The effects of culture, skin color, and other nonclinical issues on acne treatment

Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life

Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.

Moderate acne as a potential barrier to social relationships: myth or reality?

Acne vulgaris is a skin disease affecting many young people and, if it continues into their twenties, can be a substantial barrier to social relationships. Although there is evidence that sufferers are adversely psychologically affected, what is less apparent from research to date is whether this is because of negative self-beliefs or the discriminatory attitudes of others. This study set out to explore how far young people with moderate acne are viewed less favourably compared to their clear-skinned peers. The design was quasi-experimental. The faces of two male and two female 21-year-old volunteers with clear skin were photographed and then photographed again after having had facial signs of moderate acne simulated by a professional make-up artist. Photographs of a male and female face were given to 143 participants who were divided randomly into two conditions: "Clear" and "acne". The former were shown the unblemished faces and the latter were given the faces with acne. The participants were asked to estimate the age of the person in the photograph and then rate the volunteer on a scale of 16 personality items. It was found that the participants in the "clear" condition estimated the volunteers as two years older and more mature than in the "acne" condition. In terms of personality, the photographs in the "clear" condition were given higher scores for potential friendship, attractiveness and overall positive personality features than the photographs in the "acne" condition. The conclusion is that moderate acne vulgaris could be a potential barrier to social relationships for young people not simply because of their social anxiety but because they may well be meeting with prejudice. It is suggested that attitudes might be changed by more accurate information about the condition.