It is estimated that out of the five million French people suffering from acne to some extent, barely 15% of them have had the idea of talking to a competent pharmacist or dermatologist about it. The poor (or unfortunate) people are waiting for it to happen and suffer martyrdom in silence. It’s a pity, because an early treatment usually stops the pain in two or three months. Poorly treated or not treated at all, acne can on the contrary drag on for five or six years and leave indelible scars. Seeing a beautiful day bloom on his face, until then very smooth, ugly red pustules is not a good thing for a teenager. Difficult, adorned in this way, to play the pretty hearts and to assert his personality and his image! However, in general, “teenagers” don’t want to consult, they don’t dare. As if acne were a shameful disease. Girls, with their complexes, hide behind their hair and boys shut themselves up in their shells. But by far the most affected are teenagers – between the ages of 14 and 18, eight out of ten have acne in varying degrees – until about the age of 25. The proof, at the last Salon de L’Étudiant, a group called 3A (A for acne, affectivity, action), sponsored by a pharmaceutical laboratory and made up of dermatologists, gave free advice to students who came there to find out about their future career. A bit surprised at first, the pimply students listened wisely to the explanations and finally asked a lot of questions. A complete article on the subject even appeared in the newspaper “L’Étudiant”!
It all starts at puberty
If acne blossoms at that age and not before or after, you might say, it’s because it’s related to puberty. It’s true, at puberty, under the influence of male hormones (androgens), the sebaceous glands of the skin “go wild” and start producing sebum in abundance. Boys secrete more sebum than girls and have more severe acne. The result is oily hair and a shiny face, especially on the forehead, wings of the nose and chin where the sebaceous glands are most abundant. Acne is most likely to develop on the face, but also on the shoulders and upper chest. It very rarely goes beyond the waist and does not reach the limbs. This phenomenon is not serious in itself but the excess sebum ends up blocking the orifice through which it normally flows, and at the dilated end of these blocked glands are formed the famous “blackheads” or blackheads (it is oxidation that colours them). Inside: a yellowish-white vermicelli. Then, if one does not react at this stage of sebum retention, more or less whitish micro cysts break under the skin and cause inflammation. The largest cysts, red, deep and painful, are often filled with pus, persist for weeks and leave unsightly, irregular scars, particularly visible on dark and black skins. There is no need to crush them, on the contrary, you would only increase the risk of inflammation and superinfection.
The function of the sebaceous glands of the hair follicles is to ensure normal secretion of sebum. When they get out of control, excess sebum eventually clogs the pores at the ends of which blackheads or blackheads form. Inside the clogged pore, the sebum microcysts rupture, causing infection by skin bacteria and inflammation.
Pills and acne
Birth control pills can improve acne. Especially when acne is associated with hirsutism (abnormal hair growth) or alopecia (hair loss) due to a hormonal disorder. But beware: not just any pill! Some, in fact, are contraindicated, others are allowed without any beneficial effects on acne:
only your doctor can prescribe the right one for your type of acne.
How to limit the damage?
The nature of acne is still poorly defined. To put it in a nutshell, we know that three factors are involved: hyperseborrhea (excessive production of sebum at puberty), discomfort in the elimination of this sebum but also inflammation of partly microbial origin. In the advanced stage of deep microcysts that burst under the dermis, certain bacteria seem to play a role in the inflammatory phenomena. The different treatments, as we will see later, act on one or other of these factors, and therefore target different stages in the evolution of acne. These factors, essential, apart from other very varied factors and apparently very far removed from sebum and bacteria, can play an activating and aggravating role:- The use of certain poorly adapted cosmetics, comedogenic as dermatologists say. People with oily skin and a tendency to acne should only use skin care products that guarantee that they are non-comedogenic (sold in pharmacies). Certain iodine- or bromine-based medicines, oral corticosteroids, cortisone creams, lithium, certain anti-epileptic and anti-tuberculosis drugs and certain pills (more precisely the progestogen present in these pills).- A hot and humid climate (known as tropical acne).- Periods of tension, psycho-affective conflicts, emotional shocks, great fatigue that disrupts the general balance of the body and therefore the hormonal balance.- Untimely “scraping” of the skin which, instead of cleansing it as we think, unbalances the bacterial flora of the skin and reactivates hyperseborrhea.- The sun: at first, it dries out pimples, makes the skin tan, makes it more aesthetic and can make people believe that it is healing or improving. The sebum becomes, in fact, more fluid and flows better on the skin and the possible sunburn with the desquamation that it causes also has a slight peeling effect. But this does not last. Shortly after the holidays, it’s a disaster. In October and November the pimples burst again. The acne often even gets worse. Explanation: the skin thickens to protect itself from the sun and, as it thickens, it prepares new sebum plugs. Real stocks of micro-cysts build up and a small acne turns into a strong acne flare-up in the autumn. In short, no sun exposure if you have acne. Nor ultraviolet rays, even in institutes, because UVA rays are just as acne-causing as UVB rays. If you don’t want to always stay in the shade, spread anti-acne products enriched with sun filters – diet can also have an influence. It is no longer a question of banning chocolate or cold meats as in the past, but it seems that an unbalanced diet that is too fatty and too sweet, and excesses of all kinds, are conducive to acne. A recent American study particularly implicates “fast food”. It also seems that poor hygiene also plays a role, but opinions are divided on this point. However, some misconceptions continue to circulate that need to be corrected.
No, acne doesn’t come with sex, it’s a mistake!
No, acne is not a contagious disease. Acne sebum certainly contains germs, but even in severe forms, acne cannot be caught!
No, you shouldn’t rush blackheads. This is the best way to open cysts inside the dermis and not on the surface of the skin and thus increase the infection. It is better to go see a dermatologist who alone can properly disinfect the skin, extract the blackheads with a window curette and open any cysts and pustules.
Make-up: yes, but …
Contrary to popular belief, make-up is not contraindicated. As long as you cleanse your skin beforehand with gentle, non-aggressive products. No soaps, or dermatological or antibacterial bars that foam little but are well tolerated, or liquid soaps, cleansing gels that can be used on wet skin and rinsed off with water. Generally, dermatologists advise women to use cleansing milks that are suitable for oily skin or acne-prone skin, which are non-irritating and slightly acidic, but should be rinsed off with water (preferably low in calcium and chlorine) or with a lotion for oily skin, pimples, blackheads and acne, containing anti-inflammatory, astringent and calming substances. Teenage girls prefer compact make-up removers (these are solidified milks), which are convenient to use.
Finally, spraying with a mister has a soothing and decongestant effect. Exfoliating creams are recommended provided that the acne is not in full “efflorescence” (once or twice a week), to remove dead cells, unclog pores and purify the skin. After this cleansing, which should be regular (twice a day) and thorough but above all not aggressive, the application of a treatment cream suitable for oily skin is desirable. They contain non-irritating local antiseptic agents that reinforce the actual treatment of acne and are either invisible or tinted. Real foundations are not prohibited, provided they do not contain any greasy substances, as are suitable compact powders, fine and light, so as not to clog the pores. You can find all these products in pharmacies.
Ask your pharmacist to guide you in your choice.
Treat without delay
However, these gestures are not enough. Fortunately, we now have a whole arsenal of treatments that can make acne disappear, regardless of its severity. Your pharmacist will be able to advise you on the choice of products to use or, in severe cases, recommend that you consult a dermatologist. Some acnes require the use of prescription-only medication, so medical treatment may be necessary. To treat hyperseborrhea: estrogens and anti-androgens. To reduce follicle obstruction: acidic vitamin A, salicylic acid, skin cleansers of course and azelaic acid. To treat inflammation . antibiotics and local treatments. Finally, for severe cases: isotretinoin, which for some years now has made it possible to cure the most serious acne, at least to provide very long remissions. The drug fights seborrhoea (and therefore reduces inflammation) and at the same time unblocks the follicle. There is no question of using it under the pretext that it has “succeeded” to its classmate. It is prescribed by the doctor and the treatment is carried out under medical supervision, because it has side effects and, above all, it is totally contraindicated for pregnant women – or those at risk of becoming pregnant – so it is not suitable for everyone and we are obliged to resort to combinations of other drugs; these also have their limits, some of them are irritating for example. However, it can be said that, provided that the treatment is not interrupted without the doctor’s advice, acne can be cured in all cases.