Acne Vulgaris (Pimples)

 Dr K S Prasanna, Dermatologist, Institute of Applied Dermatology, Kasaragod, Kerala

15 years old,  Akash is an intelligent, talented, extrovert boy. He was at the top of his class throughout school. He was actively participating in all the activities like debate, extempore speech, etc. One day, however, he suddenly began avoiding all these activities. He became silent, withdrew from all outdoor activities, and also his academic performance came down. Whenever guests came home, he would go inside and read, which was quite unusual for him. He would sometimes even skip dinner. The mother started noticing this behavioural change in her son. When the mother visited his teachers, who are fond of Akash, during the parent's meeting, they also said that something is wrong with him. So, the mother was worried, the motherhood inside her became alert. She started to explore the reason behind this. She started thinking " Has he fallen in love with a girl? Is he becoming a drug addict?" and so on. So, she started to explore the reason. She kept an eye on him all the time. She checked his school bag, mobile, books, etc, but could not find the above-said reasons. But she observed him sitting in his room, in front of the mirror all the time. Suddenly the mother realised the problem.

He was developing pimples on his face, which made him depressed, without knowing that it is a normal physiological change for a teenager. The mother educated the son that it will get cured when he grows older. They consulted dermatologists, and they treated him and said that it will take time and not to worry. He still did not improve. She took him to child counsellors, psychiatrists. He finished his preuniversity scoring very few marks.

Teenage is a transitional phase of growth and development between childhood and adulthood. This is the period when physical, mental growth occurs in addition to sexual growth. This is the time when boys and girls develop tiny projections on the face called acne or pimples. Most teenagers are worried about this because life has just started for them. When they face bigger problems in later life, probably this would have gone unnoticed. Even though in majotity, it is minor problem, some teenagers have an increased level of self-consciousness, social isolation, anxiety disorder, depression, and even suicidal thoughts.

Acne is found in sites with well-developed sebaceous glands, most often the face and upper trunk (chest and back). These are mainly divided into noninflammatory and inflammatory groups based upon their clinical appearance. Noninflammatory acne is characterized by open and closed comedones (black and whiteheads). Inflammatory acne is characterized by papules, pustules nodules, and cysts. Open comedones(blackheads) have a conspicuous dilated follicular opening that is filled with an inspissated core of shed keratin. Melanin deposition and lipid oxidation within the debris may be responsible for the black color. As the severity of the lesion progresses nodules form and become markedly red and painful.

Acne is seen usually between the age of 8 to 24 years. If it appears beyond the age of 25, we must consider any other causes like the intake of medications like oral steroids, antiepileptic drugs, anti TB drugs, psychiatric drugs, or any other hormonal problems like PCOD. Even continuous mechanical friction to the skin like wearing a mask all the time can induce acne. Application of oil (oil acne), whitening creams, can also cause acne. Stress, extreme heat also can cause acne. There is a condition known as Neonatal Acne where the neonate within two weeks of age develops acne and it generally resolves within three months of life.

Early treatment of Acne is essential for the prevention of cosmetic disfigurement due to scarring. Redness and black pigmentation often persist after the resolution of red, painful acne lesions. Although pigmentary changes usually fade over many months if the acne is brought under control, occasionally they can be permanent. Unfortunately pitted scars or hypertrophic scars are often the aftereffect of nodulocystic acne.

As dermatologists, we always ask for a detailed history, review all the prescription and over-the-counter medications used for acne and other conditions. Also, a review of cosmetics, sunscreens, cleansers, and moisturizers used by the patient is very important. In lady patients, a menstrual and oral contraceptive history is important in determining the hormonal influence on Acne. Depending upon the type of the lesion oral antibiotic, and topical treatments can be given. Sometimes comedone extraction can improve the cosmetic appearance of acne. Intralesional injection of corticosteroids can quickly improve the appearance and tenderness of deep nodules and cysts. A low concentration of chemical peeling using alfa hydroxy acids is also beneficial to remove the scars. Laser resurfacing (fractional as well as traditional), dermabrasion, and deeper chemical peels also reduces the variability of the skin surface and smooth out depressed scars. For discrete depressed scars, soft tissue augmentation using fillers can be temporarily beneficial. Punch grafting is an option for patients with ice picks scar.