Medically Reviewed April 2023, by Dr. Ayad Harb, one of the world's leading plastic surgeons
Acne is a prevalent skin condition that manifests as pimples, affecting countless individuals worldwide. While it is most commonly linked with the turbulence of teenage years, it's a misconception to believe it is confined only to this age group. Many encounter acne during their adolescent phase, but it's not unusual for it to persist or even have its onset during adulthood. This skin concern, though seemingly superficial, is deeply rooted in the intricacies of our body's biology and the environment around us.
The genesis of acne lies in the sebaceous glands, tiny glands under the skin's surface responsible for producing an oily substance called sebum. This oil helps keep our skin moisturised and supple. However, problems arise when there's an overproduction of this sebum, which can get trapped within the skin's pores. These clogged pores become the ideal breeding grounds for skin bacteria. When sebum mixes with dead skin cells within these pores, it leads to inflammation, resulting in the blemishes characteristic of acne.
Now, the question arises, what prompts this overproduction of sebum? The answer is multifaceted. Hormonal fluctuations rank high among the culprits. Periods of hormonal upheaval, such as puberty, pregnancy, and menstrual cycles, lead to an upswing in androgen levels. Elevated levels of this hormone cause the oil glands to grow, producing more oil than the skin might need. This hormonal link is one of the reasons why acne is most prevalent during teenage years.
Another contributing factor is genetics. Your genetic makeup, inherited from your parents, can predispose you to acne. If both or one of your parents experienced acne, your susceptibility to it naturally increases. Diet also plays a role, albeit a controversial one. There's emerging evidence suggesting that foods with a high glycemic index and dairy products might aggravate acne. However, the research in this area is ongoing, and conclusive connections remain to be established.
Environmental triggers cannot be ignored. Urban settings with high pollution levels can accelerate skin blockages, making the skin more prone to breakouts. Additionally, medications—certain corticosteroids, androgens, and lithium, to name a few—have been associated with triggering or worsening acne.
Emotional stress and mental well-being also intersect with acne. While stress doesn't directly cause acne, it can exacerbate the condition. Our body's response to stress leads to increased oil production, making the skin more susceptible to acne. Moreover, the physical manifestation of stress in the form of acne can lead to a vicious cycle of increased mental distress.
Contrary to popular belief, hygiene, while important, is not the primary cause of acne. Yes, regular cleansing is vital for skin health, but the idea that acne is a direct result of poor hygiene is a myth. In fact, excessive or aggressive cleaning can be counterproductive, irritating the skin and exacerbating acne.
Understanding acne is crucial, not just for its effective treatment but also to dispel myths and misconceptions surrounding it. This understanding fosters empathy and reduces stigmatisation, ensuring that those suffering from it receive not just medical care but also the emotional support they require. At SRGN, we emphasise this holistic approach to skincare, considering both the physical and emotional dimensions of conditions like acne.
Whiteheads, scientifically known as closed comedones, are among the most common types of acne lesions. They emerge when hair follicles become clogged with sebum and dead skin cells. Unlike blackheads, the pore remains closed at the surface, forming a tiny white or skin-coloured bump. The lack of exposure to air ensures that oxidation doesn't occur, which is why they remain white. Often, whiteheads are mistaken for mere skin bumps, but they are indicative of underlying pore blockages. They can appear anywhere on the face, including the forehead, cheeks, chin, and nose. While whiteheads are generally not painful, they can cause skin texture irregularities and become inflamed if not treated properly.
Blackheads, or open comedones, present themselves as small dark spots on the skin. Contrary to common belief, the dark appearance is not due to the presence of dirt. Instead, the pore is open to the surface, and the trapped sebum and dead skin undergo oxidation when exposed to air, turning it a darker colour. Blackheads are particularly noticeable on the nose and surrounding areas, although they can form anywhere on the face. Due to their open nature, they are more susceptible to environmental pollutants, potentially exacerbating the condition. Regular exfoliation can be beneficial, but aggressive scrubbing can worsen the situation by causing skin irritations.
Papules are small, raised, red bumps that feel tender to touch. They result from inflammation or infection in the hair follicles due to trapped sebum, bacteria, and dead skin cells. Unlike whiteheads or blackheads, papules don't have a head. Instead, they appear as solid, rounded bumps on the skin. They can be scattered or clustered, often forming a patch of irritated, reddened skin. It's crucial to note that squeezing or picking at papules can exacerbate inflammation and potentially lead to scarring. Their inflamed nature can make them stand out on the skin, making many individuals self-conscious about their appearance.
Resembling the common zit, pustules are red, tender bumps with a white or yellowish centre filled with pus. They form when the walls surrounding your pores break down due to inflammation. As a result, the body responds by sending white blood cells to the infected site, leading to the formation of pus. Pustules can appear on any part of the body, but they are most commonly found on the face. As tempting as it might be, it's crucial not to pop pustules, as this can lead to increased inflammation, infection, and potential scarring.
Delving deeper into the skin, nodules and cysts represent severe forms of acne. Nodules are large, solid, and painful lumps beneath the skin's surface, while cysts are softer, filled with pus, and can be tender to touch. Both nodules and cysts form due to severe inflammation in the skin. Their deep-rooted nature can make them particularly painful and noticeable. Because of their severity, nodules and cysts often require more intensive treatments. Left untreated, they can lead to significant scarring and skin texture irregularities. Early intervention and consultation with a dermatologist are essential to manage and treat these severe acne forms effectively.
Chemical peels have emerged as a pivotal solution in the realm of aesthetic treatments. This procedure involves applying a chemical solution to the skin to expedite the exfoliation of its topmost layer, revealing a new layer of skin that's typically smoother and less blemished. Although chemical peels have traditionally been associated with anti-aging and skin rejuvenation, they've made significant strides in the treatment of acne and its consequential scars.
At the core of chemical peels for acne lies the concept of controlled skin damage. By deliberately injuring the outermost layer, the skin commences a natural healing process. As it heals, there's an increase in collagen production and cellular turnover. The result? Unclogged pores, reduced size of existing acne, and even mitigation of the appearance of scars. The fresh layer of skin that emerges post-procedure tends to be less prone to acne breakouts, making chemical peels a preventive measure as well.
The world of chemical peels is vast, with a range of solutions tailored to varying acne types and skin sensitivities. Mild peels, which utilise Alpha hydroxy acids (AHAs) like glycolic acid, are excellent for surface-level acne lesions. These peels gently exfoliate the epidermis, clearing away dead skin cells and reducing minor imperfections. Salicylic acid, a beta hydroxy acid (BHA), stands out for its ability to penetrate oil in pores, effectively exfoliating the pore lining. This characteristic renders it particularly effective for those with oily and acne-prone skin.
Then we have the more robust peels like trichloroacetic acid (TCA). These are formulated for deeper acne scars or severe forms of acne. They penetrate deeper layers of the skin, addressing more profound imperfections and stimulating robust collagen production. However, with increased strength comes an extended recovery phase. Skin might remain reddened and sensitive for a longer period post-procedure.
After undergoing a chemical peel, post-treatment care is paramount. The skin will generally experience redness, scaling, and a sensation resembling a mild sunburn. It's vital to shield the skin from direct sun exposure, diligently apply sunscreen, and keep the skin moisturised. Moreover, one must resist the temptation to pick or scratch the treated area. Proper care ensures that the skin heals optimally, making way for a clearer and rejuvenated complexion.
It's essential to underscore the importance of professional guidance when considering chemical peels. Every individual's skin is unique, with its own set of challenges and needs.
Consulting with a dermatologist or a certified practitioner can provide clarity on the most suitable type of peel. At SRGN, our commitment is not just to offer treatments but to provide a comprehensive understanding and guidance, ensuring every patient achieves their desired skin health and aesthetic.