Acne vulgaris

Acne is a very common skin condition that is accompanied by pimples, pustules and comedones (blackheads). Young people are particularly affected. After a few years, the acne usually disappears on its own. In many cases, treatment with medication is recommended.

Overview: What is acne?

Common acne (acne vulgaris) is a chronic, inflammatory skin disease with pimples, comedones and pustules. The skin on the face and neck, which is rich in sebaceous glands, is affected, often also on the chest and back. The skin disease typically breaks out during puberty and then usually subsides spontaneously.

Illustration acne

In addition to this “typical” acne, there are also some special forms that differ in terms of the trigger, type and severity of the inflammatory skin changes. These include, for example:

  • Acne inversa: Not actually a form of acne, but a disease of the terminal hair follicles. Abscesses occur, typically in the large skin folds (e.g. under the armpits, under the breast in women, in the groin and anal region).
  • Acne fulminans: Severe form of acne that progresses rapidly and violently and affects the whole body, for example with high fever, joint inflammation and swelling of the spleen and liver. Male adolescents are particularly affected.
  • Acne tarda: This late acne is when acne symptoms persist or appear for the first time after the age of 25. The skin of the mostly female sufferers is characterized by deep, persistent inflammation, especially in the lower facial area.
  • Acne neonatorum: Mild form of acne in newborns, i.e. babies in the first 30 days of life. Boys are particularly affected.
  • Acne infantum: Rare form of acne in infants and small children, again preferably in boys. The inflammatory skin changes form after the 2. to 3rd month of life.
  • Acne aestivalis: This acne-like variant of “sun allergy” (polymorphic light dermatosis) is also known as Majorca, spring or summer acne. It usually first appears between the ages of 20 and 40 in connection with high UV radiation and/or the use of oily sunscreens. In the fall, Mallorca acne usually subsides spontaneously.
  • Acne venenata: This “contact acne” is triggered by chemical compounds that are “comedogenic”, i.e. promote the formation of blackheads. These include, for example, chlorinated hydrocarbons (chloracne), lubricating oils (oil acne), tar (tar acne) or cosmetics (cosmetic acne = acne cosmetica).
  • Acne medicamentosa: Acne or acne-like skin changes triggered by medication, for example glucocorticoids (steroid acne), anabolic steroids (doping acne), certain antibiotics, B vitamins and barbiturates (sleeping pills and tranquillizers).

Acne – frequency and age

Acne is the most common skin disease worldwide. On average, around 70 to 95 percent of all young people are affected. However, only in 15 to 30 percent of cases is it severe enough to require medical treatment.

Common acne usually begins between the ages of 15 and 18. Males are affected just as often as females, but are more likely to suffer a severe course of the disease.

Acne: causes and risk factors

Various factors are involved in the development of common acne. This includes an overproduction of sebum: the sebaceous glands produce too much oily secretion, stimulated by male sex hormones (androgens such as testosterone), which are particularly produced during puberty (also by girls).

The androgens also trigger an increased formation of horny material (hyperkeratosis) in the skin. The horny material can block the excretory duct of a sebaceous gland. This creates a closed blackhead – a skin-colored to whitish, hemispherical sebaceous plug.

As the production of sebum continues, such a blackhead can become larger and larger and open up, forming an open blackhead whose central horn plug turns blackish when exposed to air.

Blackheads are a good breeding ground for bacteria: Bacteria of the Propionibacterium acnes type can multiply in the sebaceous glands. They metabolize the sebum and can trigger purulent inflammatory processes.

Other factors that can influence the development of acne include

  • Hereditary factors: Some sufferers have a hereditary predisposition to acne. The disease can then become more severe – especially if the mother had acne.
  • Smoking: Cigarette smoke is said to promote or worsen acne due to its pro-inflammatory ingredients. However, this is the subject of controversial debate among experts.
  • Medication: There are many drugs that can trigger or worsen acne, e.g. drugs for epilepsy (antiepileptic drugs) and anabolic steroids (muscle-building drugs).
  • Climatic factors: In individual cases, climatic factors such as UV rays and humidity can contribute to the development of acne.
  • Mental strain and stress: These are also thought to contribute to the development of acne. However, this has not yet been scientifically proven.
  • Diet: There are no specific foods that can trigger acne. However, eating a lot of milk and dairy products and consuming carbohydrates with a high glycemic index are obviously unfavorable for the skin. These are carbohydrates that cause the blood sugar to rise quickly and sharply (e.g. chocolate, chips).

Symptoms: Acne

The acne skin is greasy and oily-shiny and covered with numerous closed (white) and open (black) blackheads, so-called comedones. We speak of “acne comedonica” when the skin is mainly characterized by comedones. The blackheads can develop into inflammatory papules and pustules (“acne papulopustulosa”). Papules are pea-sized, hemispherical nodules that lie above the skin level. Pustules are “blisters” in the skin, up to 0.5 centimeters in size and filled with pus, which are surrounded by a ring-shaped reddening of the skin.

In severe cases, the disease develops into “acne conglobata”: here, blackheads, papules and pustules are joined by other skin changes such as large inflammatory lumps, encapsulated pus accumulations (abscesses), deep scars and crusts.

If it is the special form of acne fulminans mentioned above, other symptoms such as high fever and joint inflammation are also present.

Many acne sufferers not only suffer from the physical symptoms of the skin disease, but also from the associated psychological stress: if the face is covered in spots, blackheads and pustules, this can significantly affect self-confidence and impair quality of life.

Acne - diagnosis by a doctor

We usually recognize acne skin at first glance, especially when the blackheads, pimples and pustules appear during puberty. If we suspect that you do not have common acne (acne vulgaris), but a special form with an external trigger, we can ask you specific questions – for example about cosmetics and medication used or contact with tar or greases.

We can take a swab from severely inflamed areas of skin to examine it for a bacterial infection. Sometimes we carry out further tests, such as determining the hormone levels in the blood. This can be useful for women who only develop acne after the age of 25 and also show signs of “masculinization” (virilization) such as an irregular menstrual cycle and male hair (e.g. beard and chest hair). Affected women produce too many male sex hormones, for example due to adrenal gland disease or polycystic ovary syndrome (PCO syndrome). The latter is a common hormonal disorder in women.

Hormone levels are also measured in children who suffer from acne for more than 16 to 24 weeks after birth or who develop acne between the ages of three and seven.

Acne: prevention, early detection, prognosis

It is virtually impossible to effectively prevent the complex development of acne. You are most likely to be able to influence external factors that can contribute to skin disease. Here is some advice:

  • Do not smoke.
  • Avoid too much milk and dairy products and foods high in sugar. In general, it is good for your skin (and the rest of your body) if you eat a healthy and balanced diet.
  • Protect your (facial) skin from too much sun, heat and cold so as not to irritate it and thus promote skin problems.
  • Cleanse and care for your skin properly (e.g. with pH-neutral soaps without perfume and other additives, water-based creams).

Acne – progression and prognosis

Common acne is chronic. It usually begins during puberty and worsens in phases until it gradually heals on its own in late adolescence or early adulthood.

However, in 10 to 40 percent of those affected, acne persists beyond the age of 25 or only begins at this age. This late acne mainly affects women.

Acne: treatment is planned individually

The treatment of your acne depends above all on the form, severity and current status of the disease. Various medications are used, sometimes also physical therapies. In the case of acne with known external triggers, such as cosmetics or medication, these should be avoided if possible.

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