The key to solving acne-related problems lies in personally evaluating the patient to determine the personalized treatment suitable for each patient.
The most common causes of acne are varied and interrelated:
Keratinization alterations in the skin's top outer layer, the corneal layer: this makes the pilosebaceous follicle's epithelium become thicker and finally "clog up" preventing fatty acids from being released naturally through it (this is clinically referred to as whiteheads or blackheads). This causes the follicle to "become filled with fatty acids", increase in size and start becoming infected and, consequently, inflamed (this is known as inflamed papules or red pimples). This inflammation eventually causes the area to enter a cycle during which the greater the infection, the more inflammation. Eventually, a pustule forms (pimples filled with pus, which show at this stage).
Other times this process causes the walls of the pilosebaceous follicle and the gland to become destroyed, forming a cyst and then nodules (formation of inflamed cysts and nodules). This can lead to scarring and post-inflammatory blemishes (this is what shows and is known as acne scarring).
Generally the triggers are hormonal, which is why these symptoms begin appearing at around the age of 12 through 15. There are other causes but they are less frequent (medication such as corticoids, use of creams, among others).
Food does not trigger acne; this is more myth than fact. However, overindulging in certain types of foods can exacerbate the symptoms (bran-based bread, fats, chocolates, oils, etc.). Along general lines, a strict diet will not help cure acne, but avoiding certain foods may help diminish the symptoms.
Treatment depends on the acne's stage of development and is related to the number and type of acne lesions, in addition to their location, the time during which they have been developing, the time at which the symptoms began or when the scars or blemishes began appearing. This will be evaluated by the doctor, a dermatology specialist, who will select the appropriate treatment after evaluating all these variables. There are several possibilities and they can be combined:
For original non-inflammatory lesions: Topical retinoids and sun protection. Cleansings using weekly scrubs and mechanical blackhead removal by the specialist.
For inflammatory lesions: Gels with peroxide and erythromycin or clindamycin. If there is multiple lesions or they are located in places that cannot be reached by the topic agent (for example the back), an oral antibiotic (minocycline) can be taken for 2 to 3 months.
If the lesions have already formed cysts for several months, or the treatments listed above proved unsuccessful, or if acne has been developing for several years: Oral isotretinoin.
The above treatments are supplemented at the specialist's office with:
It is important to know that the doctor will prescribe each medication taking into account each particular case and based on the contra-indications such medication may entail.
The results are very good. Certain treatments leave the face free of acne as soon as they are applied. Certain treatments cure acne in 90% of the cases. Symptoms may recur if the topical agents are suspended; in this case the therapeutic strategy must be reassessed. The results show during the first month of treatment but this does not happen in absolutely all cases.
Sun exposure is best avoided using a sunscreen. During the summer, the topical treatment of choice is glycolic acid and a sunscreen. We do not recommend patients to avoid sunbathing but do advise staying out of sunlight during peak hours and using a sunscreen. Sun exposure is not allowed in treatments with oral isotretinoin.
There are multiple options, which can be combined. However, it all begins with a preliminary diagnosis at the first appointment, which is key.