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What is acne?

Acne is a common skin condition that causes pimples on the face, neck, shoulders, chest and back.1a
It can be emotionally stressful and, depending on its severity, can lead to scarring of the skin. 2a
It occurs when the hair follicles become clogged with oil or Sebum and dead skin cells. As a result, this prevents Sebum to leave the skin through the pores.1a

Acne Illustration

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Skin surface and Acne illustration

Acne can appear in different forms, which include: 2e

Noninflammatory lesions (Comedones, i.e. whiteheads and blackheads)

When the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria, it causes the formation of Comedones. When comedones are open at the skin surface, they’re called blackheads because of the dark appearance of the plugs in the hair follicles.2d,3a On the other hand, when comedones are closed, they’re called whiteheads and are slightly raised skin-coloured bumps.1bg,3a

Formation of Pimples and Acnes

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Illustration showing different skin follicles. From normal to infected with acne and pimples.

Inflammatory lesions

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The blocked, sebum-filled hair follicle promotes the overgrowth of a bacterium, Propionibacterium acnes, which is usually present in the hair follicle. Subsequently, Propionibacterium acnes breaks down the sebum into substances that irritate the skin. This produces skin eruptions which we commonly refer to as acne pimples1g.
Inflammatory lesions take the form of: 2e

 

Examples of inflammatory lesions on the skin (Acne and Pimples)

 

Symptoms

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Most acne occurs on the face, but it is also common on the back, shoulders and upper chest.
We can identify three levels of severity – mild, moderate and severe.9

 

Images of mild, moderate and severe acne and pimples

What causes acne?

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Four main factors cause acne

These are:

  • Excess oil or sebum
  • Hair follicles clogged by oil and dead skin cells
  • Bacteria
  • Inflammation

Factors that can trigger or worsen acne include:2b

Hormones

Male hormones called androgens increase in both boys and girls at puberty. Subsequently, they cause the sebaceous glands to enlarge and make more sebum. Similarly, hormonal changes during midlife, particularly in women, can lead to breakouts.

Medications

Medicines containing corticosteroids, androgens or lithium are known to cause acne.

Diet

Certain dietary factors, including carbohydrate-rich foods, for example bread and chips, may worsen acne.

Treatment1cd

General care is very simple:

  • Affected areas should be gently washed with mild soap once or twice a day.
  • Cosmetics should be water-based as very greasy products can make acne worse.
  • Although there are no restrictions on specific foods that a person can eat, we should follow a healthy, balanced diet.

Beyond these routine measures, treatment depends on the severity of the condition.

  • Mild acne

Topical medicines are applied to the skin. They work by killing bacteria (antibacterial). Or alternatively, they dry up or unclog the pores. Antibacterials that are commonly used include the two antibiotics, clindamycin and erythromycin, and benzoyl peroxide. Other topical medicines are salicylic acid, resorcinol and sulphur. They work by drying out the pimples and cause slight peeling but are less effective than antibiotics or benzoyl peroxide.
If topical antibacterials fail, doctors may prescribe other medicines that help to unclog the pores like tretinoin. While tretinoin is very effective, it irritates the skin and makes the skin more sensitive to sunlight.

  • Moderate acne

Oral antibiotics given by mouth are usually prescribed to treat moderate acne. Examples of these antibiotics include tetracycline, doxycycline, minocycline and erythromycin.

  • Severe acne

When oral antibiotics are ineffective in treating severe cases, oral isotretinoin is considered the best treatment. Isotretinoin is the only medicine that can potentially cure acne. It is generally prescribed for 20 weeks. While isotretinoin is highly effective, it can have serious side effects. For instance, it can harm a developing foetus.
Therefore, women taking isotretinoin must use strict contraceptive measures to ensure that they do not fall pregnant. Other people may need to use specific acne treatments. For example, a doctor may prescribe an oral contraceptive for a woman with severe acne that worsens with her menstrual period.



1. van Dyk JC,et al.

South African guidelines for the management of nocturnal enuresis. SAMJ 2003;93(5):338-340.

2. Hjalmas K, et al.

Nocturnal Enuresis: An International Evidence Based Management Strategy. J of Urology 2004;171:2545-2561.

3. Kiddoo DA.

Nocturnal enuresis. CMAJ 2012;184(8):908-911.

4. van Kerrebroeck P

Nørgaard JP. Desmopressin for the treatment of primary nocturnal enuresis. Pediatric Health 2009;3(4):311-327.

5. Vande Walle J, et al.

Practical consensus guidelines for the management ofenuresis. Eur J Pediatr 2012:1-13.

6. Neveus T, et al.

Evaluation of and Treatment for Monosymptomatic Enuresis: A Standardization Document From the International Children’s Continence Society. J of Urology 2010;183: 441-447.

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