Acne Vulgaris
Acne vulgaris is the medical term for pimples (with adolescents). There is no other skin condition more famous than acne.
It mainly occurs during puberty in both males and females. The 2010 Global Burden of Disease Study found that acne vulgaris is the eight most common skin disease, with an estimated global prevalence (for all ages) of 9.38%.
It is often said that after puberty you will no longer get acne. The following figures have been published from an extensive survey of 1,013 men and women aged 20 and older to determine whether they have acne:
- 20-29 years: 50.9% (women) versus 42.5% (men)
- 30-39 years: 35.2% (women) vs 20.1% (men)
- 40-49 years: 26.3% (women) versus 12.0% (men)
- 50 years and older: 15.3% (women) versus 7.3% (men)
On this page you will find the following information about acne:
Dr Francis Wu on acne
Below explains Dr. Francis Wu briefly about the complaints, causes and solutions for acne
Acne vulgaris is the medical term for juvenile pimples. Pimples occur in almost everyone to a lesser or severe degree. However, research has shown that acne can cause emotional and psychosocial problems in many adolescents and young adults. In some cases, acne not only leads to feelings of shame and anxiety, but also to inferiority complexes and depressed moods.
A pimple is an inflammation of the hair-sebaceous gland complex. The causes include four main processes: overproduction of androgens, excessive sebum production, inflammation and proliferation of Cutibacterium acnes (formerly Propionibacterium acnes).
Other causes of pimples include:
- Use of medications such as lithium, corticosteroids, testosterone, and anticonvulsants
- Exposure to too much sunlight
- Use of masks, occlusive clothing such as shoulder pads, headbands, backpacks and underwired bras
- Endocrine disorders such as polycystic ovarian syndrome and even pregnancy
- Genetic factors Heritability estimates range from 50-90%
- There is a relationship between sugar/carbohydrates and acne
Clinically, open and closed comedones, inflammatory papules, pustules and cysts can be seen in patients with different forms of acne.
- Blackheads: Open comedones or black heads 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 up 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.
- Blackheads: Closed comedones, or whiteheads, are similar to open blackheads, except that instead of being open, the pores are closed by a layer of skin.
- Pimples, initially containing 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.
- Papules, are firm, raised patches that are usually less than an inch 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.
- 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.
Treatment of acne can vary. Below is a list of treatments based on different acne forms.
Open comedones / black heads: Focus point is to ensure that the sebum can easily come out. Agents such as fruit acids (AHA / glycolic acid), salicylic acid, enzoyl peroxide, retinol, tretinoin and adapalene, ensure that your blackheads are unclogged, as it were. This prevents the formation of blackheads.
Closed comedones/white heads: It is very tempting to pop the whiteheads. 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: 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: 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: In this situation, the right treatment can be obtained from a dermatologist to limit or prevent permanent scars. Internal antibiotics or even isotretinoin tablets are an option. A corticosteroid cream is often added to ‘cool’ the inflammation externally. Isotretinoin (contains vitamin A) is an agent 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 dryness of the lips, nasal mucosa, eyes and skin. Sometimes liver enzymes and fats in the blood can rise during treatment. That is why blood tests are needed. Isotretinoin has serious risks when used during pregnancy.
Tips when you have acne
Below are tips from Dr. Francis Wu when you have acne
Tip: check your muscle building supplement
There is strong indication that your muscle building supplements/shakes such as: whey powder, cow’s milk protein powder, soy powder, egg protein and wheat protein cause or exacerbate acne.
Advice: try to stop this for at least 3 weeks, the acne will stop better than with your protein supplement. Possibly that is the cause.
If the acne doesn’t get better after stopping for at least 3 weeks, start your protein shakes again. If acne does not get worse after restarting the protein shakes, you can continue.
Tip: chocolate is allowed - enjoy in moderation
Chocolate has always been seen as a contributing factor to the spread of acne. However, studies on the effect of chocolate on the skin condition are controversial and inaccurate due to the additional ingredients such as milk and sugar in bars and other chocolate products.
Opinion: Dark chocolate is better, it contains less sugar and milk.
Tip: Niacinamide for your acne skin
Niacinamide, also called vitamin B3, in a cosmetic skin care product can help reduce acne. Another beneficial effect is reduction of pigment spots (post-inflammatory hyperpigmentation) caused by acne.
Advice: use sun protection with mineral sunscreen during the day, combine a product with niacinamide twice a day. The niacinamide dosage in your skin care should be at least 4%.
Tip: zinc supplement
A 2020 study concluded that zinc supplement can help you reduce pimples.
Advice: stick to the recommended zinc supplement dose and try it for 3 months. It is wise to look for a combined zinc/copper supplement. Both minerals reinforce each other.
Tip: Cleanse your skin twice a day with a mild facial cleanser
A 2006 randomized study investigated the effect of facial cleansing on acne vulgaris in men.
Conclusion: Acne worsening was significantly observed in the once-daily study group. Significant acne improvement in the group who wash their face twice a day with a mild cleanser.
Advice: for both men and women, clean your skin twice a day with a mild facial cleanser.
The best products to care for your skin with acne
Below you will find some products against acne
- All products have the ideal pH 5 acidity – for good skin resistance and skin barrier.
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- Iconic Elements skincare has been named the Best Holistic skincare line 2022 by EU Business News.
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Acne FAQs
A 2006 randomized study, examined the effect of facial cleansing and acne vulgaris in men. The subjects washed their face twice a day for 2 weeks with a standard mild cleanser. Then they were divided into one of three groups. Group 1, wash face once a day. Group 2, had to wash face twice a day and group 3, had to wash face four times a day for 6 weeks.
Study Conclusion. Acne worsening was significantly observed in the once-a-day study group. Significant acne improvement in the group that washed face twice daily with a mild cleanser.
So cleanse face twice a day with a mild facial cleanser.
Late acne (acne after adolescence) is divided into persistent acne and late acne. Persistent stubborn acne, starting in adolescence and continuing into adulthood, is the most common form. Late acne first appears after age 25. Also known as acne tarda. The prevalence of acne is 3% in men and 11-12% in women. This percentage drops sharply after your 45th year.
Hormonal is often the cause, but also medicines such as (corticosteroids, Mirena coil), genetic predisposition and Vitamin B12 supplement can cause acne.
If over-the-counter anti-acne products and gentle cleansers don't work. Extensive acne on the face and/or trunk require a dermatological treatment plan to prevent acne scars.
One of the most common side effects of roaccutane is dryness of the skin and mucous membranes (lips, mouth and eyes). An option to alleviate these complaints is omega-3 oil. A dose of 1000 mg per day seems to help well.