Introduction

Acne is a human disease and it is a chronic inflammatory condition that particularly affects the sebaceous gland follicles. These can be commonly found on the face, the shoulders, the back, or the chest. Although the pathogenesis of acne is poorly understood, it is widely accepted that the causes are complex and associated with many factors. The major ones are irregular or unusual differentiation of the follicles and high cell death, abnormally high bacterial colonization, inflammation, and excessive sebaceous gland activity. Effects of high androgenic activity and heredity factors, dietary lipids, and lifestyle factors such as smoking have also been identified as causative factors.¹ 

Acne manifests by showing different degrees of severity. For example, mild acne (physiologic acne) is the most common, accounting for up to 60% of all cases. The more severe acne makes up the remaining 40% and this is otherwise called “clinical acne”. The latter is managed by dermatologists, general practitioners, and paediatricians. Some examples of acne conditions that fall into this class include nodular or conglobate acne, juvenile acne, infantile acne, and acne tarda. These usually occur after the age of 25. Complex acne has also been known to develop due to medication use, hormonal issues, and some other external factors.²

A study conducted in Germany across 48 pharmacies studied 504 customers. The findings showed that 35% of customers treated themselves for mild acne. Only about a quarter of them (22.5%) followed the pharmacist’s advice in treating their acne while the rest followed advice from other individuals as well as their own judgement. 

Acne as a prevalent socio-economic disease

Acne is quite common across all age groups and ethnicities. Fortunately, acne is not a fatal disease. However, it significantly affects the quality of life of its sufferers and can be considered a socioeconomic challenge. Due to the severity of the condition, as much as 30% of acne patients may have to use some form of medical intervention. Consequently, many of these individuals would have to live with post-acne scars for the rest of their lives. Findings show that acne constitutes one of the highest dermatological diagnoses, up to 10.2 million diagnoses in the United States of America.² This is valued at billions of dollars per year. It has been found to make up 12.6% of the total costs in the treatment of skin diseases.²

Types of acne

In the development of acne, the integrity of the skin is first compromised by the formation of blackheads. This manifests as a bulge on the skin. This bulge may be closed if the drain hole is blocked by the follicle, or open, when unblockedand is black. The appearance of this black colour is due to the oxidation of the lipids in the blackhead and melanin accumulation, which may leave permanent scars if left poorly managed. 

A normal bacteria flora on the skin is P.acnes, however, they multiply abnormally and excessively due to the presence of excessive sebum. This causes inflammation of the skin.

Acne is divided into three different classes, depending on their characteristics. The first classification is based on the lesions in comedogenic (Level I), papular-tubular (Level II), and Nodular acne (Levels III, IV, & V). Also, the level of severity is a means of classification as well- mild, moderate, moderate, moderate to severe, severe to serious.

Table 1. Clinical classification of acne³

Other forms of acne can also be triggered by several factors, including:

1. Medications such as some used in the treatment of tuberculosis, some corticosteroids, and some anticonvulsants
2. SE of cosmetics
3. Mechanical acne from aggressive washing
4. Extratropical acne due to environmental factors such as heat and humidity
5. Pregnancy-induced acne due to endocrine and metabolic factors 

Furthermore, r researchers have divided opinions on whether diet affects acne development. Some argue that most non-westernized diets have limited amounts of dairy products, processed foods, refined sugars, etc. and they state that this is why acne is not significantly reported in these populations. A study that analyzed patients with a high-sugar diet and a low-sugar diet found that after a 12-week clinical trial, the low-sugar diet group showed far fewer acne lesions than the other group ³.

Management of acne

Acne is diagnosed through an assessment of medical history and physical examination. These help determine possible causes, such as medication use or hormonal factors such as androgen excess. The aim of management should mainly be to minimize severity, improve the appearance of skin lesions, and protect against recurrence.

Topical treatments are one of the most popular first-line treatments used in acne management. The treatments include gels, washes, solutions of retinoids, benzoyl peroxides, and some antibiotics (such as clindamycin). A major side effect of these is usually excessive drying of the skin and skin irritation. They may also have to be applied for a long time to show major improvements. Caution must be taken and therapy adapted according to the peculiarity of each skin type. For instance, drier skins would benefit more from therapies in lotion and cream forms than drying washes and astringents. Combination therapies are often more effective than individual use of treatment agents. However, to prevent skin irritation and worsening of the symptoms, care must be taken to adhere to the prescribed timing of their applications which must be separate except where they are known to be safe and gentle on the skin when used together. Apart from skin irritation, some of these drug molecules interact with one another. For example, benzoyl peroxide has been known to oxidize retinoids like tretinoin when it is applied together. Furthermore, in peculiar situations where topical treatments are insufficient due to high severity, systemic and topical antibiotics are introduced⁴. 

Summary

Acne is a chronic inflammatory condition that affects sebaceous gland follicles. It is commonly found on the face, the chest, and back. There are many causes of acne, and these include bacterial infections, hormonal factors, and environmental influences such as smoking, etc.

Acne is categorized based on its severity which may be mild to severe. Treatments may be topical solutions like retinoids or benzoyl peroxide or the use of antibiotics. It is essential to personalize treatments based on skin types and possible drug interactions. The goal of treatment of acne is focused on reducing severity, improving its appearance, and preventing the re-occurrence of skin lesions.