Teenage years, for many of us, are amongst the most memorable times of our lives — full of playful mischief and carefree days. Yet even in those good times, there were things that bothered us like studying to get good grades, looking better than the rest of the class, grabbing the TV remote before any of our siblings could and getting rid of those nasty pimples aka Acne!

Acne is one of the most common skin diseases in young adults worldwide. It usually starts during the early teens but can present itself in different age groups with varying levels of severity. Besides being a skin problem it can be a cause of significant emotional disturbance, social withdrawal, mental stress and depression. It is therefore important to treat acne as a condition that needs medical care and attention and not just whisk it away as a part of growing up or coming of age.

Acne is a chronic inflammatory disease of the pilosebaceous (hair follicle associated with a sebaceous gland) unit. It is characterised by the formation of open and closed comedones, erythematous papules and pustules and in more severe cases nodules, deep pustules and cyst like lesions. In many cases scarring also occurs. Four major factors involved in causing acne include:

1- increased sebum (oil) production under hormonal influence,

2- blockage of the duct of the pilosebaceous gland due to overproduction of the cells lining the follicles,

3- bacterial colonisation of the duct, most commonly with a bacteria named Propionibacterium acnes,

4- inflammation.

To summarise and simplify the process, we can say that acne is caused by the excessive production of sebum on the face. This sebum is released onto the skin from the duct of the pilosebaceous gland. Due to disorder in the process of skin layering and shedding, this duct gets blocked leading to accumulation of sebum, which gets infected, leading to inflammation and acne or pimple formation.

Acne most commonly affects the face but can also involve the back and the chest to a lesser extent. These areas have the highest density of pilosebaceous glands on the body, especially the face. The severity can range from mild acne presenting as black heads and white heads with no long term complications to aggressive, fulminant disease associated with marked inflammation, pain, systemic involvement and scarring in deep inflammatory lesions.

Acne is still considered, by some, as a skin problem unworthy of proper treatment and something that will just run its course and eventually be resolved with time. Although that is true in many of the cases but the scars that acne can leave, both physical and psychological, can take years to heal. Acne presents at an age where a person is acutely sensitive to external influences and internal insecurities. It is also important to understand that acne is not caused by any action on part of the patient nor is it his / her fault in any way. Acne is not a contagious disease and is not spread from direct or indirect contact with the patient. However family history, enviroment and genetics do play a significant role.

Acne can be aggravated by heat, humidity, mechanical occlusion / friction (as with a face or forehead covering or heavy make-up applied for extended periods), hormonal changes etc. Trying to pick or manipulate the pimples can also lead to its worsening and scar formation. Stress, whether physical or mental, can also cause an acne breakout. Therefore acne is commonly seen near or after exams and other stressful occasions like engagements, wedding functions, during crash diets etc. As a general care measure for acne-prone skin, keeping the face clean and dust free by washing regularly, using a suitable product can reduce acne breakouts and severity. Always ensure that you go to bed with a clean face free of any dust or make-up residue.

Despite extensive research work and many theories, a definitive link between dietary intake of various forms of food and drinks with acne breakouts and severity has not been established. It is a rather controversial subject with many doctors advising strict dietary regulations as part of acne treatment to some advising none at all. It would be safe to say that a balanced diet is recommended in all individuals whether with or without acne.

Treatment of acne basically revolves around avoiding the blockage of the pilosebaceous gland duct, preventing infection and inflammation and limiting scarring to an absolute minimum. For this, various forms of oral and topical medicines are available which are prescribed by doctors depending upon the severity of the disease, age of the patient etc. Therapy options for acne have advanced significantly over the past few decades and regimens are now available that, if done under proper guidance, can cure even the more severe forms of acne for good.

Despite the best skin care, diet and lifestyle, acne can still occur and can sometimes be somewhat of a tricky problem. However, consulting a good doctor and following his advice with regular follow-up can lead to its effective treatment and resolution.

The writer is consultant dermatologist & cosmetologist

Twitter: @nav_derm

Email: dermadna@gmail.com

Published in Dawn, Sunday Magazine, March 6th, 2016