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Acne develops from of blockages in follicles. Hyperkeratinization and formation of a blocked keratin and sebum (a microcomedo) is the first change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo (whitehead). Whiteheads are the direct result of skin pores becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedo, which results in redness and may result in scarring or hyperpigmentation.

Common Causes of Acne :-

• Hormonal activity, such as menstrual cycles and puberty. During puberty, an increased in male sex hormones called androgens cause the glands to get larger and make more sebum.
• Family/Genetic history. The tendency to develop acne is hereditary.
• Stress, through increased output of hormones from the adrenal (stress) glands.
• Inflammation, skin irritation or scratching of any sort will activate inflammation.
• Use of any medication containing lithium, barbiturates or androgens.
• Hyperactive sebaceous glands.
• Accumulation of dead skin cells that block or cover pores.
• Use of anabolic steroids.
• Exposure to certain chemical compounds.
• Exposure to halogens. Halogen acne is linked to exposure to halogens (e.g. iodides, chlorides, bromides, fluorides)
• Chronic use of amphetamines.

Treatments

There are many products available for the treatment of acne, many of which are without any scientifically-proven effects. Usually treatments show little improvement within the first two weeks. In general treatments they usually work in at least four different ways, normalizing shedding into the pore to prevent blockage, killing P. acnes, anti-inflammatory effects, hormonal manipulation. A combination of treatments can greatly reduce the amount and severity of acne in many cases. Those treatments that are most effective tend to have greater potential for side effects. Many people consult with doctors when deciding which treatments to use, especially when considering using any treatments in combination.

Common Treatments for Acne:-

Topical

Topical bactericidals such as OTC bactericidal products containing benzoyl peroxide may be used in mild to moderate acne. The gel or cream containing benzoyl peroxide is rubbed, twice daily, into the pores over the affected region. Bar soaps or washes are also commonly used and vary from 2% to 10% in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide also prevents new lesions by killing P. acnes. Topical antibiotics that are externally applied such as erythromycin, clindamycin, stievamycin, or tetracycline kills the bacteria that are around the blocked follicles are also usually used.

Oral Antibiotics

Oral antibiotics are also usually used to treat acne. They include erythromycin or one of the tetracycline antibiotics (tetracycline, the better absorbed oxytetracycline, or one of the once daily doxycycline, minocycline, or lymecycline).

Hormonal treatments

Treatment for female acne can be improved with hormonal treatments. The common combined oestrogen/progestogen methods of hormonal contraception have some effect, but the antiandrogen, Cyproterone, in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels.

Oral retinoids

A daily oral intake of vitamin A derivative isotretinoin (marketed as Accutane, Amnesteem, Sotret, Claravis, Clarus) over a period of 4-6 months can cause long-term resolution and reduction of acne. Isotretinoin works primarily by reducing the secretion of oils from the glandsand has been shown to be very effective in treating severe acne and can either improve or clear well over 80% of patients.

Topical retinoids

A group of medications for normalizing the follicle cell lifecycle are topical retinoids such as tretinoin, adapalene and tazarotene. Like isotretinoin, they are related to vitamin A, but they are administered as topicals and generally have much milder side effects. They can, however, cause significant irritation of the skin. The retinoids appear to influence the cell creation and death lifecycle of cells in the follicle lining.