Acne is a common and unsightly skin disorder, particularly common in adolescence. A quarter of adults also suffer from it. Its treatment is often local, and sometimes associated with general treatment (antibiotics, zinc or hormones).
What is acne?
Acne is an inflammatory disease of the pilosebaceous follicle that most commonly appears during puberty. Under the influence of male hormones in particular, the sebaceous gland produces more sebum, the follicular opening becomes blocked, and the comedo or black point is then formed . When it ignites, a red button appears and may become a source of complexity.
80% of adolescents have it. The first “acne breakouts” indeed occur at puberty. This is called polymorphic juvenile acne, because patients present different types of lesions.
A quarter of adults (especially women between 25 and 40) are also affected by this disease. We speak of late acne . In women, it is localized on the lower face and neck, under the ears, and is rather inflammatory. In men, acne is more localized in the upper back .
What are the different types of acne?
It also exists :
- Neonatal acne , infant acne and infantile acne . But these forms remain exceptional.
- Mild forms of acne can sometimes subside on their own;
- The moderate and severe forms generally leave scars because the lesions caused are deep. They must be taken care of.
What causes acne?
Acne is caused by skin changes and the proliferation of bacteria ( Propionibacterium acnes ) in the pilosebaceous follicle (hair and sebaceous gland).
In adolescents, puberty causes an increase in the production of sex hormones. This phenomenon stimulates the sebaceous glands which then secrete an excess of a fatty substance that lubricates the epidermis: sebum. We speak of hyper seborrhea (oily skin). When this sebum does not disappear normally, a comedone (small ball characteristic of acne) forms.
The role of male hormones in the appearance of acne (in women, these are the ovaries and adrenal glands) is no longer to be demonstrated, but it is also possible that the origin is medicinal, food, linked to stress, lifestyle …
Genetics are also a key factor . There are indeed family forms of acne: the probability of being affected by this skin disease is greater when one’s parents have suffered from it. And if two parents are affected, their child’s acne will be statistically more severe.
How do you know if you have acne?
It results in the appearance of closed comedones (microcysts or white spots) and open comedones (blackheads). They are most often found on the face (on the forehead, nose and cheeks), on the neck, shoulders, chest and back.
Other red and painful lesions can coexist with the comedones: papules (red, firm and painful pimples), pustules (larger elevations) and nodules; this is the stage of inflammatory acne.
Acne conglobata (nodulocystic)
In more severe forms, the lesions are deep and often infected. We then speak of acne conglobata , a form of severe acne that brings together fairly large nodules and cysts (a fibrous shell is present). It particularly affects young men.
Acne Fulminans (fulminans)
It is a rare form where the young acne patient (treated or not)presents a high fever, diffuse joint and muscle pain, a sudden extension of the lesions, which become very inflammatory, ulcerated, crusty and painful. This form of acne often impacts the general condition of the patient who must then be hospitalized.
The special case of excoriated acne
Excoriated acne is an anxiety disorder listed among the Repetitive Behaviors Centered on the Body (CRCC) which generally occurs in areas of “psychic vulnerability” (anxiety, mood disorders, etc.). The patient cannot help but touch or scratch their pimples, which promotes their inflammation and increases the risk of scarring. “Classic” acne treatments are often ineffective and psychiatric support is strongly recommended.
How to prevent acne pimples?
To prevent the onset of acne, it is recommended to avoid factors that promote skin lesions:
- Makeup that suffocates the skin;
- Aggressive or insufficient cleaning of the skin;
- The sun, which by rebound effect causes a strong production of sebum ;
- The tobacco…
- Apply care with previously washed hands and brushes ;
- To cleanse his skin every day (once or twice) with mild soap and rinse it well. Drying soaps (such as Marseille soap) or degreasing soaps stimulate the secretion of sebum, therefore the appearance of pimples;
- Not to abuse exfoliating creams or scrubs: removing the sebum leads to excessive stimulation of the glands which will produce more sebum;
- Not to pierce or remove blackheads yourself, or handle lesions (these actions could cause infection of the hair follicle and potentially serious complications).
Respect good food hygiene:
- Give preference to fruits and vegetables;
- avoid coffee and alcohol in excess;
- Avoid sweets and fatty foods as they set the stage for the development of the germs that cause pimples.
In women, certain contraceptives can worsen or, on the contrary, improve acne . It is essential to consult your gynecologist or attending physician in order to choose the most suitable contraceptive method.
How to diagnose acne?
There is no systematic examination to be carried out in case of acne. Before prescribing an anti-acne treatment, the dermatologist nevertheless takes into account:
- The person’s age (adult acne is often more stubborn);
- The age of the acne;
- The type of lesions and their severity (the dermatologist refers to the GEA (Global Acne Evaluation) scale which describes the severity of acne in grade 0 to 5);
- Previous treatments;
- The psychological impact and repercussions on daily life.
In adults, it is possible to confuse acne with rosacea (advanced rosacea which is accompanied by pimples).
Hormonal tests can then confirm the diagnosis of acne.
What is the most effective treatment for acne?
In front of any type of acne, medical follow-up is essential. Management of acne is often local and associated with general treatment (antibiotics, zinc or hormones). In October 2015, it changed following several controversies around certain drugs.
Different treatments depending on the severity of acne
“Small acne” on oily skin does not generally require medication. Local or topical care (in gels or creams) is preferred. There are 2 active ingredients effective in the treatment of acne: benzoyl peroxide and local retinoids . A third active ingredient, erythromycin (a local antibiotic), can be used, but its prescription is extremely limited (exceptional and of short duration because it can induce bacterial resistance to antibiotics).
The frequency of application of the treatment depends on the lotion used, the form of the acne and the tolerance of the patient. These local treatments are to be applied in the evening. In the morning, they are combined with a non-comedogenic moisturizer, to compensate for the drying effects of the treatment. It is also necessary to follow the correct hygiene of the skin with cleaning with gel or dermatological soap.
Moderate to severe acne
Local treatment is combined with oral antibiotics (cyclins or macrolides) to prevent the multiplication and activity of the microbes causing the infection. They are generally well-tolerated, but sun exposure should be avoided because there is a risk of photosensitization.
Only as a last resort, after the failure of other treatments, isotretinoin (a derivative of vitamin A) can be used, except in pregnant or breastfeeding women. Its prescription is finally very limited because of potential side effects on women and their unborn children.
In resistant acne
In very severe forms or with risk of scarring, isotretinoin (by mouth) is prescribed . Very rigorous biological monitoring (lipid balance, transaminases, carrying out pregnancy tests before, monthly during treatment and then one month after stopping it, etc.) and clinical monitoring must be ensured by the doctor. Of serious side effects may indeed occur in women (psychological disorders in depressive particular), but also with his unborn child. In a press release published on February 18, 2021 (source 1), the ANSM, the National Medicines Agency, underlines the risk of serious malformations (abnormalities of the brain, face or heart) and of neurodevelopmental disorders in patients. baby(mental retardation or retardation of motor functions, etc.).
Contraception is therefore compulsory throughout the duration of treatment for women of childbearing age. ” If a pregnancy is discovered or if the patient thinks she is pregnant, the treatment must be immediately stopped and the patient must be sent to a specialist or competent in teratology for evaluation and advice”, specifies the ANSM. In an opinion published on May 5, 2021 (source 2), it also recommends that the monthly visits “be extended to all patients, including men, in order to ensure better monitoring of the risks associated with the treatment”.
In addition, isotretinoin must be systematically combined with moisturizing care for the skin and lips .
In case of pregnancy or breastfeeding
During pregnancy , most women who have acne have had it before. But the course of the disease is variable: some women notice an improvement or the absence of changes during pregnancy, others see this disorder worsen.
According to the Reference Center for Teratogenic Agents (CRAT), only certain molecules can be used:
- Topical benzoyl peroxide regardless of the term;
- Zinc from the 2nd trimester, paying attention if there is another “poly vitamin” supplement;
- Oral erythromycin, only when needed.
- Reminder: taking isotretinoin is prohibited!
In case of scars
The more acne reaches the deep layers of the dermis, the longer it lasts, the greater the risk of scarring. And it is very difficult to make them disappear when they have been installed for over a year. It is, therefore, best to avoid the appearance of scars as much as possible.
Their support depends on the type of scar, the stability of the acne, the date of end of the treatment with isotretinoin and the colour of the skin. It should be discussed on a case-by-case basis with a dermatologist. Different aesthetic techniques supervised by professionals can then be used: deep peels, lasers resurfacing, etc.