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Acne also called as pimples can be explained for lay man as blockage and inflammation of sebaceous glands and hair follicles of the skin characterized by comedones, papules, pustules, nodules and cyst later  causing tissue destruction and scar formation. It is one of the most common skin problem faced by teenagers. It is so common that it is said that 70% of the population have some clinical evident acne at some stage during adolescence. However though common it can sometimes cause  immense psychological and cosmetic embarrassment. Teenagers with  severe acne problem usually lose their self esteem and do not want to socialize. Sometimes if affects their studies as well and if the child does not receive correct psychological help can go into severe depression.

Acne manifest in different ways

  1. Comedones blackheads
  2. Comedones Whiteheads
  3. Papules
  4. Pustules
  5. Larger nodules
  6. Cysts

Papules less severe form and cyst the most severe form of acne. A patient can have combination of these lesions.

Cause of Acne is multifactor. Hormonal changes seen at puberty, during pregnancy and menopause is  considered as one of the cause of acne. Genetic history is another theory in causation of acne. Stress could also be one of the factor for acne.

Acne is one condition that occurs in all races worldwide. Girls develop acne usually between 14-17 years commonly on the face rather than the chest, shoulder or back. Although condition tends to fluctuate during adolescence and subside during the twenties, it sometimes continues into adult life.

Patients tend to have increased oiliness on the face and often suffer from dandruff. Aggravating factors include hot and humid climate, application of acnegenic creams, emotional stress, and certain drugs such as steroids. Although oily and sweet foods can worsen the condition this appears to be an individual response not a general rule. Severe forms of acne in girls need to be investigated for underlying hormonal imbalances, especially if the patient also suffers from hair fall, excess hair on the face or body and menstrual irregularities.


The main complication of acne is that the patient tends to develop scars and pigmentation at the site of the lesions. Repeated episodes tend to leave permanent marks on the skin leading to severe cosmetic problems which is then difficult to manage. Though treatment is required for  only 20% of the affected individuals treatment depends on severity and the predominant types of lesions. Treatments aim at reducing bacterial population, reducing the rate of sebum production and facilitating shedding of horny plug to clear obstruction. A detailed history needs to be taken before deciding the treatment which should rule out all the aggravating factors.

General instructions to all patients would be to include a balanced diet with plenty of salads, green and fruits , adequate sleep,  gentle cleansing of the skin with oil free cleansers, regular shampooing of hair , treatment of dandruff . Use your own towel. Plenty of water to flush toxins out of the body is also beneficial.  Sound sleep  for eight hours can also do miracle in the cure of acne.

A number of topical medications are available which include antibiotics/ and /or comedolytic agents. Most of these can be used at bedtime gently on the affected skin after washing the face and patting it dry.  A combination of two topical agents is often advised when the patients has both comedones and more inflammatory papules or pustules. The patient should be aware that acne can worsen in the first few weeks of using  an anti-acne cream or gel and will then subside over the next three to four weeks.

If involvement is more severe oral antibiotics are advised , Isotretinoin a synthetic vitamin A derivative is very effective in severe and unresponsive acne, but has a number of side effects and needs to be used under stict medical supervision. Acne with a hormonal basis of showing menstrual flares can be managed with hormonal medications such as oral contraceptives and anti androgenic agents.

Effective treatment is now available for pigmentation and scarring following acne either with chemical peeling aents, dermato-surgical techniques or laser resurfacing.

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