Monday, March 7, 2022

Pimples (acne vulgaris): The ultimate guide for patients

Don't let pimples (acne vulgaris) let you down. Things you should always avoid to prevent pimples and things you should do. An ultimate guide.

  

       I woke up on a fine morning, it was my first day in college. I looked into the mirror and Oh God give me a break. What’s this....I’ve got a new pimple...what rubbish...this has to be on my first day of college...let me burst it out and wow, the next morning it got bigger and uglier and finally it healed with a bad scar after a while. How many teenagers have had the same sequence please raise your hands? I guess already I've got plenty of hands out there ready to be risen.

 



Why am I getting acne (pimples) every now and then?

       Well to give a scientific answer to that I'll have to dig deep in physiology, pathology and dermatology. But that's not gonna help you out. Formation of pimples (acne vulgaris) is a complex and multifactorial mechanism. Obviously there is a hormonal role, as formation of acne mainly starts during puberty. There is a genetic component as well. Few people are more prone to acne and few are less due to genetic factors. Diet also has got some role, especially diets with high glycemic index (foods that raise blood sugar quickly like white and whole wheat bread, white rice, cakes, cookies, and sweet treats, potatoes and fries, chips, fruits such as watermelon and pineapple) and dairy products. A bacteria named Cutibacterium acnes also plays some role.

 



Chances of anyone evading this nightmare

       See various studies show various results. I’m not going deep into the data. But the chances of someone not having acne at all in life is very less. But the good news is, in most of the cases the severity of pimples is less. It mostly occurs in teenagers, but I have seen many patients presenting with acne at their 30s or even 40s. In my practice both men and women are present with almost equal frequency.

 

Few things to know before you visit a doctor to treat acne (pimples)

  1. When pimples start to appear during puberty it is generally mild in nature. Most are only comedones (tiny black or white bumps) with occasional large papule (large bump) or pustule (pus filled bump). It usually resolves without any treatment with a hyperpigmented spot which may last for few months and then completely disappear.                                                                                                 
                                
  2. For people who did not suffer from teenage acne there may be appearance of acne in their 30s or 40s. It is occasional and mild in nature and you just don’t need to worry too much.
  3. Acne may appear after first few days of birth in a neonate which usually disappears within few days or weeks. Occasionally it may disappear slowly but mostly it does not go beyond 1 year of age.
  4. Along with face acne may appear on the body, especially upper part of back or chest or outer side of upper arm. It is called truncal acne.

 

When it is alarming and calls for a visit to dermatologist?

     1.    Numerous comedones that do not disappear for long duration.                          

    

2.    Sudden appearance of same sized pimples (all may be comedones or small papules). It may be due to use of comedogenic cosmetics (that contains ingredients, specially some oils which can produce acne. For more information, look at source No. 10) or steroid containing creams (which contains steroids like halobetasol, clobetasol, betamethasone, mometasone etc.). If it stays longer you need to consult a specialist.

3.    More severe forms of acne at any acne prone area of the body –

a.    Numerous large with few or many pustules which may become very painful.

b.    Multiple number of painful large nodules (larger bump than papules) or few of them that are grouped together.

c.     Cystic lesions – A large nodule that is filled with fluid.

d.    Many cystic lesions join to form a large elevated area (plaque) filled with pus

              

e.     Painful nodules or plaque that quickly becomes pus filled or appearance of ulcers (Acne Fulminans)

f.      Patients who though have mild disease but have an uncontrolled desire of scratching or picking (Acne excoriee)

4.    Sudden appearance of acne like lesions on any area of body after coming in contact with any chemical (industrial chemicals) or taking any drug. It may have other symptoms like muscle pain, joint pain or fever.

5.    Appearance of significant number of pimples at an unusual age (between age 1-8 years or after 40 years of age).

6.    In case of girls if pimples are associated with other features like increased amount of facial hair, hair loss, excessive dandruff, menstrual irregularity, excessive weight gain and/or acanthosis nigricans (Dark, velvety discoloration of skin most commonly over neck or other body folds). This may be a sign of PCOD (polycystic ovarian disease).

7.  Any form of acne that have a significant impact on your social or personal life and causing psychological stress.

 

Things you should always avoid to prevent pimples (acne)

     1.    Don’t use comedogenic cosmetics or make ups on your skin.

2.    Avoid using greasy or oily cream on your face if not suggested by a qualified doctor for some reason.

3.    Avoid using pressed powder on your face.                                                                  

Pressed powder

4.    Never scratch or pick any kind of acne lesion. This not only can induce secondary infection but also increases the chance of permanent hyperpigmentation or scarring.

5.    Don’t use any over the counter creams (that are available without prescription) or creams suggested by any friend or relative to get rid of your acne.

6.    Don’t think that vigorous and excessive washing of your face can decrease or prevent acne. Rather it may worsen the situation.

7.    Avoiding mask induced acne –

a)    If you are using disposable masks do not use the same mask again after you have removed it once.

b)    For surgical masks avoid using it for more than 4 hours. Replace it with a new one after every 4 hours.

c)    Do not use any make up or cosmetic products on face if you intend to use a mask for long duration.

d)    Wash your face gently after you remove your mask.

e)    If you are using cloth or reusable masks, then wash your mask after each use.

(For more detailed information in this topic you can go through the links at source no. 4 & 5)

8.    Avoid excessive friction on your face. Don’t rub your face frequently.

9.    Avoid taking foods with high glycemic index and too much dairy products.

10.   Try to avoid excess mental stress which can aggravate your acne.

      11. Don’t ever visit a quack or a fake doctor for treatment of your acne.

 

Things you should do

1.    Regular exercise – Always good for your overall skin and not only for acne.

2.    Maintain a healthy diet.

3.    Wash your face twice daily (once after getting up from bed and again after coming back to home from work). Only use a skin friendly soap or facewash advised by your dermatologist.

4.    If you have dandruff always consult your dermatologist about that because it can aggravate acne.

5.    Moisturizing your face is important but only let your dermatologist decide the best moisturizer for you depending on your skin condition. Do not try to choose it by your own.

6.    Whenever needed consult a qualified dermatologist for help.

 

 

Source

1.    https://www.ijpd.in/article.asp?issn=2319-7250;year=2017;volume=18;issue=3;spage=196;epage=201;aulast=Sharma

2.    https://emedicine.medscape.com/article/1069804-overview

3.    Andrew’s diseases of the skin-clinical dermatology, 12th edition, chapter 13

4.    https://www.healthline.com/health/maskne

5.    https://www.uchealth.org/today/masne-masks-and-acne-heres-what-you-can-do/

6.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194956/

7.    https://www.acne.org/stress-and-acne.html

8.    https://www.webmd.com/skin-problems-and-treatments/acne/features/exercise

9.    https://www.medicalnewstoday.com/articles/high-glycemic-index-foods#:~:text=1%20white%20and%20whole%20wheat%20bread.%202%20white,sweetened%20dairy%20products%20such%20as%20fruit%20yogurts.%20

10.                     https://skinutritious.com/blogs/articles/comedogenic-ingredients-official-skinutritious-list

 

Dr Supratim Saha

Author & Editor

If you like this post please share it. If you have any quaries or suggestions please leave a comment.

1 comments:

Please don't comment any spams