Acne Vulgaris

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
• In adult acne, emotional stress plays a role in 25.7-71%
• Cosmetic ingredients such as lanolin, isopropyl myristate, cetyl alcohol and stearic acid have comedogenic properties. Certain greasy sunscreens commonly worn by women are also culprits for causing comedonal acne

The relationship between diet and acne has long been debated. Several studies have confirmed that a diet high in sugar and dairy products can be risk factors for acne. Increased sugar intake, frequent consumption of soft drinks are significantly associated with acne. A diet with a high glycemic load can lead to increased sebum production and promote the development of acne.

Moreover, a positive relationship has been shown between the consumption of whole milk and skim milk and the incidence of acne.

Other factors also contribute to the development of acne. Fatty foods, such as fast food can promote the release of free fatty acids, which can stimulate the development of acne. Increased sugar intake (≥100 g/d), frequent consumption (≥7 times per week) of soft drinks (such as carbonated soft drinks, sweetened tea drinks and fruit drinks) were significantly positively associated with acne

However, there is no clear evidence for the influence of spicy foods on acne. Although some studies have found a link between spicy foods and acne, other studies have reached different conclusions. More research is needed to further understand the relationship between spicy foods and acne.

Acne and high-dose vitamin B6 and B12 supplements :

High doses of vitamin B6 have been linked to acne breakouts Vitamin B6 is involved in the production of hormones that regulate sebum production. Too much vitamin B6 can lead to an overproduction of sebum, which can contribute to the development of acne.

Vitamin B12 is an essential vitamin necessary for the production of red blood cells and the functioning of the nervous system. There is some evidence to suggest that vitamin B12 may play a role in the development of acne.

High doses of vitamin B12 have been linked to acne outbreaks. It is not clear how vitamin B12 causes acne, but some studies suggest that it may increase sebum production and affect bacteria on the skin. More on vitamin B12 and acne.

Iodine-related acne may be related to the use of kelp supplements and recognizable as monomorphic, inflammatory pimples on the face and upper trunk.

Whey protein supplements, derived from milk and used for bodybuilding, are associated with papulonodular acne affecting the torso and sometimes the face.

Finally, acne induced by the use of anabolic steroids such as acne fulminans, acne conglobata and acne papulopustulosa are described.

Acne comedonica: is a form of acne that mainly consists of closed comedones (subcutaneous, white bumps) and open comedones (blackheads). Little to no inflammation is visible.

Acne excoriee des jeunes filles: is actually not really a form of acne, but is scratching spots, bumps or pimples. This ensures that the skin is damaged and appears irritated, while this has been applied by the person himself.

Acne neonatorum: is a pustular rash, with blackheads (comedones) in a newborn. It usually begins several weeks after birth. And after a few (1-3) months, it disappears on its own without scarring. It is located mainly on the head (forehead and cheeks).

Cause of acne neonatorum: is unknown, but is thought to be an acne-like rash caused by androgen hormones, either from the mother or produced by the baby itself.

Acne tarda: Late acne (acne after adolescence) is divided into persistent stubborn 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.

Cause acne tarda: hormonal is often the cause. Significantly high (dehydroepiandrosterone sulfate) DHEAS levels were found in 39.6% of cases, followed by androstenedione in 21.3% and total testosterone in 10.7%. Medications such as (corticosteroids, Mirena spiral), genetic predisposition and Vitamin B12 supplement can cause acne. Also underlying conditions such as: PCOS (Polycystic ovary syndrome), Primary ovarian insufficiency (POI) – premature menopause before the age of 40 and Cushing’s syndrome – caused by endogenous factors such as chronic overproduction of glucocorticoids or by external factors such as long-term medical treatment with corticosteroids or ACTH .

Acne inversa/hydradenitis supperativa/acne ectopica: is chronic inflammation arising in the hair follicles, especially in the armpits and groin. Less common sites include the buttocks, perianal area, pubic area, under the breasts, neck, ears, chest, back, body flanks, and navel. It is slightly more common in women than in men. In women it is often in the groin area, in men more often in the perianal area.

Cause acne inversa: smoking, genetic, overweight sweating, heat, overheating (in body folds), mechanical irritation such as tight clothing, friction from clothing, certain activities such as cycling and horseback riding. A large proportion of patients smoke and this percentage rises to over 95% in the group of patients with severe acne inversa. . There is an association with Crohn’s disease, diabetes, and (rheumatoid) arthritis.

An interesting French study from 2016: they suggest that a brewer’s yeast-free diet can be part of the treatment of acne inversa. Brewer’s yeast free diet meant no bread, wine, beer, pastries, fermented cheeses and pizza for 3 months. They saw less inflammation and flare-ups, but unfortunately the improvement wasn’t for everyone.

More about: hydradenitis suppurativa

Acne conglobata: is a severe inflammatory form of acne that can start in adolescence and often continues after the age of 20. Not infrequently, the condition lasts until the age of 40. Acne conglobata can occur in young people who already have acne, as well as in young adults when the original teenage acne has cleared. Acne conglobata occurs mostly in young men. Due to the long duration of the disease and severe inflammation, deep disfiguring scars may appear later.

Cause acne conglobata: It is still not entirely clear why some people get acne conglobata and others do not. It is probably related to testosterone levels in the blood, as the disease is more common in men. Acne conglobata is also common among bodybuilders and men using anabolic steroids. In rare cases, acne conglobata occurs in people with a tumor that produces male hormones.

Acne fulminans: if the inflammation of acne conglobata becomes more intense, acne fulminans may appear. This is an acute situation where pimples and acne suddenly begin to swell, turn red and hurt more intensely. Fever and general malaise are also common. The condition usually affects young males, mainly of the white race, between 13 and 22 years old. Most of these men have a history of acne.

Oorzaak acne fulminans: is a rare skin disease, with an estimated 200 cases documented worldwide.
As a result, the cause cannot be properly investigated. Acne fulminans can be caused by high doses of isotretinoin early in acne treatment. Elevated testosterone levels may also play a role in pathogenesis. Anabolic steroids are known to increase sebum production and the density of Cutibacterium acnes bacteria. Bodybuilders who use anabolic steroids develop acne in a very short time. Finally, a genetic predisposition has also been described. The skin condition may be part of synovitis, acne, pustulosis, hyperostosis and osteitis syndrome (SAPHO syndrome), pyogenic arthritis, pyoderma gangrenosum and acnes syndrome (PAPA syndrome).

Acne rosacea: is a bit confusing because rosacea has nothing to do with acne. It literally means “red like a rose” in Latin. It can be recognized by a striking red color of the nose, cheeks, forehead and chin. In addition, accompanied by pimples, bumps and thickening of the skin. Rosacea occurs later in life than pimples, usually between the ages of 30 and 60 and especially in women.

More about rosacea

Clinically, open and closed comedones, inflammatory papules, pustules and cysts can be seen in patients with different forms of acne.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.