Understanding Acne: Causes and Cure


Acne vulgaris (Common acne) is a self-limited and non-communicable disorder associated to the increase in sebum release by the sebaceous glands that primarily affects teenagers and young adults.

Common Causes of Acne

The usual causes of acne are related to physiologic hormonal variation, alteration in hair maturation, recent use of medications (steroids and contraceptives), occupational contactants, clothing, emotion and stress, genetic and even tropical climate.

These are characterized by comedones, papules, pustules, cysts and nodules. Acne is a result of a complex interaction between hormones, specifically androgens, and an acne causing bacteria, with the right genetic background for acne susceptibility. It is known that the bacteria Proprionibacterium acnes liberate free fatty acids from sebum which is produced in the sebaceous glands, which then would cause a sterile inflammation. This would then yield to formation of cysts, closed sac with a distinct membrane developing abnormally in any cavity or structure. This sterile inflammation would then cause hyperkeratinization, blocking the follicle openings of the sebaceous gland and eventual rupture of the cyst. Scars are the results from rupture of the cysts and intense inflammation.

The hallmark of acne vulgaris is the comedone, which may be open (blackhead), and closed (whitehead). Comedones are results of defective sebaceous follicle openings and defective keratinization at the follicle openings. Aside from the physiologic aspect, other factors that alter the manifestations of acne are friction and trauma that may affect preexisting comedones and elicit inflammation; cosmetics and hair preparations which are comedogenic; medications such as glucocorticoids; and hormonal diseases affecting the ovaries and adrenal glands as well as immune suppressing illnesses. It is important to know that acne may develop even among older adults and the thought that only teenagers develop acne is purely a misconception.

Treatment for Acne Breakout

Treatment of acne aims to eliminate comedones, reduce bacteria-causing acne and decrease the inflammatory process. Mild acne can be treated with topical (ointment) antibiotics like Clindamycin and Erythromycin, gels like Benzoyl Peroxide (2%, 5% and 10%), and topical retinoids (tretinoin).

Meanwhile, moderate acne can be treated with oral antibiotics like Tetracycline, which is added to the for mild acne regimen.

Lastly, severe acne is treated with Isotretonoin, an agent which is successful in reducing sebaceous gland activity and decrease in keratinization. It is of utmost importance that Isotretinoin is a teratogen, a drug which may cause developmental malformations. It is advised that pregnancy must be avoided and that women who may get pregnant should use contraceptives.

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