On the skin’s surface, blackheads and whiteheads (comedones), papules (pimples) and pus-filled spots (pustules) erupt (see Figure 1).
Acne usually starts in teenagers and can persist into adulthood, with up to half of women and 40% of men affected. Besides permanent scarring, the condition, which affects around 650 million people worldwide, can lead to anxiety and depression.
If they are going to work, treatments can have a measurable effect in four weeks, but many take sixteen weeks to plateau.“Although many of the medications work well if used properly, the complex combination treatment regimens required to target different aspects of acne pathophysiology lead to poor adherence, which undermines treatment success,” says Steven Feldman, a dermatologist at Wake Forest Baptist Medical Center in North Carolina. Benzoyl peroxide, for example, causes redness and peeling; oestrogen hormones are unsuitable for boys; the overuse of broad-spectrum antibiotics is thought to lead to antibiotic resistance and to damage microbiota; and retinoids can cause red, sore skin that blisters and is sensitive to sunlight.
The possible side effects of isotretinoin include hyperlipidaemia, abnormal liver function tests, loss of night vision, depression and suicidal thoughts.
The bane of a teenager’s life and among the most common skin conditions, acne vulgaris, is far from superficial.
Rather, deep within the skin, four key elements are at play: androgens activate the sebaceous gland to overproduce oily sebum; dead skin cells lining the pores don’t shed properly, clogging up the hair follicle opening; the commensal bacterium proliferates; and immune chemicals are released causing inflammation.
Isotretinoin is also extremely teratogenic, and so, has to be prescribed and taken with great caution.
Although many of the medications work well if used properly, the complex combination treatment regimens required to target different aspects of acne pathophysiology lead to poor adherence, which undermines treatment success Figure 1: Acne pathogenesis Acne is characterised by inflammation of the pilosebaceous units caused by the interplay of four key factors: excessive sebum secretion, hyperkeratinisation, colonisation of The good news is that scientific advances in the understanding of acne complexity are revealing new targets for development.
There are more and more examples of the ways in which we can benefit from our bacteria.
According to new research, this is true for the skin as well.