In France, around 15 million people are affected by acne, a very common skin problem of varying severity and extent, which primarily affects adolescents at the time of puberty (80% of cases) but also a growing number of adults, mainly women. Acne is the first cause of consultation with a dermatologist and can have significant psychological repercussions, in particular on confidence and self-esteem and social relations. Several methods can prevent acne and limit the appearance of blemishessuch as comedones, blackheads and cysts. Pharma GDD looks at the causes and the different forms of acne and presents the main preventive measures to follow on a daily basis.
Where does acne come from?
Acne is a chronic skin disease that more specifically affects the pilosebaceous follicles. These cavities are part of the structure of the epidermis and consist of a hair and a sebaceous gland whose main function is to secrete sebum, an oily fluid responsible for protecting the skin from all external aggressions. On normal skin, sebum remains fluid and flows normally. On the other hand, in the event of acne, this functioning is altered: the sebaceous glands secrete a greater quantity of sebum. This thickens and mixes with dead cells located on the surface of the skin, causing tension inside the pilosebaceous follicle and obstruction of the hair canal, which can then no longer evacuate the sebum normally.
This environment, rich in lipids, creates favorable conditions for the multiplication of a bacterium naturally present in small quantities at the bottom of the sebaceous gland: Propionibacterium acnes . This bacterium is said to be anaerobic, that is to say that it is able to develop in the absence of oxygen. The fatty components of sebum (wax, squalenes, triglycerides) accelerate the proliferation of the bacteria which then causes the blemishes typical of acne : blackheads, whiteheads, cysts, dilated pores …
The different forms of acne
In over 90% of cases, the area most affected by acne is the face. However, this skin problem can also appear on the back, neck and chest. There are several forms of acne , each involving different lesions and varying degrees of severity.
Retentional acne
The first stage of acne is retention acne . This form is characterized first of all by a significant production of sebum (hyperseborrhea) at the origin of the famous oily skin . The skin then presents zones of shine generally localized on the middle zone (also called “zone T”, grouping together the forehead, the nose and the chin). Its texture is modified,
The main lesions of retentional acne are open comedones or micro-comedones, commonly called blackheads.. They result from the accumulation of sebum and dead cells in the hair canal. Their black color is due to the oxidation of keratinocytes (epidermal cells mixed with sebum) in contact with air. Blackheads are 1 to 3 mm in diameter and can spontaneously expel or ignite.
Retentional acne is also manifested by the appearance of closed comedones (microcysts), better known as white spots . These lesions are the direct consequence of the obstruction of the pilar canal and the accumulation of sebum. A closed comedo causes a hard, localized bulging of the skin with a pale area in the center, hence its name of white point. These lesions measure 2 to 3 mm in diameter and promote the proliferation of the bacterium P. acnes.. Retentional acne can progress more or less quickly to inflammatory acne.
Inflammatory acne
When retentional acne lesions are infected with P. acnes , the body defends itself. The inflammatory acne begins following this natural mechanism. Three types of lesions can then appear on the skin: papules, pustules and nodules.
The papules are red elevations, firm and sometimes painful, surrounded by an inflammatory halo. They are a sign of a superficial infection and measure less than 5 mm in diameter. With more advanced inflammation, pustules may appear on the papules. They contain a yellowish-colored purulent fluid which drains or causes a lump.when the pustules rupture in the deep layers of the skin. Several microbes proliferate on these lesions and can spread to the dermis and hypodermis.
The nodules represent a deeper attack on the skin. They form small, painful bumps larger than 5mm in diameter and are not necessarily accompanied by visible redness on the skin surface.
Cystic acne
If the inflammatory lesions have been improperly treated or handled, they can be the cause of cystic acne . This form of acne induces a change in the structure of the skin due to the presence of cysts. These encapsulated comedones are surrounded by a fibrous shell that prevents drainage from the sebaceous gland. Cysts take on the appearance of permanent bumps under the surface of the skin. Variable in size, they sometimes occur at the same time as other types of lesions and can leave scars , one of the most feared complications of acne.
Evolution, complications and serious forms of acne
Juvenile acne affects adolescents during puberty: around 12 years old for young girls and around 14 years old for boys. It lasts on average 3 to 4 years and disappears spontaneously between 18 and 20 years . However, acne can also affect adults. Almost a quarter of women over 25 face this skin problem. It can be due to recurrent or late juvenile acne or other causes like hormones, stress, cosmetics. Acne in adult women is especially concentrated on the lower face (chin, jaws).
The first complication of acne is the appearance of scars , temporary or permanent, following the lesions. They mostly occur when the inflammation has been deep and the pimples have beenhandled or improperly cared for . The scars can be hollow (“micro-craters”) or raised and give a “pockmarked” appearance to the face.
There are two serious forms of acne, fortunately quite rare. The acne conglobata begins in adolescence and gradually spreads to the trunk, shoulder and buttocks. It manifests as large, inflammatory comedones and nodules that can coalesce, form abscesses and leave multiple scars. The acne fulminansis a serious course of pre-existing lesions characterized by numerous inflammatory nodules. This form of acne mainly affects men. It appears with a sudden outbreak associated with a high fever (up to 40 ° C) and joint pain. These symptoms then subside until healing thanks to appropriate management.
Factors favoring acne
There are many things that can promote acne and predispose some people to suffer from it longer than others. Heredity and genetics play an important role in the occurrence of acne. For example, if two parents have been affected by this skin problem, their children are more likely than others to have acne and it will sometimes be difficult to treat.
Acne is closely linked to sex hormones and in particular to male hormones, androgens. In adolescence, these hormones begin to be secreted in quantity, both in boys and in girls. This significant production of androgens stimulates the development of the sebaceous glands and activates the secretion of sebum. Some skin types are more sensitive than others to hormones and react by showing more extensive lesions. The dermatologist can sometimes suspect hyperandrogenism (excess male hormones) and prescribe a hormonal assessment or even an ultrasound of the ovaries to rule out polycystic ovary syndrome (PCOS) which is often the cause of persistent acne. The pregnancy but also the hormonal contraceptive (combined pill, patch, ring, IUD) can also promote acne in people who already have a predisposition.
The hygiene of lifehas a significant impact on the quality of the skin. The consumption of tobacco, alcohol and a diet too rich in sugars and fats can weaken the epidermis and accentuate skin problems , including acne. It is also important to learn to manage your stress to limit the risks. This is because many nerve cells are located near the sebaceous glands. In the event of stress, they release a substance called “substance P” which in turn leads to an increase in the production of sebum .
Finally, cosmetic productsare also elements that can promote acne. Some components derived from plastic (the famous silicones) have an occlusive character and can prevent the normal flow of sebum, which results in imperfections. Products that are too oily are not suitable for acne-prone skin and increase pore clogging .
Acne-prone skin: what to do
If your skin is prone to acne, you should know that there are many ways to limit the appearance of blemishes. The essential step is to know your skin type . Indeed, acne is a disease that can affect oily skin as well as normal, combination or sensitive skin. Identifying your skin type is a must before embarking on the use of specific care for acne-prone skin. To achieve this, do not hesitate to consult our advice sheet: “Recognize and maintain each type of skin” .
An adapted anti-acne skincare routine
To avoid acne, it is essential not to attack your skin. Therefore, avoid excessively stripping products which contain alcohol, for example: they would damage the hydrolipidic film and the skin would then defend itself by producing even more sebum . Use soap-free cleansing gels and moisturize your skin daily. For boys, avoid gels, foams and aftershaves that contain alcohol and try to space shaves to limit the impact on the sebaceous glands.
The dual cleansing is a good way to maintain beautiful skin. Very common in Asian countries, it is wrongly considered too aggressive and is in fact a key stepfor an effective routine as long as the acne products are correctly chosen. Double cleansing involves a makeup remover and a cleanser. The make-up removal must be performed with a fatty substance such as an oil, a milk or a salve to remove soluble impurities (make up, sebum) and some particles of pollution. The cleanser , in the form of gel or foam, helps rid the pores of water-soluble impurities that have resisted the makeup remover. The combination of these two steps guarantees greater effectiveness than simple cleansing with micellar water and helps limit the appearance of acne-related imperfections . The treatments applied subsequently will penetrate better and will also be more effective.
For hydration, choose a light non-comedogenic cream or even a serum alone so as not to overload the skin. The vegetable jojoba oil is especially recommended for the care of acne skin. Its biochemical composition is indeed very close to human sebum and gives it many properties: it is moisturizing, regulating, balancing and protective.
Once or twice a week (depending on the sensitivity of your skin), you can exfoliate followed by a purifying mask . The scrub eliminates dead cells and promotes skin renewal. Purifying masks, especially those based on clay, absorb excess sebum and impurities, leaving the skin perfectly clear.