Acne: Causes, Forms and Control of Impure Skin


Acne, medically acne vulgaris, is the world’s most common skin disease. Between 60 and 80 percent of all adolescents suffer from impure skin in different forms. Typical of acne are blackheads, purulent pimples and inflamed nodes – how it comes to it and what helps.

Behind acne is a disease of the sebaceous follicles, which manifests itself in terms of severity in pimples or blackheads (comedones). These blemishes occur mainly on body parts that have relatively many sebaceous glands. Impurities accumulate on the face, décolleté, neck, back or upper arms.

Acne usually recedes after puberty , with five to seven percent of those affected permanently retaining scars . About ten percent of people still struggle with symptoms beyond the age of 25, women more often than men. However, as a teenager, slightly more boys suffer from blemishes than girls, and severe cases are more common in male adolescents.

Forms of acne

Acne usually refers to the common acne. In addition, there are a number of other forms of acne, which differ in their causes and signs of the common acne vulgaris:

  • With the Acne inversa the hair follicles ignite in the armpit and pubic hair area and provide for painful knots.
  • Acne venenata or contact acne: This type of acne occurs when the skin frequently comes into contact with certain chemical substances (such as chlorinated hydrocarbons, tar or mineral oils and lubricants).
  • The neonatal acne (acne neonatorum , baby acne, infant acne ) occurs in the first weeks of life and is often a reaction to hormonal changes after birth . Changes in hormone levels during pregnancy also play a role.
  • Those suffering from Mallorca acne , hypersensitive to a combination of sunscreen and UV radiation .
  • Late acne or acne tarda usually occurs after the age of 25 to 30 years.

Acne can severely affect the quality of life

Although acne is often dismissed as a normal puberty. In fact, between 15 and 30 percent of patients need medical treatment because of the severity or persistence (persistence) of the skin disease. In addition, pronounced acne can severely affect the quality of life – according to patient surveys, the deterioration in quality of life is comparable to bronchial asthma, epilepsy , type 2 diabetes, or arthritis . Even anxiety disorders and depression can be triggered by acne.

Causes: How does acne develop?

Acne vulgaris usually arises from a combination of several triggering factors. This includes:

  • Sebaceous glands overactive
  • Cornification disorder in the sebaceous duct
  • inflammatory response
  • Over-colonization of bacteria

In all these processes, hormones play an important role. The keratinization and blockage of the sebaceous glands, the sebum can no longer flow properly, it form blackheads. These can be colonized by bacteria and ignite.

The hormones are changing

When the hormonal balance changes, it is possible that acne is triggered. The main focus here is on fluctuations in the distribution of androgens (male sex hormones). The sebaceous glands, where the inflammatory pimples form, have androgen receptors. They react to the sex hormones with increased sebum production. During puberty, the body spends a lot of hormones, so mainly teenagers fight with acne. Scientists believe that inheritance plays a role in the development of acne. Genetically caused, for example, it can lead to an overproduction of androgens in puberty.

Impure skin is more common in women during menstruation, pregnancy, or postpartum. Again, the occurring hormone fluctuations are probably responsible for the imbalance of the skin.

Acne Cause: Medication, environmental factors or stress

Environmental factors such as climate, humidity and UV radiation can promote the development of blemishes. Also drugs are considered as the cause of acne: Many substances are suspected to cause pimples and pustules, for example, by affecting the production of androgens. These include cortisone medications, lithium or certain hormone supplements that can mess up the sebum.

The extent to which stress and mental stress have an influence on the skin and thus the development of acne, needs to be further investigated. There are studies indicating that stress is involved in the development of inflammatory processes in the sebaceous follicles. In addition, the body increasingly produces the hormone cortisol during prolonged stress, which can have a negative effect on the skin’s health.

Diet as a risk factor for acne

The diet may also have an effect on the skin, although its role in the development of acne is controversial. Investigations showed that Inuit, Chinese, and residents of Okinawa, Japan, were prone to acne after switching to Western dietary habits. Scientists believe that those affected rarely omega-3 fatty acids , which occur in larger quantities, for example in fish, but consumed more omega-6 fatty acids that promote inflammation.

Other studies have shown that carbohydrate-rich foods with high glycemic index, such as milk, wheat flour or sweets, promote the development of pimples. Insulin levels may also affect the appearance of the skin.

Symptoms of acne vulgaris

Patients suffering from acne show symptoms of blackheads, pustules, small fistulas, and knots in their complexion depending on their severity. In severe acne scars remain after healing.

Acne is particularly evident in areas where there are particularly many sebaceous follicles – so on the face and on the neck, chest and back. Depending on the severity, blackheads develop, which can later become inflamed by invading bacteria. The pimples are filled with pus, which is seen in small blisters on the skin surface. This form is medically called acne papulopustulosa. Based on the symptoms of acne, dermatologists can divide the skin disease into different degrees of severity.

Severity levels for acne

  • Dermatologists speak of a mild acne when few blackheads (comedones) and few to no pimples occur.
  • A moderate severity is associated with more pronounced symptoms of acne: Here, the skin shows many comedones, few to many pustules and a few small nodules or cysts. In contrast to mild acne, inflammation is present with moderate severity.
  • A severe acne is present when the blackheads are very many pustules, small cysts and possibly also added nodes and sometimes painful inflammation occur. These leave scars on healing.
  • Doctors speak of a very severe acne, if the inflammation is very pronounced. In this form, it always comes to the formation of nodes that reach deep into the skin.

Acne conglobata mainly affects men

The inflammatory knots under the skin that occur in severe and very severe acne are painful and itchy. The knots occur not only in the typical acne regions, but also on the arms, legs and buttocks. They often leave acne scars. This most severe form, the acne conglobata, affects mostly men.

How Acne vulgaris is diagnosed

To diagnose acne, the doctor first performs an anamnesis . In it he asks the time of the first appearance of the complaints, their development and the previous treatment.

Many sufferers have already used a range of over-the-counter cosmetics before the doctor’s visit. Possible allergies to contained ingredients or taking medications are also important in your medical history. A familial accumulation of acne vulgaris and other skin diseases is especially important for the planning of the therapy.

Check hormone status

For a precise diagnosis, a dermatologist must first determine the skin type in detail. Thus, the disease can be divided into degrees of severity, to which the treatment is based. Depending on the severity and development, further procedures may be necessary, such as a hormone examination. This is necessary, for example, when women suddenly experience severe acne, the severity of acne increases or therapy fails. For the hormone examination, the dermatologist takes blood.

Microbial examination only necessary in individual cases

However, another procedure that is not routinely recommended by clinicians is a microbial examination. In individual cases, this investigation on bacteria serves to differentiate other causes of the complaints or to detect antibiotic-resistant germs.

Only a few pimples or already acne?

When a teenager shows first symptoms, parents tend to dismiss this as a common puberty phenomenon. Most of the teens use common funds from the drugstore or pharmacy. However, between 15 and 30 percent of sufferers must be treated for the severity or persistence of the skin condition.

Therapy: What helps against acne?

The treatment of acne depends on the severity and speed of development. In addition, skin type, sex and age play a role in acne therapy. The emotional distress due to externally visible pimples and blackheads also influences the decision of which form of therapy is chosen.

The first step in the treatment is to remove cornification, reduce inflammation and, if necessary, reduce sebum production. If it has already come to social withdrawal and effects on self-esteem due to the skin, a rapid relief of externally visible symptoms is particularly important.

For therapy, both external (topical) and medicinal (systemic) options are available. Often both are combined, with the main criterion for taking medications being severe acne forms with scarring. Not every acne therapy leads to success. Thus, less than a quarter are very satisfied with the success of therapy, just under a third, however, not at all. It is important to adjust the treatment under the guidance of the dermatologist if no therapeutic success occurs.

Remedies for Acne: How do creams, ointments and solutions help?

A number of drugs can be used for the external therapy of acne vulgaris. In order to dissolve cornifications and to smooth the skin surface, anti-comedogenic and keratolytic substances are suitable. Anticomedogen means that it does not contain any substances that clog pores, resulting in comedones, while keratolytic agents release horny cells from the upper layer of the skin to prevent blackheads from forming.

The anti-comedogenic and keratolytic agents used for acne treatment include azelaic and salicylic acid, tretinoin and isotretinoin. Antimicrobial agents such as benzoyl peroxide, azelaic acid, zinc, disinfectants, and topical antibiotics are suitable for slowing down the spread of inflammation and minimizing existing ones.

Medicines for acne vulgaris

In stubborn course as well as in severe cases, especially when scarring, however, antibiotics are taken for the treatment of acne: tetracyclines, clindamycins or trimethoprim inhibit the formation of bacteria. However, taking antibiotics is sometimes associated with side effects such as gastrointestinal discomfort, allergic reactions or liver damage. In addition, as antibiotics may reduce the effects of hormonal contraceptives such as birth control pills, it is advisable to use additional contraceptives such as condoms during treatment. The active substance isotretinoin narrows the sebaceous glands and reduces sebum production.

Antiandrogens or estrogens can be used in women. An excess of male sex hormones can contribute to the development of acne. Antiandrogens inhibit their production. For many women, birth control pills can be used as a remedy for acne. The hormone estrogen contained in it has visible effects on the appearance of the skin in many patients. However: For overweight and smoking women, the contraceptive pill is not suitable because it increases the risk of thrombosis.

Consequence is important for successful acne therapy

Regular cleansing of the skin is crucial in acne vulgaris. Dermatologists recommend pH-neutral wash gels. not to irritate the skin in addition. A healthy diet also supports acne therapy. In addition, good compliance, ie adherence to the therapy guidelines by the doctor, is an important prerequisite for the success of the treatment. However, one study showed that between 19 and 79 percent of acne patients do not consistently enough to the prescribed acne therapy.

Tips for acne treatment

Pharmacies and drugstores offer effective means of treating acne. Important is a mild and not exaggerated cleaning of the skin, because it is already irritated and sensitive by therapeutic measures against acne. These basic tips help sufferers:

  • Gentle cleansing: Wash the skin twice daily with lukewarm water. We recommend slightly acid syndets (pH 5.5 or 6.5). They create a milieu in which the bacteria are not viable, while the acid mantle of the skin remains intact.
  • Facial steam baths or moist compresses expand the pores of the skin and are a gentle treatment for acne. Chamomile additionally relieves the inflammation.
  • Avoid fat skincare products. You can increase the acne – this also applies to make-up. Especially products with ingredients such as petrolatum, lanolin or paraffin oil can worsen the appearance of the skin. Better are special care series based on water, which are tailored to the impure skin (consult with the dermatologist). Make-up should be thoroughly removed every night before going to bed.
  • well-balanced diet often has a positive effect on the skin condition. Smoking and alcohol are negative. Anyone who realizes that certain foods make the skin bloom best bans them from the diet.
  • Beware of the sun! It does not always improve the appearance of acne and is not considered a blanket acne treatment. In about 30 percent of those affected, the skin even deteriorates. Special care should be taken if the doctor has prescribed antibiotics or derivatives of vitamin A. Because this makes the skin more sensitive to light. A so-called Mallorca acne can only co-trigger sunlight.
  • Steer clear of the pimples! If you push yourself around, you risk spreading inflammation and even more scars. Pimples and blackheads should be removed by a trained beautician or dermatologist.

Well-known home remedies for acne

There are also some known home remedies for acne.

  • Treat affected areas up to three times a day with camomile compresses . The medicinal plant calms the skin and has an anti-inflammatory effect. Boil a tea from 250 ml of water and two bags of chamomile tea. Dip cotton pads in the tea and wait until they have cooled. Then place the compresses on affected areas of the body and leave on the skin for 15 minutes.
  • Mix a mask of healing earth. The healing earth absorbs the superfluous sebum. To do this, stir in a paste of four tablespoons of healing earth and a little water. Apply the paste on acne-affected areas of the body and let it dry for 15 minutes. Then wash off the healing clay.
  • Another effective home remedy for pimples: Prepare a 20-minute steam bath with sage . The steam bath opens the pores, sage has an anti-inflammatory effect. Add 40 grams of sage with 1 liter of hot water to a bowl. Then inhale the steam with a towel over your head. Alternatively, you can make the steam bath with thyme or rosemary .

Acne: course and stages

With puberty, the acne is usually over. Only in rare cases can it persist until the age of 40. Doctors then talk about persistent acne. The course is different for boys and girls. In male patients, the acne often lasts longer and it comes to more severe acne forms, which is partly due to the increased production of androgens.

Three stages of acne symptoms

Acne runs roughly in three stages:

  • At first, comedones form. This is called a non-inflammatory phase during the course of acne. Open comedones recognize affected persons at the black dot in the middle. This blackish spot consists of melanin, which is derived from the pigment-forming cells (melanocytes).
  • When a blackhead in the second phase inflames, the typical pimples and pustules form. That is why we speak here of an inflammatory phase.
  • In the third phase of acne, the pimples disappear, leaving scars in severe acne. Since these can be a cosmetic problem, some cosmetic studios now offer laser treatment to reduce scars.

The acne course does not always follow these three stages. Some sufferers only develop blackheads.

How to prevent acne

The causes of acne are many. Most hormonal changes during puberty trigger the annoying pimples. The familial predisposition also plays a role. Targeted, safe acne prevention is therefore not possible.

Choose the right skin care

Proper skin care helps to a certain extent to prevent pimples. For the prevention of acne, doctors generally recommend the use of cosmetic products that are not comedogenic. These are free of active ingredients that additionally block the sebaceous glands and thus contribute to the formation of blackheads. Comedogen-free products are marked accordingly on the packaging and thus easy to recognize.

Gentle skin cleansing and balanced nutrition

Regular cleansing of the skin with neutral wash gels also contributes to acne prevention. However, sufferers should not wash the skin too often. Frequent washing, especially with unsuitable cleaning products, irritates and dries out the skin. Dermatologists recommend the use of light oil-water emulsions and hydrogels to care for youthful, blemish-prone skin. Additives with fruit acids, glycolic acid, salicylic acid and lactic acid demonstrably counteract the development of new blackheads and are recommended. It is not recommended to use greasy ointments because they can clog pores.

Although the impact of diet on the development of acne is not well established, there are many indications that it plays a role in acne prevention. For impure skin, it is worth trying to reduce the following foods:

  • Dairy products
  • sugar
  • very fatty foods
  • High glycemic index foods (chocolate, cakes, sweets, wheat flour)