Acne, as it is obvious, is a sebaceous gland disorder. This means that the sebaceous glands are either functioning to aggressively or not enough, in the case of acne, its too aggressively. Acne is a chronic inflammatory disorder of the sebaceous glands that is caused by many factors and has many myths around it. It seems to be a topic that confuses the beauty industry and clients equally.
So here is what happens in your skin when acne shows up: every oil pore is accompanied by a hair follicle, when that hair follicle gets plugged with sebum(oil), dead skin cells, and bacteria called propionibacterium, or P.acnes bacteria. This is the kind of bacteria that can survive and actively grow without oxygen, so when the pore is clogged it is the perfect environment. The sebaceous gland doesn't stop producing sebum at this point, it continues to pump which causes more irritation and inflammation and it is mixed with pus, the by-product of the growing bacteria. This can produce potential ruptures leading to acne lesions.
There are several causes of acne, all of which can't be pinpointed exactly because it can be as simple as cleansing the skin properly, or changing your moisturizer or it can be a quite complicated situation like hormonal adult acne. And trying to get rid of it and keep it away! That's another story!
There are 4 grades of acne, grade 1 being the lowest level of acne and grade 4 being the highest, usually requiring medical attention.
Grade 1 acne is mild acne consisting of open and closed comedones(blackheads and whiteheads) scattered over less than half of the face or back. This is the least sensitive and can be treated easily at home with antibacterial cleanser and an astringent toner (no more than %2 salicylic acid for most acne treatments) and a moisturizer that controls oil production and contains acne fighting ingredients, salicylic is sufficient, but there are others on the market like benzoyl peroxide, which is only recommended for severe breakouts, as it dries the skin quite a bit.
Grade 2 acne is moderate acne that has more open and closed comedones than grade 1, and it present on on approximately half of the surface area and can consist of pustules(containing pus) and papules(not containing pus/blind pimple). This grade and be treated the same as above, and both grades can be treated by a licensed esthetician using mild cleansers, mild enzymatic peels and oxygenating products. The esthetician will to proper extractions to free the clogged oil without breaking the skin (this is why it is important to not pick at home!). Acne is quite sensitive so if you pick at it yourself and cause any breaking of the skin, bleeding, or transfer of bacteria then the acne will actually spread and get worse due to the aggression and spread of infection.
Grade 3 acne is moderately severe and is characterized by numerous open and closed comedones, papules, pustules and the occasional cystic acne pimple(quite large and painful). The skin surrounding the breakouts are frequently red and inflamed. Scarring will occur if lesions have been picked or opened and not treated with proper precautions. It is best to use the most gentle products for home care and consult a dermatologist if the symptoms remain the same or get worse.
Grade 4 acne is the most sensitive and painful. It consists of severe acne with pustules and papules, as well as cysts and open and closed comedones all over the face, neck and back and sometimes the chest. Larger cystic lesions can cause deep scarring in the skin leaving a "pit" like appearance. This type of acne should be treated at home with the utmost care and gentleness, and should be treated by a dermatologist. Keep in mind that when you see a dermatologist for acne such as grades 3 and 4 they will prescribe a medication, it could be topical or oral (usually Vit A ointments or Accutane(isotretinoin) which is a derivative of Vitamin A).
Acne can be caused by anything! Emotional stress, oral contraceptives, greasy or humid environment, improper skin care routine, steroids, hormonal changes, or even skin surface friction and irritations. One thing is for sure, acne is always caused by excess androgen (a male hormone produced in the adrenal glands of men and women). Hormonal acne usually shows itself around the jawline and mouth area, and one rule of thumb for noticing hormonal changes is if you have acne, superfluous hair(not esthetically pleasing like hair on the chin of a woman) and weight gain show up all around the same period of time, then you may want to get your doctor to check your hormone levels.
Treatments for acne include topical and oral and can either be used together or separately, depending on severity. Topical treatments typically include benzoyl peroxide(dries and exfoliates) and salicylic acid(mildly dries and promotes cell turnover by mild exfoliation). Other more severe treatments include other acids such as azaleic acid and glycolic acids that promote cell turnover by produce a more than mild keratolytic action(exfoliation), Retin-A which contains tretinoin(an ingredient from the same derivative as what is in Accutane) and topical antibiotics that can be prescribed by a physician.
As an esthetician, I work to treat the skin as gentle as possible and believe that the better you are to your skin, the better it will be to you. No matter your skin type or skin condition, I always recommend a very mild cleanser. Something that doesn't strip too much oil and moisture from the skin but cleanses properly. A gentle toner, and a moisturizer that helps to disinfect. If there are open lesions present, polysporin or other topical antibiotics that don't require a prescription will work to heal the openings. This isn't a replacement for treatments for grades 3 and 4 but can help. Tea tree oil is a great extra if you are looking for a more natural route, but keep in mind it will tingle a bit like an astringent.
Keep an eye out for the next series; skin types! And what routines and products are best for each type!
Always remember to cleanse, tone and moisturize! Why all three? That's for another post ;)!
Presley Charlotte :)
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