Acne

 It is one of the commonest problems in adolescents and young adults. It is a disorder of the pilosebaceous unit of the skin that consists of the hair follicle and sebaceous or oil glands of the skin. It can present as comedones (blackheads and whiteheads), papular, pustular or nodular cystic lesions.

Comedones are the primary lesions of acne. Sebum production increases, follicular wall cells fail to desquamate to the surface in the normal manner, and Propionobacterium acnes grows in the sebum-cell mixture and forms a plugged pore or a microcomedo and then a visible comedo. Papulopustules may evolve from the comedones. The nose, forehead, cheeks may be involved on the face. Even the back, chest, upper arms may be involved.

Acne may occur even before other signs of puberty appear around the age of 10 and may go on till as late as early 40s. It lasts longer in women and is more severe in men. In case of resistant acne it is important to rule out underlying use of drugs, or hormonal disorders like PCOD/PCOS (polycystic ovarian syndrome).

Treatment includes topical medicines like retinoids, clindamycin, benzoyl peroxide, sulphur, azelaic acid, salicylic acid etc. as single or combination treatment regimes. Oral medications like azithromycin, doxycycline, minocycline, isotretinoin, oral contraceptives. Certain cosmetic procedures like chemical peels, microdermabrasion, microneedling (dermaroller), lasers etc. can help to alleviate the sequel and complications like hyperpigmentation and scarring.