Acne Vulgaris

A common disorder of the pilosebaceous unit affecting millions of teenagers around the world.

There are three factors which play a role in the pathogenesis of acne:
a) Hyperproliferation and hyperkeratinization of epidermal cells lining the duct, which results in plugging of the duct and comedone formation.
b) Excess sebum production, which is usually regulated by androgens or other hormones such as Growth Hormone or Insulin-like Growth Factor.
c) Propionibacterium acnes, which causes inflammation at the site of infection is not always the causative agent, and not found in all acne lesions.
d) Inflammation, which may be due to the presence of P. Acnes bacteria as mentioned above or due to release of various cytokines from the comedone.

Medical care is aimed at attacking one of the above causative factors.

Topical retinoids may act as a comedolytic and as an anti-inflammatory agent.
Topical antibiotics and benzoyl peroxide are used to combat the P. Acnes bacteria in the lesions. They may also have mild anti-inflammatory action.
Systemic antibiotics like tetracylcine or minocycline, are sometimes used for the same purpose as the topical ones.
Antibiotics like, Trimethoprim and sulfamethoxazole are also often used.

In some severe cases, especially in those who have an underlying disorder (such as PolyCystic Ovarian Disease) may require hormone therapy. Oral contraceptive pills have been found to be useful in this regard. However, the side effects should be weighed against the benefits and should be used with care.

Isotretinoin is to be used as a final alternative. It affects acne development at all 4 stages mentioned above. However, it should be used with great care due its teratogenic effect (avoid pregnancy during its use). it is also compulsory to do regular blood profile analysis including cholesterol and triglyceride, hepatic transaminases and a CBC count.

There are studies which are still to be conducted and under-progress to establish a solid relation between diet and acne. It is highly likely that they are linked. Myself along with 3 other colleagues of mine conducted a study on the relation between acne and diet among university students in the United Arab Emirates. We found a significant relation between the severity of acne and the glycemic index of their diet. The higher the glycemic index of their regular diet, the more severe the acne they suffered from. Studies have shown that high glycemic index food increases the level of circulating Insulin-like Growth Factor. However, there were several limitations and un-avoidable confounding variables in the study due to the lack of time and resources. Further studies need to be done to re-establish this point.

Also, exposure to sunlight has proved to increase acne lesions in various subjects. This may be due to the inflammatory reaction, increased sebum production or hyperproliferation of the epithelial cells.

Another factor may be the use of certain creams and cosmetics. A possible explanation is an allergic reaction due to the irritation caused by the chemical ingredients in the creams and cosmetics. The resultant inflammation again results in comedones and other acne lesions.

Hence, non-medical treatment such as abstinance from food items which may trigger acne flares and avoiding exposure to sun-light is as important or perhaps even more important than the medical treatment. Identify the trigger factor and avoid them. Prevention is always better than cure.