Tackling Acne

Published in "Panorama"


Emotional Support Important in Acne Treatment & Management




The 19 year old newly wed bride was distraught, fearful of her spouse, of people known and unknown to her! Her self esteem and confidence were at their lowest and she shied away from meeting people. The reason for her trauma – those angry looking spots on her face which chose to multiply as her wedding date drew near. “This is typical of youngsters with acne – the emotional and psycho-social damage they suffer is often much worse than the physical scars that severe acne might leave on their faces,” says Dr.Ikramullah Nasir, Specialist Dermatologist and Cosmetologis, Medlink Clinic Dubai.

The common type of acne, acne vulgaris which consists of plugged pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules), mainly affects adolescents passing through puberty, usually from 10-17 years in females and 14-19 years in males, but may persist or even become more severe in adulthood, according to Dr.Samer Kudsi, Consultant Dermatologist and venereologist, International Private Hospital, Deira.

Explaining the course of acne, Dr.Kudsi says, “Acne vulgaris may occur on the Face, shoulders, back and chest, in this sequence, areas which have the fat producing glands. Acne is inflammation of the unit which secretes fat. Because in young people, passing through puberty, the body starts to secrete excessive amounts of the male hormones androgen, present in both men and women. This excessive amount of hormones leads to increased sweating and fat. Sometimes the secretion of fat is more than what the body is able to expel, leading to retention of fat inside the skin making for inflammation. After a period, this is invaded by bacteria and infection happens. During adolescence, acne is seen to be more severe in males than females because they have more of the hormone which lead to more fat secretion. Acne usually becomes less of a problem after the age of 25 years, although about 15% of women and 5% of men continue to have acne as adults.”

Clarifying further, Dr.Nasir explains, “It is a myth that people attribute acne to abnormal hormonal activity. Two individuals having similar levels of hormone can have two different activities of the oil glands. People can have very normal levels of hormone but extra sensitivity of the oil glands to this, is what triggers acne.”

Family background or heredity plays a very important role, particularly in severe forms of acne, according to the specialists.

Stress and tension increase the hormones in the body which in turn increases the fat secretion and perspiration. Both these factors aggravate acne. Dr.Kudsi emphasizes, “Therefore we see very often that there is a worsening of acne during exam time in youngsters. Also, many youngsters have the habit of leaning their face on the palm of their hands for long periods of time. This can aggravate acne by obstructing the pores of the skin, preventing ventilation to the region.” Humidity is another contributory factor to triggering or worsening acne, says Dr.Nasir. Acne may increase before or during the monthly cycle of females as a result of increased hormones present at that time.

Indiscriminate use of cosmetics – creams, lotions, moisturizers, foundations, and the whole range of them, can actually worsen acne by blocking the skin pores, opine the specialists. Some people may suffer from very severe acne due to Polycystic ovaries, deficiency of the Enzyme sterol hydroxylase which is a very rare occurrence and excessive use of corticosteroids as used to treat Cushing's disease which is again a very rare condition.

Contrary to common belief, acne is not caused by eating oily foods, soft drinks, or chocolates, emphasize the doctors.

Treatment of acne according to Dr. Kudsi depends on the stage of the acne. “Simple acne doesn’t need any treatment specially in young age of 12 or 13. We have classification for acne, 1st, to 4th degree acne. First degree we call white head and black head; it doesn’t need any treatment except using mild soap to remove the oily texture of the skin.”

“2nd degree is characterized by inflammatory papules made up of red pimples. I would give topical treatment for this condition. 3rd degree involves acne in pustules form where the red pimples have yellow heads with pus. This is infected acne which need treatment with oral antibiotics and topical application. The 4th degree, cystic acne is a 1-2 cm thick acne under the skin. This would require systemic treatment with stronger medicines because this type of acne can cause very bad scarring which may become permanent. This form of acne you feel it more than you see it; the skin is red and some areas are elevated.”

A few words of caution from the doctors:
1. First of all, go as early as possible to the doctor when you spot an acne; don’t go when scars start appearing. Sometimes it may be too late to remove the scars by whatever technique; even now the laser machines will not improve the condition more than 60% and the original skin texture may not be gained.
2. For those predisposed to acne who have family history of acne, don’t use any form of cosmetics except those prescribed by your doctor.
3. Don’t restrict your diet, specially young people, thereby starving your body of essential nutrients.
4. Use tepid water to wash face and body and not use extreme temperatures of water, because these can cause dryness of the skin. And when there is dryness of skin, the tendency is for applying moisturizers which may not be suitable.
5. To avoid acne, use warm water, mild soap twice a day to wash face and olive or almond oil may be applied twice a week, allowed to remain on the face for not more than half an hour. Then wash it off with mild soap before going to bed. Don’t allow any cream or oil to remain on face overnight since these will clog the pores and aggravate acne.
6. Sleep with clean face, never with an oily face.
7. Don’t squeeze the pimples because they tends to force the oil and bacteria into the deeper skin layers, making cysts more likely to occur.
8. Don’t scrubbing your skin excessively since this actually irritates the skin and increases the number of loose skin cells, leading to increased pore clogging. Anything that puts pressure on, or rubs the skin excessively will aggravate acne.

Severe acne, which generally has a poor response to treatment, has plenty of psycho-social impact on the patients. Unfortunately this is the most ignored aspect of acne management, says Dr.Nasir. “Firstly, what is important to know is that acne, whatever form, is NOT contagious. Secondly, there is no need for people, all and sundry, to sympathise with acne sufferers. I have seen young girls avoid social gatherings because they are afraid of facing the people who are full of queries, concerns and solutions for their acne! This will only severely affect and traumatize the individual with acne. These victims generally show an introverted personality, display lack of interest in their surroundings, are withdrawn and have very low levels of self esteem and confidence.

The important message is that young people should not look upon acne as something unusual happening to them. It is natural and normal as they pass through adolescence and they should be prepared for it by their family physicians, paeditricians, family members and educational institutes where they study and are most likely to be ridiculed by peers and others. Emotional support is more important in the treatment and management of acne than medication and physical treatment.”


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