Acne - Causes and Treatment

Acne vulgaris is a juvenile or the most common skin disease in the world.

It is estimated that up to 85% of adolescents have acne in some degree. But also up to 10% of people over age of 50 complain of the presence of blackheads and pimples.

Although causing few complications, acne (particularly facial acne) in severe cases, can wreak havoc on self-esteem and social life of young people. The lack of treatment or inadequate treatment can leave stains and unsightly scars.



Acne vulgaris is a disease of the pilo-sebaceous follicles. Let me explain:

The pilo-sebaceous units are just below the skin surface, and there are some on the face, back and chest. They consist of a hair follicle, which is where the hairs are born, and a sebaceous gland, responsible for the production of sebum, a fatty substance responsible for skin hydration.

The process of acne formation begins when there is obstruction of the channel of the follicle, preventing the drainage of sebum to the skin. Normally this obstruction occurs when there is a large production of sebum combined with dead skin cells. The junction of these two forms is a stopper or cap called comedo. When you squeeze a blackhead the white substance comes out with a black tip, and it is nothing more than the comedo.

During adolescence, the increase in sex hormone stimulates increased production of sebum by the sebaceous glands, thus favoring the formation of blackheads.

The comedones are excellent medium for bacteria that normally live on the surface of our skin, called Propionibacterium acnes. The p.acne invades the follicle and feeds on the fats in sebum, to proliferate and cause infection of the pilo-sebaceous unit. From now on, a person has no longer a harpsichord composed of the comedone and a pocket of pus around.

Patients with severe acne are those that have sebaceous glands hyper-responsive to sex hormones, especially to testosterone.


As have already been mentioned, hormonal changes are responsible for the stimulation of sebaceous glands and the formation of comedo. Genetic factors contribute to high probability of acne emergence in those people who have greater hormonal response to this stimulus.

It is therefore not surprising that adolescents, pregnant women, hormonal fluctuations by changes in birth control, women with polycystic ovaries and users of anabolic steroids have an increased risk of developing acne.

Some drugs such as steroids (cortisone) are structurally similar to sex hormones, and therefore also facilitate the appearance of pimples and blackheads.

Substances and oil-based cosmetics may favor the appearance of acne. Give preference to the water-based products, labeled as non-comedogenic. Although it is a fact that there is no evidence there is correlation of acne with food.

Another known myth is that acne is caused by lack of hygiene of the skin. In fact, wash skin with soap and water actually reduces oiliness, however, does not prevent the sebaceous gland from production of sebum. After a few hours of cleaning, the skin is already oily again and repeated rub may even worsen the injury.

This in no way means that one should not bathe with soap every day, just do not expect that only this solves the problem of pimples. Periods of psychological stress seems to contribute to a worsening of the lesions. In overweight women, irregular menstrual cycle, abnormal distribution of hair and acne, you should think of polycystic ovary syndrome.


Acne is most common in areas where there is a greater presence of sebaceous glands, especially on the face, neck, back, chest, shoulders and upper arms.

The severity of acne is graded as:

• Grade I - Presence mostly of comedones and occasionally some pustules (pimples).
• Grade II - Comedones and pustules in larger quantities, especially on the face with the possibility of scarring.
• Grade III - Numerous comedones and pustules diffuse across the face, shoulders and trunk. There may be lumps and cysts. Scarring is common.
• Grade IV - Numerous cysts and nodules and severe scarring.

There is also a rare and most severe form, called acne fulminans which goes with fever and lesions in the bones, kidneys, and sepsis.


Acne treatment depends on the extent thereof.

General measures

• Avoid squeezing the pimples and blackheads
• Wash your face daily, preferably with specific products for acne. Use special soaps for the face. Avoid using products that help scrub
• Avoid sun exposure, especially if you are dealing with acne medications.
• Avoid excessive makeup and do not go to bed without first removing it
• Avoid tight or too warm clothing
• Take a shower after exercising

Grade I - Acne comedonica

The goal is to decrease the formation of comedones. The treatment is Tazarotene, Adapalene or retinoic acid. Soaps made of salicylic acid and azelaic acid may also be used. In more resistant cases the manual extraction of comedones by qualified professionals (facial) may be required.

Moderate acne - Grade II

In this case those, already infected by P. Acnes, need drugs with antibacterial activity. The scheme includes the most commonly used benzoyl peroxide and an antibiotic.

Moderate to severe acne - Grade III and IV

In the topical case oral antibiotics and Isotretinoin (Accutane) are required. In women the use of some types of birth control pills can help a lot.


The Accutane is a potent drug for the treatment of moderate and severe acne but has a range of side effects.

Isotretinoin decreases the size and sebum secretion of the sebaceous glands and decreases the accumulation of skin cells in the channel. Thus it acts on the factors that contribute to the formation of comedones.

Roaccutane is contraindicated in pregnancy by causing severe malformations in the fetus. So it should be used with caution by women of childbearing age. Ideally it good is to associate the pill and pregnancy testing monthly.

The Isotretinoin can also cause skin lesions, especially if there is sun exposure. Reduction of sebum production, may be associated with dry skin.

Other complications include: joint pain, decreased night vision, drug-induced hepatitis, bone marrow suppression and increase in triglycerides.

The famous relationship between Roaccutane and depression / suicide established during the decades of 80/90 has been challenged by recent work. Currently it is assumed that this hypothesis is not as certain as it was.