decrease. Clean your skin daily (once or twice a day) with lukewarm water. Do not use soap. Do not rub or exfoliate your skin. Do not squeeze out your blackhead, pimples and spots yourself, it can only exacerbate the condition and can also cause scars. Do not smoke as this has a detrimental effect on your skin. Although healthy eating, drinking enough water and moderate alcohol consumption will not directly affect acne, it will certainly not exacerbate the acne. Be careful with make-up, some products clog up the sebaceous glands and aggravate or cause acne. Take a lukewarm shower after exercise, because sweating combined with the friction of clothing can exacerbate acne. A moisturising cream can sometimes help. Despite all these measures, acne may require more thorough treatment.  

What are the forms of treatment? 

The treatment of acne depends on the severity of the condition.  

Non-medicinal 

A first possible step in the treatment of acne could be a deep cleansing. Black and white comedones are removed using a thin, small needle. The purpose of deep cleansing is to reduce inflammation and prevent scarring. 

Medicinal 

Medicines are prescribed to remedy the acne as soon as possible. The condition is classified into mild form, moderate form and severe form.  

  • The mild form has comedones and almost no inflammation.  
  • The moderately-serious form has a mixture of comedones and inflammatory reactions in the face. 
  • The severe form has many inflammatory reactions or a mixed pattern of comedones and inflammatory reactions on the torso or acne congoblata or acne with scarring or hyperpigmentation.  

For mild acne, a treatment directly on the skin is the appropriate treatment. For moderate acne and severe acne, treatment with a medication to take is the basis of the medicinal treatment. Attention to the psychosocial experience of the acne can be part of the treatment.  

Read the package leaflet carefully before you start taking a medicine. Do not use antibiotics to which you were previously allergic. Always complete an antibiotic course, unless you have allergic reactions. The following products can be used: 

  • Benzoyl peroxide gel  
  • Adapalene gel 
  • Tretinoin cream 

These products loosen the top layer of the skin, making the pores less likely to become clogged. A gel is more suitable for oily skin, a cream for drier skin. 

Antibiotics applied to the skin (locally):  

  • Clindamycin solution/lotion or gel 
  • Erythromycin solution 
  • Clindamycin/benzoyl peroxide gel 
  • Clindamycin/tretinoin gel 

Antibiotics for the skin and to take are combined with skin care products because that works faster and is more effective and prevents or reduces the bacterial resistance. 

Antibiotics to take: 

  • Doxycycline (not during pregnancy or breastfeeding) 
  • Erytromycine  

Other medication to take: 

  • The contraceptive pill: a contraceptive pill can offer a solution for women who do not want to become pregnant. Although the pill is not a direct remedy for acne, it can have a positive effect on acne. The effect may vary from one pill to another. If one contraceptive pill does not help against acne, another type of pill may be chosen. 
  • Isotretinoin: in case of insufficient effect of an oral antibiotic, moderate acne may be the last alternative isotretinoin prescribed, the products for on the skin are then no longer needed. 

During treatment with medication a microdermabrasion treatment can often be started. The top layer of skin is removed with crystals.  

Alternative treatments 

Treatment with medication and microdermabrasion is aimed at calming, counteracting and reducing the acne. Acne does not disappear overnight, but can eventually heal. Any kind of acne can leave scars. 

A scar is in fact an expression that the body has repaired the damage to the skin in that place. However, it has a different structure than ordinary skin, which makes it stand out. Over time, scars become less visible. There are several treatments to reduce scars. 

The following treatments are possible: 

  • Chemical peeling, the epidermis is removed by an etching liquid. 
  • Laser treatment, the epidermis is burned off layer by layer. 
  • A combination of sandblasting, tretinoin cream and laser has a beneficial effect on the scars by increasing the subcutaneous connective tissue. 

Find out about the treatments and where you can best have them carried out.  

Lifestyle changes 

Under "Can I do something myself about acne?" you can read advice on lifestyle changes. 

The psychosocial well-being 

Having acne can greatly reduce quality of life. The shame and grief that people with acne feel can be enormous. People often feel insecure, they often have less self-confidence. It makes some people dejected or even depressed. If these feelings prevail, consult your doctor. If necessary, ask for a referral to a psychologist and/or dermatologist.  

Additional risks and side effects 

Always read the package leaflet of the medicines you are prescribed. Do not use antibiotics to which you were previously allergic. Always complete an antibiotic course, unless you have allergic reactions.  

Additional risks and side effects of acne medication: 

  • Bleaching effect
  • Benzoyl peroxide, can have a bleaching effect on clothing, bedding, metal, hair and eyebrows.  
  • Hyperpigmentation (dark spots in the skin)
  • Benzoyl peroxide and tretinoin can irritate the skin, increasing the risk of hyperpigmentation. The risk of hyperpigmentation is greater in people with dark skin. People with sensitive or dark skin should use the treatment every other day and use a sunscreen with a minimum factor of 15 in the summer.  

Pregnancy and breastfeeding: 

  • Do not use adapalene, tretinoin, clindamycin/tretinoin gel, doxycycline and isotretinoin when pregnant or breastfeeding.  

 

 

References

Acne vital (z.d.). Acne fulminanns and acne congoblata. Consulted on 23 April 2019 from https://acnevitaal.nl/acne/soorten-acne/acne-fulminans/ 

Apotheek.nl (Last updated KNMP: 29-09-2017). What medications are used for acne? Consulted on 23 April 2019 from https://www.apotheek.nl/klachten-ziektes/acne#welke-medicijnen-worden-gebruikt-bij-acne 

Dr. Njoo D (z.d.). Acne. Consulted on 23 April 2019  from https://www.huidarts.com/huidaandoeningen/acne/ 

Ear skin therapists (z.d.). What does acne look like? What forms of acne are there? Consulted on 23 April 2019 from https://www.thoord.nl/aandoening/acne/ 

ETZ Dermatology. 41.517 (2019). How does acne occur? Consulted on 23 April 2019 from https://www.etz.nl/ETZWebsite/files/06/061852e8-67cc-4f82-9c4b-ab60bfd6fb03.pdf 

NHG (z.d.). Acne summary map. Consulted on 23 April 2019 from https://www.nhg.org/standaarden/samenvatting/acne 

Pharmacotherapeutic compass (z.d.). Treatment plan Acne. Consulted on 23 April 2019 from https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/acne_vulgaris#acne_vulgaris_treatment plan 

Skin care Royale (z.d.). Acne and quality of life. Consulted on 23 April 2019 from https://huidzorgroyale.nl/huidproblemen/acne/acne-vulgaris/ 

Skin care Royale (z.d.). Acne ectopia. Consulted on 23 April 2019 from https://huidzorgroyale.nl/huidproblemen/acne/acne-ectopica/ 

The Blaak outpatient clinic (z.d.). Acne treatment. Consulted on 23 April 2019 from https://www.polikliniekdeblaak.nl/huidziekten/acne-behandeling/