Many people suffer from several skin problems; perhaps the most prevalent is acne, along with its side effects. Although acne mainly affects the youth it may nevertheless affect any age category beginning from childhood and ending with old age.
It is worth mentioning that in the United States of America alone there are 40 to 50 million people affected yearly; with an estimated treatment cost of approximately USD 2.5 billion.
Dr. Ahmed El Khatib, dermatologist, from Cosmesurge polyclinics in Abu Dhabi, and assistant researcher in California, has given a speech on Arabia.net, concerning acne, medically known as Acne Vulgaris. He said: “It is a disease that affects mainly the sebaceous glands, the ducts of which open in the upper segment of the hair follicle, along with the presence of multiple precipitating factors causing clinical lesions of different shapes that vary from simple a comedo to cystic nodular lesions”.
The genetic factor:
Dr. El Khatib declared that the pathogenesis of acne is such a complicated one, incorporating many factors are which affect the hair’s sebaceous system. It begins in the form of a comedo or blackhead which results from hyperkeratosis and the occlusion of the upper segment of the hair follicle, in which the duct of the sebaceous gland opens causing keratin and sebum accumulation. Therefore the comedo breaks down, causing an immuno-inflammatory reaction which then turns to a septic lesion through the Propionibacterium Acne effect.
He added that: “Androgenic hormones play a stimulating role to produce more sebum which stimulates more acne formation; furthermore, some studies show a genetic tendency which plays a significant role in increasing the incidence of acne in some families where the size of sebaceous glands in an individual is controlled by genetic factors”.
Types of acne:
- Comedonal Acne with both its types, either the closed comedo, i.e. the white and black comedo (whiteheads and blackheads), or the open comedo.
- Inflammatory Acne; which includes different stages according to the degree of inflammation, of which the most troublesome is Acne Conglobata”.
- Factitious Acne; which appears in young girls as a result of neglecting acne
- Acne Fulminans; which is the worst form as it appears suddenly and becomes very severe, and is further associated with systemic manifestations like arthralgia, fever, and hepatomegaly.
Dr. Ahmed El Khatib also says that: “Inflammatory Acne and Acne Fulminans are more liable to leave scars. The scars get worse as the degree of inflammation increases; that’s why treatment of Inflammatory Acne in its early stages prevents and limits the appearance of scars”.
Treatment of acne:
- Topical treatment: such as salicylic acid that is used as an exfoliant (a lytic element for comedos), an anti-inflammatory, which can also be used at home (a 2 % concentration), or which can be prescribed by specialized doctors (with a concentration up to 30%). Topical treatments also include Azelaic acid which has an anti-bacterial efficacy, acts as an exfoliant, and has an anti-pigmentation effect; benzyl peroxide can also be applied topically and greatly limits the growth of Propionibacterium Acne through the production of free radicals that are bactericidal.
- Systemic treatment: the most effective systemic treatment is through Isotretinoin, which is given in severe cases of acne, such as Cystic Acne and Acne Conglobata, or in case of failure of traditional treatments. Isotretinoin dramatically reduces sebum secretion; which causes the sebaceous gland size to decrease. At the end of the treatment interval, ranging from 8 to 10 months, the recurrence probability decreases significantly.
In cases of hormonal impairment in ladies, we can use oral contraceptive pills as a method of treatment, particularly when acne is associated with polycystic ovaries.
- Modern treatment: which implies treatment using mechanical light; also known as Photodynamic Therapy.
A photosensitive substance is applied onto the face, and then a specific concentrated light-wave can be applied which is able to kill the causative pathogens. It also has a regulating effect on sebum secretion; this therapy needs several sessions with an interval of 2 to 4 weeks between sessions, and it gives good results in mild and moderate cases of inflammatory acne.
Dr. Ahmed El Khatib declares that improvement takes place by administering both: topical treatment and Photodynamic Therapy. However, in severe case, it is recommended to use the oral systemic drugs, in order to achieve a high percentage of recovery. Nevertheless, a recurrence can take place in all cases.
Management of effects and scars:
- LASER: is considered one of the most effective methods of treatment in scar management. It is also known as “abrasive Laser therapy”; examples of which are Fraxel Laser and Carbon Dioxide Laser” therapy, which require several sessions for results to be achieved; it also requires convalescence period of 10 days after each session. The improvement ratio is uneven.
- Platelet rich plasma: includes the stimulating growth factors that induce skin restoration – several sessions are also needed to achieve reasonable improvement. The improvement ratio is uneven.
- Treatment through releasing scars or “Subcision“: is considered a revolution in the treatment of acne scars. In this procedure, a special Core needle is used to release the skin from the fibrous tissue formed beneath it, thus allowing better vascular perfusion of the target area, thus stimulating scar healing.
Dr. El Khatib confirmed that the result is often excellent from a single session, and may rise to an 80 % success rate when used along with Platelet rich plasma.
Acne became a problem with a promising solution:
Regarding the effects of acne treatment, Dr. Ahmed El Khatib pointed out that treatment using the above stated methods helps in persistent improvement of acne, but the temporary treatment of effects occurs by using a Filler, which is used to refill the scar pit, and this is usually recommended as a rapid solution in cases of big pit formation.
Dr. El Khatib advised patients who develop acne to seek early medical consultation and treatment, and to avoid tampering in order to minimize the incidence of scar formation and the probable side effects. In the case of already present scars, your doctor is the one entitled to define the best solution and method of treatment. He also referred to the modern methods of treatment as being very promising; furthermore, these refute the belief that acne is a permanent problem with no solution.