For many, it is simply part of puberty: acne vulgaris. Even though it is not preventable in most cases, there are ways to significantly mitigate its course.
What is acne vulgaris?
The typical symptoms of acne vulgaris include, first and foremost, skin blemishes and, if necessary, scars due to incorrect treatment by the affected person. Acne vulgaris is among the most common skin diseases, because the main causes that trigger acne are present in the organism of everyone: Hormones. Namely, it is “male” hormones, also called androgens in medical jargon, that most often cause acne vulgaris. Precisely because the hormone balance changes fundamentally during puberty, acne vulgaris occurs almost exclusively in the younger years and heals on its own by the third decade of life. According to various studies, 70 to 95 percent of all Germans have had skin blemishes at one time in their lives that were due to the presence of acne vulgaris, which has since healed. The typical symptoms of acne vulgaris include primarily skin blemishes and possibly also scars, which are due to incorrect treatment by the affected person.
Causes
As mentioned above, the sudden increased presence of androgens is “to blame” for acne vulgaris. It is known that these stimulate the sebaceous glands, which are found everywhere on the skin and especially on the facial skin, to produce more hard fat. On the one hand, the natural sebum is of great importance for the skin to keep it elastic and to prevent the skin from drying out. If the natural sebum is thickened by an excessive amount of skin fat, there is a risk that the skin pores through which it escapes will become clogged. As a result, the sebum remains under the skin and causes the pimples typical of acne vulgaris. Bacteria belonging to the skin flora begin to feed on the skin fat. Their waste products in turn irritate the skin, which eventually leads to inflammation of the facial skin and further worsens the skin’s appearance. Hormones, however, are not the only possible causes. It is medically proven that the facial skin of some people reacts to certain medications – not only because of a possible intolerance – with the increased formation of skin fat. The consequence is the same as in acne vulgaris caused by hormonal fluctuations.
Symptoms, complaints and signs
Usually, acne vulgaris is manifested by the typical redness of the skin that appears on the face, neck, back and décolleté. The complaints and symptoms can vary in severity. In most cases, mild inflammation occurs, which manifests itself, for example, as itching and slight pressure pain. In severe cases, entire skin areas are affected by the blackheads and pimples. When touched or caused by external stimuli – for example, cotton shirts or perfume – severe pain occurs. Externally, acne vulgaris can be recognized by the typical skin redness and elevations. These are often filled with pus and cause increasing pressure pain as the condition progresses. In the case of severe acne, nodes, abscesses and crusts can form from the initially harmless skin changes. If the pimples are scratched open, scars may remain. Depending on which areas of the body are affected, further complaints may occur. For example, pimples in the intimate area may cause pain on movement or painful abscesses may form, which can break open inwards. In particularly severe forms, acne vulgaris can be associated with fever. Joint inflammation and concomitant diseases may also occur under certain circumstances, insofar as the disease is not adequately treated.
Diagnosis and course
Dermatologists can usually determine whether acne vulgaris is present with a simple visual diagnosis. Nevertheless, further diagnostic measures are necessary to determine the exact cause and to direct treatment toward it. For example, by asking the patient about recently taken medications, the physician can identify whether medications may be to blame for the onset of acne vulgaris.
Complications
Depending on genetic predisposition and skin condition, acne vulgaris can lead to significant complications. If sebum production is too severe, the sebaceous glands cannot clean themselves.Pus-forming bacteria infect the area. In the worst case, inflammatory and painful elevations lead to the formation of bulging knots or boils. If the degree of inflammation is more extensive, these phenomena are called carbuncles. The upper part of the body and the face are particularly affected. Rarely, this form of acne is found in the groin region and in the armpit area. In the severity of its manifestation, acne requires accompanying medical therapy. If the medication is not taken in a coordinated manner, physical indisposition may occur. There is a risk of headache, swelling of the lymph nodes and sepsis. Therefore, it is important to have the triggers of acne determined by a doctor in order to exclude concomitant symptoms, for example due to a peeling cure, special antibiotics or a disharmonious hormone level. If a specific acne therapy is omitted, permanent scars can form. These can only be remedied to some extent with great cosmetic effort. External circumstances can also negatively affect the healing process of acne. Adolescents are most affected by acne vulgaris, adults rather rarely. If the acne worsens, the quality of life suffers, especially in adolescence. Young patients complain of bullying, depression and even suicidal thoughts during their acne therapy.
When should you see a doctor?
Acne vulgaris does not always require medical clarification. In most cases, the pimples disappear on their own after a few weeks or months and usually do not result in complications. Dermatological treatment is recommended if the symptoms persist for longer than eight weeks or are associated with accompanying symptoms. For example, a doctor should be consulted in the event of complaints such as itching, pain or psychological problems. If symptoms such as fever or chills occur in addition to the acne, a doctor’s office or clinic should be visited for further clarification. Anyone who notices a reddish streak on the skin should immediately call in an emergency physician, as there may be blood poisoning. Otherwise, acne vulgaris should be examined by a doctor as soon as scars appear or the general well-being is affected. If the known care products and home remedies show no effect or if there are even allergic reactions or intolerances, the family doctor must be consulted. Other contacts for acne vulgaris are the dermatologist and, depending on the symptoms, an allergist or therapist.
Treatment and therapy
In principle, acne vulgaris does not require treatment, since in most cases it is a temporary disease limited to puberty, which disappears by itself from the age of 30 at the latest. Nevertheless, psychological stress on the patient may make treatment of the symptoms necessary. Local as well as systemic therapy options are possible. In the case of mild acne vulgaris, it is sufficient to remove the skin impurities with peeling ointments and at the same time improve the skin’s appearance by reopening the pores. Common active ingredients of such peeling preparations are skin softening substances such as salicylic acid, fruit acid and vitamin A creams. In severe cases of acne vulgaris, it is necessary to treat it systemically (i.e. from the inside). For this purpose, the patient is administered low doses of antibiotics that liquefy the skin fat so that it can drain through the skin pores again. Regardless of which treatment is chosen, the therapy is lengthy. The first successes in the treatment of acne vulgaris are seen only after several weeks, if not after several months.
Outlook and prognosis
For the best-known form of acne, the prognosis is good – provided that sufferers follow a few basic rules. The blackheads and pimples, which appear mainly during puberty, but occasionally also in adults, are harmless in themselves. They can be successfully treated with special creams and lotions. A change in diet to a healthy whole food diet with a high vegetable content can also be helpful. The outlook worsens if the affected person presses on the pimples. This can lead to bacteria-related inflammation and purulent foci. These can reach deeper layers of the skin and, in the worst case, leave deep craters on the facial skin. To avoid this, an appropriate form of treatment for acne must be found. In case of severe acne vulgaris, the affected person should see a dermatologist.The prospects for boys to retain deep crater scars are worse than for the female sex. It is possible that the inflammations are more severe due to the onset of beard growth or for hormonal reasons. Depending on the severity of acne, different treatment strategies must be found. Girls should not cover the affected areas of skin with cosmetic makeup. A dermatologist can recommend suitable cosmetics. Avoidance of stress, a healthy lifestyle and mental balance ensure that acne heals a few years after puberty. In all cases, the chances of success are good.
Prevention
The majority of cases of acne vulgaris are caused by hormones and to that extent cannot be prevented. Nevertheless, there are a number of recommendations to mitigate the course of acne vulgaris, if not inhibit its onset. The main focus of all preventive measures is to keep the skin pores open, i.e. to prevent them from becoming clogged. This includes, for example, refraining from smoking, staying away from places with strong emissions, and switching to water-based cosmetics (e.g. light moisturizers) instead of oily ones. Likewise, it is recommended not to squeeze out existing pimples; this not only does not improve acne vulgaris, but leads to scars.
Aftercare
Acne vulgaris usually does not require aftercare. The pimples disappear on their own as soon as treatment is started, with no late effects. If acne vulgaris occurs during puberty, often no therapy is necessary because the pimples recede and eventually subside with the end of puberty. Only in severe cases, follow-up care must be given in addition to drug treatment, which may consist of anti-inflammatory ointments and mild painkillers. During follow-up visits, which can take place twice a month to every six months depending on the severity of the condition, it is checked whether the pimples continue to subside as expected. The doctor will ask the patient about any accompanying symptoms as part of the medical history and adjust the medication if necessary. If there are no complications, the frequency of follow-up visits can be gradually reduced. A check-up every six months is usually sufficient, provided that no unusual symptoms become apparent. However, if symptoms recur, the doctor must be consulted. If the acne vulgaris has already led to scarring, psychological care is often also necessary. The patient can also turn to a self-help group and thereby overcome the psychological problems in the long term.
What you can do yourself
There are several simple ways to counter mild to moderate acne in everyday life. A daily facial care with mild soap and water represents the basis for this and should be done in the morning and evening. It is important that the hands are thoroughly cleaned beforehand. In the case of severely inflamed pimples, zinc ointment – if not prescribed by a doctor anyway – can provide relief. Due to its antiseptic effect, it can fight the bacteria that trigger the acne. Cosmetic covering of acne is indicated only in the most necessary cases. This is because most cosmetic products stop the respiratory processes of the skin, which inhibits the repair of the same. In the case of acne vulgaris, it is more important to take care that no other bacteria get into the face. When handling the face, for example for skin care, the hands should always be washed beforehand. A healthier diet also has a positive effect. Fats, salts and spices increase sebum production and nourish bacteria. A healthy and balanced diet is therefore recommended for a healthier complexion. Sunlight also helps. In addition, the intake of sunlight is ideal to combine with good ventilation of the skin. By means of a facial steam bath, the pores can be opened and bacteria, excretions of the skin and skin flakes can be easily washed off afterwards. Here should not be rubbing the skin, as this only further irritates the inflammation.