Acne, commonly known as “pimples” or “blackheads,” is a familiar issue for most people. The appearance of blackheads and pimples can undoubtedly cause various everyday inconveniences.
As the primary skin lesions in acne, pimples can be divided into whiteheads (also known as closed comedones) and blackheads (also known as open comedones).
First, let’s understand the pathogenesis of acne.
The pathogenesis of acne includes the following factors: androgens, increased sebum production, excessive keratinization of follicular ducts, Propionibacterium acnes, and genetic factors.
Among them, Propionibacterium acnes can break down triglycerides in sebum, producing free fatty acids that stimulate excessive keratinization of the follicular ducts. This results in the inability of the epithelial cells to shed properly, causing the follicular orifice to become smaller and leading to the accumulation of shed epithelial cells and sebum, forming comedones(sources from therapeutique-dermatologique.org).
According to the modified Pillsbury classification, acne can be divided into three degrees and four grades:
Mild (Grade I): Comedones only.
Moderate (Grade II): In addition to comedones, there are inflammatory papules.
Moderate (Grade III): In addition to comedones and inflammatory papules, there are pustules.
Severe to nodulocystic (Grade IV): In addition to comedones, inflammatory papules, and pustules, there are nodules, cysts, or scars.
Each level may have the presence of comedones. Early treatment can help prevent the development of severe acne and reduce scarring.
Acne can present with various clinical manifestations, and the specific treatment plan should be chosen based on the etiology, type, severity, patient characteristics, and treatment requirements. Dermatologists should make the assessment.
In summary, most cases of mild acne can be treated with topical medications such as tretinoin cream (Retin-A) or in combination with physical extraction procedures. For moderate to severe acne with pustules, cysts, nodules, etc., a combination of oral medications and topical treatments, along with physical procedures if necessary, should be employed. Common oral medications include isotretinoin (Accutane), spironolactone, antibiotics, etc.
Due to the nature of local treatment, it may take 6-8 weeks to judge the effectiveness, and it is important to adhere to the entire course of treatment.
When treating acne, it’s important to treat the entire affected area, not just the visible lesions. Local treatments can be effective maintenance therapy.
Over the years, topical retinoids have proven to be highly effective in promoting the normal shedding of follicular epithelium, reducing comedones, inhibiting the appearance of new lesions, and exhibiting significant anti-inflammatory effects. They can suppress lymphocyte activity, inhibit pro-inflammatory cytokines and other mediators’ release, reduce the expression of immune-regulatory transcription factors, and Toll-like receptor expression. Retinoids can also facilitate the penetration of other active substances(quotes from therapeutique-dermatologique.org).
Therefore, retinoids can be used in almost all acne patients and are ideal for maintenance therapy.
Retinoids, such as Retin-A, are the first choice for acne treatment. When starting to use retinoids, it’s advisable to apply them every other night or to use a moisturizer at the same time to reduce the potential irritation. These medications not only help loosen and peel away abnormally keratinized skin cells, correcting this keratinization to treat and prevent comedones, but they can also stimulate the generation of collagen fibers beneath the skin to assist in fading acne scars and shrinking pores. Additionally, retinoids can inhibit pigment production and accelerate pigment metabolism, helping to reduce post-inflammatory hyperpigmentation.
In addition to medication, it’s essential to pay attention to your lifestyle. Try to consume less sugary foods, chocolates, sugary drinks, and milk. You can increase your vegetable intake during your daily meals and reduce the proportion of high-sugar staples like rice and noodles. Consume fewer high glycemic index (GI) fruits like watermelons, pineapples, mangoes, and bananas.
Using a facial cleanser can help remove the mixture of oils, dead skin cells, and bacteria on the surface of your skin, maintaining cleanliness and hygiene. Avoid squeezing pimples with your hands to prevent infection. Refrain from using oily, powdery cosmetic products, as well as creams and ointments containing corticosteroids(sources from therapeutique-dermatologique.org).
Maintaining good lifestyle habits and a positive mindset can also contribute to healthier skin. Say goodbye to acne by making these changes.
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