Acne vulgaris is the medical term for pimples. Almost everyone has pimples to a greater or lesser degree. It is an inflammation of the hair-talgland complex. The causes include four main processes: overproduction of androgens, excessive sebum production, inflammation and proliferation of Cutibacterium acnes (formerly Propionibacterium acnes). Clinically, open and closed comedones, inflammatory papules, pustules and cysts can be seen in patients with different forms of acne. These different forms of acne require different treatment strategies.
1. Blackheads: open comedones or black heads
Called open comedones, they get their name from the fact that they appear as a black spot on your skin.
Comedones start just like any other pimple: Excess skin debris (also known as keratin) mixes with overproduction of sebum — the natural oil in your skin — clogging your sebum drain.
What makes open comedones different is that the pore is open to the air. Oxygen from the air causes a chemical reaction — oxidation — with the material in your pore, turning it black.
How to treat.
Focus point is to make sure the sebum can get out easily. Agents such as fruit acids (AHA / glycolic acid), salicylic acid, benzoyl peroxide, retinol, tretinoin and adapalene, ensure that your blackheads are unclogged, as it were. This prevents the formation of blackheads.
2. Blackheads: closed comedones or whiteheads
Whiteheads, also called closed comedones, are similar to open blackheads, except that instead of being open, the pores are closed by a layer of skin.
How to treat.
It is very tempting to squeeze out the whiteheads, to snap them. Try to avoid this to avoid scarring and slow down the healing process.
As with blackheads, the best treatment is to wash your face with glycolic acid, for example, and use oil-free, non-comedogenic products (skin and sun protection).
Pimples initially contain fluid and later pus. They appear as large white bumps surrounded by red, inflamed skin. Usually causes bacterial growth (cutibacterium acnes) in clogged follicles. These bacteria thrive in low-oxygen environments.
How to treat.
Smaller pimples may go away without treatment, but you can also use topical benzoyl peroxide, tretinoin, or adapalene. They are mainly antibiotics that inhibit the growth of bacteria. This can be done topically such as clindamycin or erythromycin lotion or antibiotic tablets (minocin, doxycycline). For extensive and moderately severe acne, a combined treatment is chosen, for example adapalene and antibiotic tablets. Both can reduce inflammation and kill bacteria growing in the follicle and on the surface of the skin.
Papules are firm, raised spots that are usually less than one centimeter in diameter. They can have different shapes and colors. They start out firm, and after a few days can become full of pus and become a pimple.
How to treat.
Here it is important to avoid further irritation in the area. Do not exfoliate your skin and be careful when cleansing with warm water. You can wash your face with a glycolic acid cleanser.
It is wise not to apply makeup on papules so that the area does not close off too much. Bacteria can thrive in an enclosed area and cause inflammation.
Cystic acne is considered the most severe form of acne. Like pimples, cysts are caused by clogged pores under the skin’s surface. They contain fluid or pus and can be large and red and are usually painful. This type of acne produces scarring in the form of dents in the skin. Sometimes hypertrophic scar and in severe situations keloid (thickening outside original site) formation.
How to treat.
In this situation, proper treatment can be obtained from a dermatologist to reduce or prevent permanent scarring. Internal antibiotic therapy or even isotretinoin tablets are an option. A corticosteroid cream is often given with it to “cool” the inflammation externally
Isotretinoin (contains vitamin A) is a drug that suppresses sebum production. In addition, isotretinoin has an inhibitory effect on the cornification in the drainage duct of the sebaceous gland and suppresses the inflammatory response. The most common side effect is dehydration of the lips, nasal mucosa, eyes and skin. Sometimes liver enzymes and fats in the blood may rise during treatment. Therefore, blood tests are needed. Isotretinoin has serious risks when used during pregnancy.
Myths about acne
Acne is not contagious; it is not transmissible to anyone else.
An allergy to food is not the cause of acne.
Chocolate has not yet been well established to cause acne. Studies on this are conflicting.
Poor hygiene is not related to acne. However, it is better to wash your face with a mild cleanser twice a day instead of once a day.
Taking extra mulitvitamins does not improve acne. An excess of vitamin B12 can even aggravate pimples. Learn more about vitamins, what you didn’t already know. Vitamins are not the same as minerals such as zinc, copper, calcium, etc.
After puberty, acne disappears like snow in the sun. At 25-75% of 12-25-year-olds and 10% of 30-40-year-olds suffer from pimples.
Having acne does not represent anything. Acne can lead to many psychological problems such as depression, social isolation, obsessive hygiene behaviors such as washing face with soap many times a day and even increased suicidal thoughts and attempts among young people.
What can the skin therapist do for you?
In addition to the medicinal treatment of acne, the skin therapist can also apply treatments for acne.
- Chemical peeling: With a chemical peeling, the top layer of skin is thinned. This stimulates exfoliation of the skin, dissolves sebum and inhibits inflammation. Red spots, which often remain after acne, also become lighter and the skin gets a better condition in general.
- Manual (manual) cleaning: The skin therapist cleans the skin and frees it as much as possible from blackheads and inflammation.
- Product advice for at home.
For more advice, please contact our skin therapist. She can give advice on products that you can use at home and which treatment options are suitable for you.
Xu S, Zhu Y, Hu H, et al. The analysis of acne increasing suicide risk. Medicine (Baltimore). 2021;100(24):e26035.
Choi JM, Lew VK, Kimball AB. A single-blinded, randomized, controlled clinical trial evaluating the effect of face washing on acne vulgaris. Pediatr Dermatol. 2006 Sep-Oct;23(5):421-7.
While you’re here
Dermatitis perioralis is a rash most commonly seen in women between the ages of 16 and 45. But children between the ages of 7 months and 13 years are not spared either. The skin condition consists of small inflammatory papules and pimples and/or red/pink scaly areas around the mouth or eyes. For more info: Dermatitis perioralis