Pathogenesis of Acne:

1. Hyperkeratinization - Abnormal shedding and rapid proliferation of dead skin cells. These dead skin cells end up clogging the opening of the oil glands. This leads to accumulation of sebum in the sebaceous glands (oil glands). Increased oil gland secretion / sebaceous gland secretion.
2. Increased oil gland secretion / sebaceous gland secretion.
3. Propionibacterium acnes - The increased activity of sebaceous glands elicited by androgen causes proliferation of P. acnes, an anaerobe present within the retained sebum in the pilosebaceous ducts. It produces several biologically active mediators that may contribute to inflammation
4. Inflammation – This precedes or occurs post the action of P.acnes since it releases various mediators known to contribute to inflammation. This leads to the formation of whiteheads, blackheads, papules, pustules, nodules and cysts.

Various aggravating factors for acne include:

• Hormones – Conditions that cause hormonal imbalance like PCOD (Polycystic Ovarian Disease), Premenstrual flare
• Genetics
• Cosmetics
• Diet – High Glycemic index containing food like dairy products (which also contain hormones), junk food, and chocolates which cause increase in in-su-lin like growth factors that stimulate follicular epidermal hyperproliferation
• Tobacco
• Stress
• Drugs

There are various types of presentation of acne

• Grade 1: Comedones. They are of two types, open and closed. Closed comedones (whiteheads) are due to keratin and sebum plugging the pilosebaceous orifice below the skin surface. They appear as white circular spots. Open comedones (blackheads) are due to plugging of the pilosebaceous orifice by sebum on the skin surface. They appear as black colored spots.
• Grade 2: Inflammatory lesions presenting as a papule. Papules are small tender red bumps.
Grade 3: Pustules are formed when a papule gets filled with pus. They are tender, larger than a papule with whitish and yellowish pus inside.
• Grade 4: Many pustules coalesce to form nodules and cysts. Nodules are present deep inside the skin and present as large, solid and painful lumps. Cysts are very large pus-filled painful lumps present again deep inside the skin. Nodules and cysts tend to leave scars.

Management of acne depends on severity. For mild acne, we can use topicals like benzoyl peroxide, and retinoids. For moderate acne, we will include oral antibiotics since Propionibacterium acne plays an important role in pathogenesis. Oral Retinoids are required for severe acne.

Chemical Peels along with topical and oral management helps in controlling the active acne and residual pigmentation.

Instant Power Radiance involves both physical and chemical exfoliation along with LED light therapy which imparts anti bacterial properties to this treatment

The approach to treatment of acne scarring involves both a comprehensive physical exam of the patient and a discussion regarding patient goals, concerns, and tolerance of various treatment options. Considerations include the presence of erythema and the type, depth, and location of scarring

For acne scars, we, Estique Clinic have the Best Dermatologist in Gurgaon For Acne, offer various modalities like

1. LASERS
2. Radiofrequency Microneedling.
3. Dermarollers.

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