Acne, or acne vulgaris, is an inflammatory skin disorder that mainly affects adolescents, but can also occur in adulthood. This disorder is characterised by the appearance of skin lesions such as comedones, papules, pustules and, in severe cases, nodules and cysts, caused mainly by inflammation of the hair follicles and excess sebum. It usually appears on the face, chest, shoulders or back. Let’s take a detailed look at the most common types of acne, what causes them and how they can be treated.
Types of acne
There are two main categories of acne: non-inflammatory and inflammatory. Non-inflammatory acne manifests itself mainly in the form of comedones, i.e. ‘plugs’ of sebum, bacteria and dead cells that clog the hair follicles, the skin structures from which hair grows. Connected to these are the glands that produce sebum, a secretion useful for keeping the skin moisturised. Blackheads, depending on whether the follicle is dilated or closed on the skin surface, are differentiated into whiteheads and blackheads.
Whiteheads are also called closed comedones. They form when the hair follicle is completely obstructed, but the skin surface remains closed. This prevents the contents of the pore from escaping, creating a small white bump under the skin.
Blackheads are known as open comedones. In this case, the hair follicle is obstructed, but remains open on the surface. The contents of the pore, in particular sebum, oxidises on contact with the air, taking on a black colour. Contrary to popular belief, the dark colour is not due to dirt, but to the oxidation of the sebum.
Inflammatory acne, on the other hand, manifests itself with more obvious signs and symptoms, such as:
- Furuncles: inflamed white spots
- Papules: solid, raised protuberances
- Pustules: superficial, pus-containing protuberances
- Nodules: deeper, solid protuberances containing pus
- Cysts: larger sacs containing pus
- Abscesses: even larger and deeper sacs containing pus
Causes of acne
The causes of acne are many and may include:
- Excessive sebum production and accumulation of dead cells in the pores, which encourages the multiplication of the bacterium Cutibacterium acnes, normally found in hair follicles. This bacterium transforms sebum into substances that irritate the skin and can generate infections. The sebaceous glands may produce more sebum to compensate for the dryness of the skin due to, for example, excessive sun exposure.
- Hormonal factors, such as the increase during puberty of androgens, a category of male sex hormones that are present in both men and women. Around the age of 25, hormone levels generally decrease, resulting in the reduction or disappearance of acne. Other hormonal changes, such as those occurring during pregnancy or the menstrual cycle, can also influence sebum production and favour the appearance of acne.
- Poor skin care. In particular:
Excessive cleansing: washing the face too often or using an aggressive cleanser can irritate the skin and stimulate greater sebum production, worsening acne.
Occlusive lotions or cosmetics: the use of cosmetics such as foundation or creams that are too heavy and oily can clog the pores, encouraging the formation of blackheads and pimples.
Inadequate hydration: not moisturising the skin, especially when using anti-acne treatments that dry out the skin, can cause dryness and irritation, aggravating the problem. - Certain medications, such as corticosteroids.
- Clothes that are too tight. Wearing clothes that are too tight can promote the appearance of acne in areas of the body where the skin is in contact with the clothes. This type of acne is often called mechanical acne and develops when the pressure, rubbing or friction of clothing irritates the skin.
- High humidity and sweating, which can aggravate mechanical acne.
- Air pollution.
- Smoking. Smoking triggers an inflammatory response in the body, which also affects the skin, resulting in intensified irritation. In addition, smoking clogs the pores of the skin, creating an environment suitable for the proliferation of bacteria and the formation of blackheads and pimples.
- Stress. When we are stressed, the body releases hormones such as cortisol, which can stimulate the sebaceous glands to produce more sebum.
Acne and nutrition
The relationship between acne and diet is a controversial issue. Although this is not the only cause, studies have shown that certain foods can aggravate acne. In fact, a diet rich in:
- Refined sugars
- Milk derivatives, due to the presence in milk of various hormones that are said to favour the onset of acne. However, the role of milk as an aggravating factor in acne remains controversial: several studies have obtained different results
- Foods with a high glycaemic index
In fact, in populations that followed low glycaemic index diets free of dairy products and fat, the absence of acne was observed. In the same populations, recent studies have shown an increase in the incidence of acne when western diets, rich in high glycaemic index foods, were adopted.
Choosing low glycaemic index foods and reducing dairy and fat consumption may therefore be helpful in controlling acne.
Treatments and remedies
The treatment of acne varies according to severity. In mild cases, topical products can be used based on salicylic acid or niacinamide and retinol, which help maintain the skin barrier, and zinc gluconate, which exerts a sebum-normalising action and controls the superficial microbial flora. The use of sebum-balancing cleansers is also recommended, provided they are formulated without the use of aggressive substances and respect the skin’s hydrolipid film.
A valid support to both the pharmacological and dermocosmetic protocol is the use of probiotic-based food supplements that help restore the balance of intestinal bacterial flora. Taking care of one’s gut is in fact essential to combat inflammatory skin conditions, including acne.
In the case of acne-prone skin with moderate to severe lesions, it is necessary to undergo a clinical evaluation as part of a visit with a dermatology specialist, following which the doctor may prescribe an oral or topical treatment with antibiotics to fight bacteria and reduce inflammation, or with retinoids that promote proper keratinisation processes and reduce inflammation. In the case of acne caused by hormonal imbalances, myo-inositol, which is particularly indicated in women with acne caused by polycystic ovary syndrome (PCOS), also helps to reduce androgen levels.
To eliminate pimples and reduce the severity of acne, laser treatment, which reduces the secretion of oils by the sebaceous glands, is now also available.
Useful tips
Whatever the cause of the acne or the type of lesion, it is important:
- Avoid touching or squeezing the lesions, as the risk of aggravating inflammation and causing scarring is high.
- Carry out a daily skincare routine, cleaning the face gently, in the morning and in the evening, with products suited to your skin type. In the morning to remove sebum and dead cells deposited on the skin during the night, in the evening to remove dust and traces of make-up.
- Moisturising the skin. As we have seen, moisturising acne-prone skin with a specific product is very important to prevent the sebaceous glands from producing more sebum.
- Apply non-comedogenic and hypoallergenic make-up.
Sources:
https://www.niams.nih.gov/health-topics/acne
https://www.adoi.it/wp-content/uploads/2022/09/DERMATOLOGY-REPORTS-5%C2%B0USCITA.pdf
https://pubmed.ncbi.nlm.nih.gov/17448569
https://www.ide.it/come-il-fumo-di-sigaretta-influenza-la-tua-pelle