Acne

Flawless, well-tended skin is con­sidered a sign of attractiveness and health. This makes it all the worse for many young people in puberty when impure skin and pimples are booming. About 70 to 95 percent of this age group suffer from acne vulgaris, male adolescents far more frequently than females. Whether and how many pimples a person develops and in which form seems to be hereditary, the pathomechanism is complex.

One thing is certain: hormones, especially androgens, play a role. The body produces more of these in both sexes during puberty. The male sex hormones stimulate the sebaceous glands in the face, the décolleté and back to increase the fat production. It varies from person to person as to how sensitive the sebaceous glands react to the hormones. The androgens also ensure that the hair follicle openings keratinise stronger and prevent the excess sebum from flowing off. The backlog causes blackheads (comedones) to form. Bacteria – including propionibacteria – multiply, the skin becomes inflamed and nodules and pustules develop. Doctors divide acne into different degrees of severity depending on the clinical picture. The most severe form is cystic acne (acne conglobata), which results in cysts and painful nodules and very often leaves scars.

An important step is to get the very oily skin under control. The daily care should therefore be as oil- and grease-free as possible. The ingredients to which people react with skin impurities vary from person to person. Coconut oil, olive oil or Vaseline, for example, can cause problems. To keep the skin moist, it is best to use light gels or day creams that do not leave an oily film or residue on the skin.

Strongly degreasing or de-oiling agents as well as skin tonics with alcohol should be avoided. They stress the skin and can actually fuel sebum production. Mild syndets are available as alternatives. Face and whole-body peelings, for example, with alpha-hydroxy acids (= AHA, for example with glycolic acid, lactic acid, malic acid, tartaric acid, citric acid and mandelic acid) or beta-hydroxy acids (= BHA, for example salicylic acid), counteract the hornification of the pores. The ingredient panthenol promotes wound healing and also soothes inflammation. Some patients have good experiences with anti-inflammatory zinc ointment. Taken orally as a dietary supplement, zinc is also said to relieve acne. Fragrances, UV light and other irritants can increase sebum production.

A visit to the doctor is called for if the acne is accompanied by scarring. Severe forms of acne with many purulent nodules or cysts, symptoms that persist beyond puberty and acne-like skin problems with an uncertain diagnosis are a case for the dermatologist.

Topicals with variants of vitamin A (so-called retinoids, mostly isotretinoin) are indicated for any degree of severity of acne. They regulate keratinisation and soothe inflammation. At the beginning of the application, irritation and redness may occur. For pregnant women, local treatment with the potentially teratogenic isotretinoin is contraindicated. For non-inflammatory comedone acne (acne comedonica), characterised by black or white blackheads, this treatment together with an appropriate skin care is usually sufficient.

As soon as there is an inflammation and papules and pustules (acne papulopustulosa) appear, over-the-counter topicals with benzoyl peroxide in various concentrations are indicated. Three to five percent preparations are used for mild to moderate acne, the highly irritating ten percent concentration only for severe acne. Benzoyl peroxide dries out oily skin and reduces the growth of acne bacteria. Many patients experience that their skin condition worsens (so-called »blooming« of acne) if they start applying a cream or gel with benzoyl peroxide. However, this is only temporary. The active ingredient can also burn or irritate the skin. It is best for patients to avoid sunbathing or going to a solarium because the skin reacts more sensitively to UV radiation. Moreover, benzoyl peroxide also has a bleaching effect. If you use it also on your back and décolleté, you should only wear white clothes after the application. Coloured clothing will otherwise bleach out in an unsightly way.

To counteract infections, topical antibiotics may be required in combination with topical retinoids and/or benzoyl peroxide. The doctor mostly prescribes clindamycin, erythromycin, chloramphenicol or tetracycline, usually for external use. In cases of severe inflammation and cysts, antibiotics such as doxycycline and minocycline are also used systemically, and if a topical therapy is not successful. From the severity degree of moderate acne onwards, azelaic acid is also used. It has comedolytic, anticomedogenic as well as antimicrobial and anti-inflammatory effects. In severe acne, it may be necessary to use the teratogenically effective isotretinoin systemically too.