Acne

Causes & Treatment

Dr. Tinny Ho,

Specialist in Dermatology
June 29, 2004
Acne is one of the most common skin
diseases, there are about 17,000,000
Americans affected by acne.
According to the data in US research, close to
100% of people between the ages of 12 to 17
have acne. After the age of 15, around 40% of
adolescents have acne severe enough to
require treatment by a physician.
Half Respondents Suffer From
Acne At Least Twice A Month
Frequency of having acne:

once a week 16%

47%
2-3 times a month 31%

once a month 24%

once in 2-3 months 19%

once in quarter year or less 9%

don't know/hard to tell 3%

0% 10% 20% 30% 40%

valid sample:506
 Nearly 50% Respondents Thinks The
Cleanliness Of Skin Is The Major Cause of
Acne
What are the causes of having acne?

cleanliness of skin 48%

food 40%

hormone secretion 34%

daily habit (not enough rest) 30%

pressure/mood 14%

oil secretion 6%

others 12%

don't know/hard to tell 5%

0% 10% 20% 30% 40% 50%

valid sample:503 (multiple responses)

Causes of Acne
Acne is caused by the plugging of follicles, which is
mostly due to excessive sebum production by
sebaceous glands stimulated by the influence of
androgens (male sex hormones).
Skin keratinization and plugging of follicles speed up
the formation of acne.
A normal skin bacteria called P. acnes, produces
irritating substance that can cause inflammation.
Androgens & Acne
Androgens (male hormones) are present in females as
well as males, but in higher amounts in males.
Androgens cause the sebaceous (oil) glands of the
skin to produce more sebum (oil), excess androgens
will cause excess sebum production.
If excess production of sebum plugs the opening of
the follicles, it may increase the amount of bacteria
which cause inflammatory acne.
Despite having normal level of androgen, if the
sebaceous glands are over-sensitive to androgens,
excess sebum is thus produced, acne results.
Types of Acne
Whitehead:
a closed
Its
comedo is a
appearance
sebaceous is that of skin-
follicle plugged colored or
with sebum. slightly
inflamed
bump
in the skin.

Blackhead:
a comedo is
open.

The surface of
the plug in the
follicle has
blackish
appearance.
Types of Acne

Papules Pustules
Papules: Pustules:
a small, solid a dome-
lesion slightly shaped,
elevated above fragile lesion
the surface of containing pus
the skin. It is that typically
caused by consists of
localized mixture of
cellular white blood
reaction to the cells, dead
process of skin cells and
acne. Papules bacteria.
Pustules
Types of Acne
Nodules Cysts
Nodule: Cyst:
is characterized by It may be severely
inflammation, extends inflamed, extends
into deeper layers of the into deeper layers
skin and may cause of the skin, may be
tissue destruction that very
results in scarring. painful, and can
It may be very painful. result in scarring.

Cysts
Variation of Acne

Light Moderate Severe

Characterized by Inflammatory Characterized by
whiteheads, increases and cysts and nodules,
blackheads, papules, becomes more many are in the body,
pustules. serious. It usually scars are easily
happens on surface formed.
but sometimes have
deeper pustules.
 50% Of Respondents Have
Acnes On Forehead
Where is the acne you usually having

forehead 51%

cheek 31%

chin 28%

nose 26%

near the mouth 6%

others 1%

don't know/hard to tell 4%

0% 20% 40% 60%

valid sample:506 (multiple
Normal Distribution of Acne
Acnes lesions are most common areas with
sebaceous (oil) glands, mainly on the face, but
they can also occur on the upper back and
chest.

Face Upper back

Causes of Excess Sebum
Production & Increase of
Androgen
Hormonal secretion becomes higher during puberty,
which causes the sebaceous glands becoming larger
and producing more sebum.
Womens menstrual cycle, being pregnant, starting or
ending to take contraceptive pill will cause hormonal
changes.
Others causes:
Heredity
Taking drugs containing androgens and lithium
Facts about Causes of Acne...
1. Eat chocolate and greasy food (e.g. French Fries) will
case acne
No scientific proof on the correlation between the
formation of acne and food.
2. Will dirty skin cause acne?
Acne is caused by the excess production of sebum
from skin.
3. Stress causes acne!
Some studies have demonstrated there is no
relationship between acne and stress. However, recent
studies show that corticosteroids (which are increased
during times of stress) may stimulate sebum
production, hence worsen the acne. A 2003 study
targeting medical students also shows patients with
acne may experience worsening of the disease during
examinations, suggesting stress may have a significant
influence.
Facts about Treatment of
Acne...
1. I wash my face several times a day. Why do I still get
acne?
Too much washing will only irritate the skin further and worsen
their acne. Gently wash your face daily with mild cleanser or
soap, pat dry and use appropriate acne treatment.
2. Just let acne run its course!
Some acne scar will remain permanent, so patients should use
appropriate acne treatment as soon as possible.
3. Is it essential to squeeze the acne?
Squeezing forces infected material deeper into skin, causing
additional inflammation and possible scarring. If you have
severe acne problem, consult the doctor as soon as possible.
4. If the acne cannot be cured in a month, then should try other
drugs.
Give acne products enough time to do their job. Some
medicines might take a few months to take effect. Ask your
doctor how much time is needed for each particular product to
work.
Acne Treatment
Purposes of Acne Treatment
Decrease sebum production
Reduce P. acnes (bacteria)
Reduce keratinization
Eliminate inflammation

A dermatologist may combine two or more

treatment options to create effective therapy
and prevent new lesions from forming.
Treatment for Mild Acne
Topical Treatment
External keratolytics may reduce
keratinization. Treatment such as:
Salicylic acid
Alpha hydrosy acids (AHA)
Benzoyl peroxide (cannot eliminate
inflammation)
Retinoids
Anti-inflammatory drugs to inhibit P. acnes
(bacteria)
Treatment for Severe Acne
The Common rationale of some of the treatment
method
1. Use anti-androgen (e.g. oral contraceptive pills) to
regulate androgen, to prevent excess sebum production.
This method is only suitable for women.
2. Use anti-biotic to curb the growth of bacteria.
3. Use retinoids, derivative of vitamin A (e.g. isotretinoin) to
reduce sebum production and keratinization. Patients
may experience side effects.

Beside the above treatment methods, other non-

medical treatment may be introduced, for example
to keep the skin clean by using skincare products
correctly.
Treatment for Severe Acne
Oral Anti-biotic
Use anti-biotic, for example tetracycline,
erythromycin or co-trimoxazole etc. to curb
the growth of bacteria and reduce
inflammation.
Use with care and prolonged treatment may be
necessary to achieve the desire results.
Treatment for Severe Acne
Oral Retinoids (isotretinoin)
To reduce sebum production and help skin cells inside
follicles to return to normal. Effective but takes 4-5
months before beginning to see an improvement.
Early use will cause dryness and shedding of skin, and
even cracking around the mouth.
Might cause foetal abnormality, hence not suitable for
pregnant women or women planning to have babies.
Studies show it might cause suicidal attempt.
Physician follow-up is required.
Treatment for Severe Acne
Anti-androgen
Androgens stimulate sebum production. To
tackle of root cause of acne, women should
find ways to tackle androgens.
Oral contraceptives works by regulating the
hormones (estrogen, progestogen and
androgen), blocking the effect of androgen on
the skin, and thus reducing sebum production.
It is effective in acne treatment and sebum
control among women.
 Antiandrogenic Effect of Different
Oral Contraceptives
Antiandrogenic
Effect
Synthetic Progesterones (active
ingredients of most oral contraceptives)
e.g: Levonorgestrel, Norgestimate,
-
Desogestrel, Gestodene
Drospirenone (Brand name: Yasmin)
+
Cyproterone acetate (Brand name:
Diane)
++
Source: Pharmacological profiles of progesterone, drospirenone and other synthetic progestogens.
Foldert et al. Eur J Contracept Reprod Health Care 2000; 5: 124-34
CPA synthetic hormone
effective in reducing androgen
CPA (cyproterone acetate) was developed in
1961.
CPA attaches itself to androgen receptors in
the skin and then blocks the receptors (like
the wrong key jammed in a lock). The
androgens then cannot affect the skin.
Additionally, it also reduces the activity of the
ovaries, so it also works as a contraceptive
pill.
Diane-35 is the only oral contraceptive that
contains CPA.
Treatment for Severe Acne
Anti-androgen: Diane-35 Acne
Treatment with Contraceptive
As oral contraceptive pill effective on acne treatment and
skin improvement.
Clinical studies show:
1. After 3 cycles (months): improvement/healing for 35-50% of
patients
2. After 12 cycles (months): improvement/healing rate of acne
for 90% of patients
The only oral contraceptive approved by the Hong Kong
Department of Health for the indication of acne treatment.
Oral contraceptives not suitable for pregnant women and
cigarette smokers.