Acne

This disease is caused by a combination of different factors: it starts after hyperkeratinisation of the hair follicle, causing obstruction of the follicular orifice and resulting in the formation of blackheads. In addition, there is an excess production of sebum as a result of hormonal stimulation and inflammation, which causes the appearance of papules and pustules. Cutibacterium acnes overgrowth is also common in these lesions, which favours the appearance of inflammatory lesions.

This type of acne is also known as hormonal acne, and appears in women between the ages of 20 and 40, and even later. This type of acne usually appears or worsens cyclically and usually affects the jaw area, neck, neckline and back, and can be associated with alopecia, hirsutism, oily skin or other signs of hyperandrogenism. This type of acne can be complex to manage and must be studied correctly in order to consider long-term treatment, as its control may require specific control of the acne lesions and hormonal alterations that may cause it.

Different treatments are available to improve and resolve acne lesions, and their selection will depend on the intensity and location of the lesions, the risk of scarring, and the patient’s profile and preferences. The treatments available will improve the factors that cause acne to a greater or lesser extent.

There are currently different types of treatment available. Topical treatments include:

• Cleansers and products that control sebum production, keep the skin clean and facilitate the action of other topical treatments.
• Topical drugs and cosmetics: keratolytics such as retinoic acid and its derivatives, alpha-hydroxy acids (glycolic acid) or beta-hydroxy acids (salicylic acid), seboregulators such as benzoyl peroxide and retinoids (tretinoin, retinoic acid, adapalene, etc.), and products with anti-inflammatory and antibiotic properties such as topical retinoids, erythromycin and clarithromycin. Current therapeutic guidelines advise against the use of antibiotics in monotherapy due to the high risk of resistance.
• Oral treatments: moderate and severe cases of acne may require the use of antibiotics such as tetracyclines (doxycycline, minocycline), and oral retinoids. Isotretinoin is an oral retinoid, derived from vitamin A, which has been shown to be effective against multiple aetiological factors of the disease. The response to treatment is usually very satisfactory, with a high safety profile, especially if the dermatologist’s recommendations are followed and correct clinical and analytical monitoring is carried out. Some types of acne, such as adult female acne, may require hormonal control treatments such as anti-androgen contraceptives or other anti-androgen drugs such as spironolactone or metformin.

The choice of acne treatment should be individualised for each patient according to the type of acne and its location, and the patient’s preferences (age, gestational desire, pathological history, response to other treatments, etc.).

The most worrying consequence of acne is the appearance of scars. These can be bulky (hypertrophic or keloid scars), or atrophic, which are the most frequent. In this link you can find all the information about this type of scars.

Although we currently have different tools to improve the appearance of these scars (ablative and non-ablative fractional lasers, fractional needle radiofrequency, peelings, hyaluronic acid fillers, etc), the improvement of these lesions is usually between 30 and 50% depending on the technique used and the patient’s ability to generate new collagen. In addition, these techniques have a considerable economic cost. For this reason, an early approach to acne is essential to avoid or reduce the appearance of scars.