Patient education-Basics to Advanced; Information to the patients affected with pimples.   

What is Pimple or acne?

Acne is the medical term for pimples. They are the disorders of pilo-sebaceous unit, i.e. hair follicle and sebaceous gland (oil secreting gland). They occur when pores get clogged with dead skin and oil, and bacteria accumulate. Then, the skin gets inflamed and can turn red or swell. It is the most common skin disorder, affecting an estimated 85 percent of adolescents in western countries, whereas in Nepal and India, it’s around 40-50% in adolescents.

How does acne develop?

There are four basic events involved in the development of acne lesions.

• Hair follicles get blocked with keratin which combine with sebum (an oily substance), creating a plug in the follicle.
• The sebaceous glands, enlarge during adolescence and sebum production increases.
• The increase in sebum allows for the overgrowth of a bacterium called Cutibacterium acnes that normally lives on the skin.
• Inflammation occurs as a result of bacterial overgrowth or other factors. This can lead to the rupture of the follicle and the formation of a swelling, abscess or tender pimple.

What are the aggravating factors of acne?

Multiple factors have been proposed to cause precipitation or aggravation of acne including cosmetics, drugs, stress, hormones, sunlight, seasonal variation etc.

Stress — Psychological stress can probably worsen acne. Acne severity appeared to worsen during times of increased stress. Stress is frequently implicated in the aggravation of acne while acne itself induces stress.

Hormonal changes — Hormonal changes during adolescence cause the sebaceous glands to become enlarged. Although acne is principally a disorder of adolescence, the prevalence of adult patients with acne is increasing.

Diet — The role of diet in acne is controversial though  studies have found weak associations between cow's milk and an increased risk of acne, perhaps because of hormones that occur naturally in milk. However, there is no strong evidence that milk, high-fat foods, or chocolate increase the risk of acne.

Is there anything I can do on my own to reduce acne?

Yes. The way you take care of your skin has a big effect on your acne. Here's what you should do:

• Try to be cool, calm and stress free. You can also try some yoga or music.
• Wash your face to remove dirt and grease. Use warm water. Use a gentle non-soap facial skin cleanser. Do not scrub your face, because that can make acne worse and damage the skin.
• Do not pick or squeeze pimples. This can make acne worse and damage the skin. It also can lead to infections.
• Avoid oil-based make-up and skin products. They can make acne worse. If you use a moisturizer for your face, a moisturizer labeled as "non-comedogenic" is often best.
• Moisturizers — Use of a moisturizer minimizes dryness and skin peeling. Moisturizers that are labeled as "noncomedogenic" are less likely to block skin pores.
• Sun protection — Some acne treatments increase the skin's sensitivity to sunlight. To minimize skin damage from the sun, avoid excessive sun exposure and use a broad-spectrum sunscreen with SPF 30 or higher.

How is acne treated?

There is no single best treatment for acne and is also individualized. Treatment depends upon the grade of the disease using different types of medicines. Please don’t use the medication without the doctor’s supervision.

• Topical medication
  • Medicines you put directly on your skin – These can be gels, creams, or lotions. Examples: retinoid, salicylic acid, glycolic acid, antibiotics
• Oral Medication (Pills)
  • Antibiotic, Retinoid, Hormones

Can I treat my own acne in these Lock Down periods?

Do not use OTC (over the counter) product that contain steroids. If you have mild acne, you may try non-prescription acne products like facewash. But, you need to be under observation of skin doctor. In rare cases, you might have a severe allergic reaction to these products, so for the first 3 days, try them on just a small area. If you do not improve after 3 months, or if you have moderate or severe acne, you must visit dermatologist.

What about my scars from acne?

Try not to pick up the pimples or use harsh measures. If you have severe or ugly scar, they might need some treatment using some surgeries, LASER or chemicals or combination of all of those. But, majority of the scars would heal with time. Protect from sunlight to prevent pigmentation.

What if I get pregnant during medicine use?

Discuss with the doctor about planning of your family before starting any medication. Many of medicines used in acne could be harmful in the pregnancy.