There are different types of acne:
- Infantile acne /Neonatal acne;
- Pseudofolliculitis barbae (razor rash);
- Acne cosmetica;
- Acne rosacea;
- Acne aestivalis and many more.
Acne vulgaris is one of the most common skin problems. It is a chronic condition and affects 95% of the population at any stage of our lives.
It is most common during adolescence and puberty and is caused by an increase in the hormone testosterone, regardless of gender. Especially during puberty, oil (sebaceous) glands are stimulated which secrete excessive oil (sebum) in the skin. The function of the oil is to act as a natural moisturizer and to lubricate and protect the skin.
Under certain circumstances the oil glands become blocked with keratin (skin debris) and sebum (oil) and form microcomedo. This stage can be recognised by an early change in the appearance of the skin. The microcomedo may enlarge to form blackheads (open comedo) or whiteheads (closed comedo).
The microcomedo may become enlarged comedo with an excess of oil and this creates a perfect environment for the naturally occurring Propionibacterium. As the bacteria multiply, some of them become inflamed and this leads to various kinds of inflammatory lesions: papules, infected pustules, nodules or cysts.
In our practice we treat patients suffering from acne according to the South African Guidelines, updated and published in November 2005 in the South African Nursing Journal (SANJ).
We ensure that we grade the acne vulgaris accurately according to the level of severity because the treatment of acne depends on the grade of acne.
Below are descriptions of the grades:
Grade 1: This grade has comedones only. No inflammation is seen in any large amounts. Most people affected by this grade are in their early adolescence and the acne appears first on the forehead and nose. Blackheads and whiteheads are also commonly found around the eyes and chin.
Grade 2: This occurs if Grade 1 level acne is left untreated. More blackheads and whiteheads are present than at Grade 1 level. Inflammatory papules start developing and skin breakouts happen more often and look more prominent with slight inflammation. This grade of acne spreads to other parts of the face. It may also spread onto the shoulders, chest, and back.
Grade 3: Pustules (bumps with fluids or pus) as well as many more whiteheads and blackheads are present. Compared to Grade II acne, this stage presents a more inflamed and reddened skin. Other areas can be infected with acne such as the chest, neck, shoulders, and upper back. There is a potential for scarring with this grade of acne because the level of infection is higher than the other grades.
Grade 4: Nodules (large, hard bumps), cysts (closed boils), conglobate lesions or ulcers are present in addition to the symptoms of the previous grades of acne. This stage is often called the Cystic or Nodulocystic acne. Other than inflammation, this type of acne also causes severe pain particularly on the lesions because the infection is deep. Several sessions of treatment may be needed in order to see results.
During the first appointment we assess and grade the level of acne in the patient. We then prescribe appropriate topical and/or oral medication.
We also offer Intense Pulse Light therapy (IPL). IPL has received FDA approval for mild and moderate and inflammatory acne. Light decreases the sebum production, destroys the bacteria and causes shrinkage of the inflamed sebaceous glands. (See more on IPL).
We also use Diode laser treatment. Diode lasers can destroy sebaceous glands in the dermis, which is the thick middle layer of skin. This is done without harming the outer layer of skin.
One of the complications of acne is acne scarring. It is very important to deal with acne in the early stages to avoid this.
There are different types of acne scarring:
- Ice pick scars – Deep pits that are the most common;
- Box car scars – These usually occur on the temple and cheeks and can be superficial or deep, like chickenpox scars.
- Rolling scars – Scars that give the skin a wave-like appearance;
- Hypertrophic scars – Thickened, or keloid scars.
For acne scarring we offer the follow treatments:
- Meso-needling/Dermal Needling
- Laser/Light and Radio Frequency Therapy (IPL, Diode Laser WRA, Matrix IR Fractional, triniti)
- Injectable Fillers