What exactly is acne and what works against it?

Pimples and blackheads all over the face - teenagers in particular know the problem. But acne can be treated. What causes acne, what types are there, and what the therapy is like

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Acne - a brief explanation

  • Acne is one of the most common skin diseases.
  • It occurs particularly in young people. In a little more than half of the cases, treatment with over-the-counter products is sufficient.
  • If the course is more severe, medical therapy with medication for external or internal use is necessary.
  • If you suffer from acne, you should make sure to use pH-neutral washing lotions or water-based soaps and moisturizers instead of oily or greasy creams when caring for your skin. Make-up and sunscreens should also be as fat-free as possible.

What is acne

Acne is one of the most common skin diseases. Around 85 percent of the population has already been affected. Due to the hormonal changes during puberty, acne mainly occurs in adolescents from the age of nine. Almost every teenager has noticed the characteristic blackheads and pimples on their face. The disease usually subsides by the third decade of life. If acne occurs in adults over the age of 25, it is called acne tarda, late acne or adult acne.

Physiological or mild acne

About 60 percent of young people suffer from harmless, so-called physiological or mild acne. You usually only have to struggle with a few blackheads and pimples for a short period of one to two years, which can be controlled with over-the-counter drugs from the pharmacy.

Clinical acne

In around 40 percent, on the other hand, there is a more pronounced form, the so-called clinical acne. It can last until the end of the second decade or beyond and requires treatment by a dermatologist (specialist in dermatology). If the medication is stopped too early, the patient will relapse and the therapy will start all over again. Therefore, if the acne is largely under control, the doctor will prescribe maintenance therapy. This can take a few years or even longer to reach the natural regression phase at the end of the second and the beginning of the third decade of life.

Acne can be a heavy burden not only on the body but also on the soul. This is particularly the case with the very severe forms. Papules, pustules and lumps - especially on the face - can be cosmetically very annoying and reduce personal self-esteem. In the case of severe acne, because of these psychosocial factors, you should definitely consult a dermatologist who, if necessary, also consults a colleague from the psychosomatic department.

What Causes Acne?

Several factors are involved in the development of acne. These are:

A.) Overactive sebum glands

B.) Cornification disorder in the sebum duct

C.) Overgrowth with bacteria

D.) Inflammatory Response

Overactive sebum and cornification disorder

In adolescents, with the onset of puberty, under the influence of male sex hormones (androgens) and the growth factor (GH), the sebum glands enlarge and produce more sebum. This leads to an overactive sebum gland. Normally, the sebum penetrates unhindered through the sebum canal to the surface of the skin. In the case of acne, however, the cells lining the duct and also stimulated by androgens increase the amount of horny material. The excess horn material eventually clogs the duct so that the sebum can no longer drain away. Initially, blackheads (microcomedones) are formed that we cannot see with the naked eye.

All other skin conditions typical of acne, including open and closed blackheads, arise from these. With gentle pressure you can see the thread-like emptying whitish content - the sebum-horn mixture - of the blackhead. Open comedones can be recognized by their black point in the middle. This blackish discolored area consists of melanin, which comes from the pigment-forming cells (melanocytes) at the mouth of the duct. So it's not dirt. The horn sebum material can be removed more easily from open blackheads using peeling substances, acne cleansers or drugs such as vitamin A acid preparations. In the case of closed blackheads, there is a risk of inflammation, deterioration, discoloration and scarring, especially when squeezing them out. The so-called acne toilet provided by experienced medical comedians can also help here.

Because the fat and horn cell production in the sebum glands is stimulated even more strongly by male sex hormones, acne is usually more pronounced in men and boys than in girls and women.

Overgrowth with bacteria and inflammation

Due to the overactivity of the gland, a certain bacterium, the Cutibacterium acnes, finds improved growth conditions and multiplies in the sebum duct. But acne is not an infectious disease. We all have these bacteria on our skin. They have many enzymes that, among other things, break down the sebum and keep the inflammation going in the area around the sebum system. Special immune cells migrate into the region, loosen the wall of the passage and the back and forth of inflammatory messenger substances is facilitated and intensified. As a result, pustules, papules and nodules form on the skin. If the bacteria encapsulate in the follicular duct, antibiotic resistance can develop, which is closely related to the inflammation and poor response to certain acne drugs for topical use. External factors that promote clogging of the sebum ducts should also be avoided. These include fats or oils in care and cosmetic products, certain medications, hot and humid climates or mechanical stimuli, for example from tight clothing or work-related clothing (chin straps, helmets, face protection).

Symptoms and forms of acne

Acne mainly develops where there are many sebum glands:

  • in the face,
  • on the neck and side neck,
  • on the front breast triangle (cleavage),
  • on the back to the buttocks
  • on the outer upper arms and especially shoulders

However, acne can also occur under the armpits as well as in the genital, buttock and groin regions. However, this is not a disease of the sebum glands but one of the hair follicle follicles (terminal hair follicles), i.e. a completely different disease (acne inversa or hidradenitis suppurativa). This has a different treatment concept and those affected should be cared for by specialized skin centers.