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
Frequency of having acne:
Month
16%

once a week

47%
31%

2-3 times a month

24%

once a month
once in 2-3 months

19%
9%

once in quarter year or less

3%

don't know/hard to tell

0%

10%

20%

30%

40%
valid sample:506

Nearly 50% Respondents Thinks The

Cleanliness Of Skin Is The Major Cause
oftheAcne
What are
causes of having acne?
48%

cleanliness of skin

40%

food

34%

hormone secretion

30%

daily habit (not enough rest)

pressure/mood
oil secretion
others
don't know/hard to tell

0%

14%
6%
12%
5%
10%

20%

30%

40%

50%

valid sample:503 (multiple

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
comedo is a
sebaceous
follicle
plugged with
sebum.

Its
appearance
is that of
skincolored or
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:
a small,
solid lesion
slightly
elevated
above the
surface of
the skin. It
is caused by
localized
cellular
reaction to
the process
of acne.

Pustules

Papules

a domeshaped,
fragile
lesion
containing
pus
that
typically
consists of
mixture of
white blood
cells, dead
skin cells
and
bacteria.

Pustules

Types of Acne
Cysts

Nodules
Nodule:
is characterized by
inflammation,
extends
into deeper layers
of the skin and may
cause tissue
destruction that
results in scarring.
It may be very
painful.

Cyst:
It may be
severely
inflamed,
extends into
deeper layers of
the skin, may be
very
painful, and can
result in
scarring.

Cysts

Variation of Acne

Light
Characterized by
whiteheads,
blackheads,
papules, pustules.

Moderate

Severe

Inflammatory
increases and
becomes more
serious. It usually
happens on surface
but sometimes
have deeper
pustules.

Characterized by
cysts and nodules,
many are in the
body, scars are
easily formed.

50% Of Respondents
Have Acnes On Forehead
Where is the acne you usually having
51%

forehead
31%

cheek
chin

28%

nose

26%

near the mouth

6%
1%

others

4%

don't know/hard to tell

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 cotrimoxazole 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
To reduce
sebum production and help skin
cells inside follicles to return to normal.
(isotretinoin)
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
Androgens stimulate sebum production.
Anti-androgen

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
CPA (cyproterone acetate) was developed
androgen

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
As oral
contraceptive pill
effective on acne
Acne
Treatment
with
treatment and skin improvement.
Contraceptive
Clinical studies show:
1. After 3 cycles (months): improvement/healing for 3550% 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.