Acne is the most common form of skin disease, and affects about 80 per cent of people at some time in their life. It is an inflammatory condition of the sebaceous follicles primarily affecting the face, chest and back. It is characterised by the presence of blackheads and whiteheads, known as comedones. It most commonly starts at puberty and is problematic during adolescence, although older adults can also suffer. The number and spread of acne lesions varies considerably, and understanding the manner of its development is key to its prevention and treatment.

The face, neck, shoulders, chest and back are the areas usually affected by comedones and acne pustules. Increased production of sebum from the sebaceous gland, coupled with an increase in keratinisation, the shedding of the lining of the follicle, obstructs the sebaceous duct causing the formation of a blackhead, so called because of its dark colour. Contrary to popular opinion, the discolouring is due not to dirt but chiefly to the presence of the pigment melanin in the dead cells and oxidised skin debris.

A whitehead is an engorged sebaceous gland beneath a barely visible pore.

With the sebaceous gland distended and blocked, the gland often ruptures into the surrounding tissue causing it to react in order to rid the body of the invading sebum and debris. The area becomes inflamed, making it red and swollen, and the death (necrosis) of the gland then forms a pustule. Bacteria, which are naturally present in the skin, begin to multiply abnormally and a localised infection may develop, becoming a complicating factor.

It seems that hormones and heredity are significant factors in acne. Increased levels of the androgen hormone occur at puberty, and in varying levels at menopause, menstruation, during pregnancy and at times of stress. Sufferers are more likely to be the children of parents who also experienced the condition, particularly if the acne is severe. Some people inherit more sebaceous glands on the face and other areas.

There are some pre-disposing factors thought to contribute to the symptoms of acne which include:

1. Use of some contraceptive pills
2. Use of oily cosmetics
3. Consistent occlusion of the skin's surface with face masks, helmets or other work or sports equipment
4. Poor diet and general health
5. Stress

These and other possible factors may influence the progress of treatment.

Treatment

Acne usually subsides naturally, but will resolve quicker with less scarring if treatment according to medical advice is given. Milder cases can be treated by good skin care to reduce the possibility of sebaceous gland obstruction, dissolve keratin and sebum plugs and reduce the activity of facial bacteria.

Acne victims often mistakenly associate the condition with dirty skin, which they then treat inappropriately, perhaps with vigorous scrubbing or with harsh chemicals that exacerbate the situation. Dirt is not the problem, but sebum is, and gentle cleansing of the skin with applications that help to dissolve sebum and reduce bacterial activity, therefore help to control acne outbreaks.

Although it is a fallacy that chips, chocolate and cheese cause acne, healthy nutrition with plenty of fresh vegetables and good water intake, do help keep it at bay as does regular exercise. Additionally, facial and skin care applications containing helpful ingredients like salicylic acid, benzoyl peroxide and tea tree essential oil, are sold as over-the-counter (OTC) products.

For more persistent cases, antibiotic applications or tablets may be prescribed. Severe persistent cases may be treated with powerful prescription drugs containing a form of vitamin A known to reduce gland activity and sebum production, or anti-androgen drugs.

Sunshine can usually bring some improvement due to the sun's drying effect, but sun protection should still be worn as usual. Other treatments that have had positive results on both acne and post-acne scarring such as micro-dermabrasion, skin peels and enzyme masks performed by skin care or dermatological professionals, are all valuable options to consider.