Acne and Rosacea Center

What is Acne?

• A common skin condition characterized by pimples, blackheads, whiteheads, and cysts.
• Affects the face, chest, back, and shoulders.

Etiology (Causes of Acne)

• Increased Sebum Production:
  • Overactivity of sebaceous glands leads to excess oil production.
  • Hormonal changes during puberty, menstruation, pregnancy, or stress increase sebum.
• Clogging of Hair Follicles (Pores):
  • Dead skin cells and excess sebum accumulate, blocking follicles.
• Bacterial Growth:
  • Overgrowth of Cutibacterium acnes (formerly Propionibacterium acnes) within blocked follicles.
  • Bacteria break down sebum, causing inflammation.
• Hormonal Factors (Androgens):
  • Androgens increase during puberty, causing sebaceous glands to enlarge and produce more sebum.
  • Hormonal fluctuations can worsen acne, such as before menstruation or with certain endocrine disorders.
• Inflammation:
  • Immune response to blocked follicles and bacterial presence leads to inflammation and formation of red, swollen lesions.

Pathophysiology of Acne

• Follicular Hyperkeratinization:
  • The follicle lining sheds more rapidly, causing clogging and formation of microcomedones (precursors to visible acne).
• Sebum Overproduction:
  • Hormonal influences cause sebaceous glands to produce excessive oil, contributing to follicle blockage.
• Bacterial Proliferation:
  • C. acnes bacteria thrive in the sebum-rich environment of clogged follicles.
  • Bacteria release enzymes and substances that lead to further inflammation and pus formation.
• Inflammation and Immune Response:
  • The immune system responds to bacterial growth and clogged follicles, resulting in red, inflamed papules, pustules, and nodules.
  • Inflammatory acne can lead to deeper lesions like cysts and potential scarring.

Factors Contributing to Acne Development

• Genetics: Family history increases risk for acne development.
• Hormonal Imbalances: Conditions like polycystic ovary syndrome (PCOS) can worsen acne.
• Dietary Factors: High glycemic index foods, dairy products may exacerbate acne in some individuals.
• Medications and Topical Products: Certain medications (steroids, lithium) and comedogenic skincare products can contribute to breakouts.

Outcomes and Effects

• Varied Severity: Ranges from mild comedonal acne (blackheads/whiteheads) to severe nodulocystic acne.
• Risk of Scarring: Inflammatory acne can lead to permanent scarring, hyperpigmentation, and post-inflammatory marks.
• Psychological Impact: Acne can affect self-esteem, mental health, and quality of life.

Current Treatments for Acne

Treatment for acne depends on the type and severity of the condition. The goals of acne treatment are to reduce oil production, control bacterial growth, reduce inflammation, and promote skin healing. Some of the common treatments include:

• Topical Treatments: These are usually the first line of treatment and include products applied directly to the skin. Over-the-counter options often contain benzoyl peroxide, salicylic acid, or alpha hydroxy acids, which help unclog pores and reduce bacteria. Prescription topical medications may include:
  • Retinoids (e.g., tretinoin, adapalene): Vitamin A derivatives that help prevent clogged pores and promote cell turnover.
  • Antibiotics (e.g., clindamycin, erythromycin): Help reduce bacteria and inflammation when applied to the skin.

Standard Acne Treatments

Acne is a multifactorial skin condition, and its treatment often requires a tailored approach based on severity and individual response. Standard treatments focus on reducing sebum production, controlling bacterial growth, and promoting exfoliation to unclog pores.

1. Topical Treatments: First-line therapy for mild to moderate acne often includes over-the-counter (OTC) topical agents such as benzoyl peroxide, salicylic acid, and sulfur-based treatments. Topical retinoids, like tretinoin and adapalene, are also widely used to prevent clogged pores and promote skin cell turnover【Zaenglein et al., 2016】. Topical antibiotics like clindamycin are combined with benzoyl peroxide to enhance effectiveness and prevent antibiotic resistance.
2. Oral Antibiotics: For moderate to severe acne or widespread inflammatory lesions, oral antibiotics (e.g., doxycycline, minocycline) can help reduce bacteria and inflammation. However, they are generally recommended for short-term use due to concerns about antibiotic resistance【Zaenglein et al., 2016】.
3. Hormonal Therapies: For females, hormonal treatments like oral contraceptives and anti-androgens (e.g., spironolactone) can be effective in reducing sebum production and controlling hormonal acne. Hormonal treatments are particularly beneficial in those who experience acne flares around the menstrual cycle【Lucky et al., 1997】.
4. Oral Isotretinoin: For severe cystic acne or acne resistant to other treatments, isotretinoin (commonly known by the brand name Accutane) is often prescribed. It is highly effective but can have significant side effects, including teratogenicity (birth defects), mood changes, and liver toxicity; thus, it requires close monitoring【Layton, 2009】.

Newer Acne Treatments and Advances

Recent advances in acne management have brought about newer treatments targeting different aspects of acne pathogenesis, including inflammation, sebum production, and hormonal regulation.

1. Topical Minocycline and Clascoterone: A newer addition to the topical acne treatments is minocycline foam, which delivers antibiotic action with lower systemic absorption and reduced potential for resistance. Another recent innovation is clascoterone cream, a topical androgen receptor inhibitor that reduces sebum production without the systemic effects associated with oral hormonal treatments【Hebert et al., 2020】.
2. Light and Laser Therapies: Light-based therapies, including blue and red light phototherapy and laser treatments, have shown promising results in reducing Propionibacterium acnes (C. acnes), the bacteria implicated in acne, and decreasing inflammation. Laser treatments can also help reduce acne scarring and pigmentation【Gold et al., 2016】.
3. Dapsone Gel: Dapsone 7.5% gel is an anti-inflammatory topical treatment specifically helpful for inflammatory acne lesions. It is particularly useful in those with sensitive skin, although it may take several weeks to see an improvement【Shah et al., 2017】.
4. Microneedling and Chemical Peels: These procedures have gained popularity not only for active acne but also for improving acne scars. Microneedling involves creating tiny punctures in the skin to stimulate collagen production, while chemical peels use acids to exfoliate the top layer of the skin, both helping to smooth the skin’s appearance and reduce scarring【Fabbrocini et al., 2009】.

While these newer treatments offer additional options and can be combined with traditional therapies for better results, the approach to acne treatment remains individualized. Dermatologists will often tailor treatment plans to a patient’s skin type, acne severity, and response to previous treatments.

References

1. Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., … & Thiboutot, D. M. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945-973.
2. Lucky, A. W., Biro, F. M., Huster, G. A., Leach, A. D., Morrison, J. A., & Ratterman, J. (1997). Acne vulgaris in premenarchal girls. Archives of Dermatology, 133(8), 1041-1044.
3. Layton, A. M. (2009). The use of isotretinoin in acne. Dermato-endocrinology, 1(3), 162-169.
4. Hebert, A. A., Thiboutot, D. M., Stein Gold, L. F., Webster, G. F., & Leyden, J. J. (2020). Efficacy and safety of topical minocycline foam for moderate-to-severe acne vulgaris: A randomized, double-blind, vehicle-controlled study. Journal of the American Academy of Dermatology, 82(3), 832-835.
5. Gold, M. H., Andriessen, A., Biron, J. A., & Garassino, M. C. (2016). Light-based therapies in the treatment of acne vulgaris. Dermatologic Surgery, 42(3), 349-357.
6. Shah, S. K., Alexis, A. F., & Resh, W. (2017). Topical dapsone in acne: Overview and safety profile. Journal of Clinical and Aesthetic Dermatology, 10(1), 34.
7. Fabbrocini, G., Annunziata, M. C., D’Arco, V., De Vita, V., Lodi, G., Mauriello, M. C., … & Monfrecola, G. (2009). Acne scars: Pathogenesis, classification and treatment. Dermatology Research and Practice, 2009.

Importance of Skin Checks for Skin Cancer and Melanoma Screening

Skin cancer is the most common cancer worldwide, with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma being the main types. Early detection through regular skin checks is critical, as it can significantly improve outcomes and reduce morbidity associated with skin cancers. Skin checks allow for the identification of suspicious moles or lesions early, which can lead to timely intervention before the cancer progresses or metastasizes, especially in the case of melanoma【Garbe et al., 2016】.

Regular Self-Examinations and Dermatologist Screenings

Performing regular self-skin examinations is a key preventative measure in the early detection of skin cancers. Individuals are encouraged to examine their entire body, including hard-to-see areas like the scalp, back, and soles of the feet, and to use mirrors or the help of a partner when needed. The “ABCDE rule” is often used as a guideline to spot potentially cancerous moles: Asymmetry, Border irregularity, Color variation, Diameter larger than 6mm, and Evolving in size, shape, or color. These features help identify melanomas, which can be more aggressive and life-threatening if not caught early【American Cancer Society, 2021】.

Annual skin checks by a dermatologist are recommended, particularly for those at higher risk, such as individuals with a history of sun exposure, tanning bed use, fair skin, a large number of moles, or a personal or family history of skin cancer. Dermatologists use tools like dermoscopy, a specialized magnifying device, to evaluate moles and skin lesions in more detail. Studies have shown that regular screenings can lead to earlier diagnosis, which is associated with higher cure rates and better survival outcomes, particularly for melanoma, where early-stage detection has a 5-year survival rate of over 98%【Watts et al., 2017】.

Importance of Early Detection

The benefits of early skin cancer detection are substantial. For non-melanoma skin cancers like BCC and SCC, early removal usually results in high cure rates with minimal treatment. For melanoma, which is more likely to spread to other parts of the body, early detection is vital for effective treatment. Once melanoma progresses to later stages, it becomes more difficult to treat and has a higher risk of spreading (metastasizing) to other organs, significantly impacting survival rates【Garbe et al., 2016】.

Conclusion

Skin checks and melanoma screening play a vital role in reducing the burden of skin cancer. Awareness and education on self-examination techniques, combined with regular professional screenings, empower individuals to take proactive measures for early detection. This is particularly important for those with risk factors or previous skin cancer diagnoses. Adopting these practices can help reduce mortality associated with melanoma and improve overall skin health outcomes.

References

1. Garbe, C., Peris, K., Hauschild, A., Saiag, P., Middleton, M., Bastholt, L., … & Eggermont, A. M. (2016). Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline–Update 2016. European Journal of Cancer, 63, 201-217.
2. American Cancer Society. (2021). Skin cancer prevention and early detection. https://www.cancer.org/
3. Watts, C. G., Madronio, C. M., Morton, R. L., Goumas, C., Armstrong, B. K., Curtin, A., & Mann, G. J. (2017). Diagnosis and outcomes of melanoma detected in private and public screening clinics. International Journal of Cancer, 140(2), 310-320.