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Acne is an inflammatory disorder of the pilosebaceous units of the skin, arising mostly during adolescence. Most acne lesions occur over the face, neck, upper arms, chest, and upper back. Acne complications are caused by worsening of the primary acne lesion i.e., when there is inflammation or infection of the comedo.
The comedo is the primary lesion of acne. This refers to the plugged up hair follicle which is enlarged with pent-up sebum, dead skin cells, and other debris. It may appear as a white, yellow, or blackish spot on the skin. The white lesions are due to a comedo which has not reached the skin surface, and are called whiteheads. Yellow or black lesions are due to a comedo which is exposed to air, leading to oxidation of the sebum with black oxidation products. These are termed blackheads.
Inflammation or infection of the comedo causes other lesions to arise, such as papules, pustules, nodules, and cystic acne. These represent aggravated forms of acne.
Scarring is the most feared sequel of acne, and affects approximately a tenth of people who have had acne. Since acne scars worsen with age, many patients may present for acne treatment in middle age. Scars due to acne may be classified in different ways. One common system is:
Acne affects 90% of adolescents. It is important to realize that both the patients and their family have many misguided beliefs about how and why acne starts. These should be dispelled by giving out correct information.
Firstly, children should be reassured that they are not to blame for the acne through their misbehavior or poor hygiene.
Chocolate and fatty foods do not have any documented effect on acne, despite popular belief in their causative role. Thus children with acne need not be penalized unduly.
Thirdly, the aim of medical treatment is to prevent the eruption of new acne lesions and not to shrink the existing ones. For this reason, the topical therapy should be used over the whole skin, rather only over the lesions.
Acne is caused by changing hormone levels around the time of puberty, rather than by individual dietary habits. It is affected by genetic predisposition and immune reactions as well.