Acne is a common condition of the pilosebaceous unit. It is an inflammatory disease characterized clinically by polymorphic lesions of the hair follicles and sebaceous glands, mainly on the face, but also on the shoulders and upper torso. It is especially common during adolescence and youth, though it can also appear in older ages. Acne is one of the most common dermatological disorders and is considered a chronic condition.
Four factors are involved in the pathogenesis of acne:
1. Hyperplasia of the sebaceous glands resulting in increased sebum production (seborrhea), which is caused by the influence of androgens on the pilosebaceous unit.
2. Disruption of the keratinization process in the pilosebaceous follicle. Instead of shedding and being excreted as they normally would, keratinocytes accumulate, leading to the formation of comedones.
3. Colonization of the pilosebaceous follicle by the acne bacterium (P. acnes). P. acnes is the main microorganism that colonizes the follicular flora. Although it is not considered pathogenic, it plays a role in the pathogenesis of acne. 4. Inflammation development. The onset of inflammation is due to the activity of P. acnes, as well as other mechanisms, such as the production of pro-inflammatory lipids by the sebaceous glands.
The types of lesions that appear on the skin in each case, depending on the presence or absence of inflammation, determine the clinical type of acne. Non-inflammatory acne lesions include comedones (open and closed), while inflammatory lesions include papules, pustules, nodules, and cysts.
- Comedonal Acne
This type of acne is characterized by the presence of comedones only. Comedones are generally present in all types of acne and appear as blackheads or whiteheads (open and closed, respectively).
- Papulopustular Acne
This form is characterized by the presence of papules and pustules. It is important to differentiate this type of acne from other conditions, such as acneiform eruptions caused by medications, the papulopustular form of rosacea, gram-negative folliculitis, and perioral dermatitis.
Nodulocystic Acne
This is the most severe form of acne. Clinically, nodules and cysts are observed, along with significant inflammation. This form of acne is also associated with the development of scars, which can have a significant impact on the patient’s psychology and, consequently, on their quality of life.
Acne treatments are individualized and depend on its clinical type. There is no single treatment that is equally effective and safe for all acne patients. The Dermatologist is the most qualified to diagnose acne, identify its type and severity, and recommend the most suitable treatment for its management. Therapeutic options for acne include:
Local treatment: Local antibiotics (clindamycin, erythromycin), benzoyl peroxide, azelaic acid, tretinoin, isotretinoin, adapalene can be used.
Systemic treatment: Oral antibiotics (tetracyclines), contraceptives in women, and retinoids (isotretinoin) are used.
Laser use: Laser technology in recent years has expanded the dermatologists’ therapeutic options in the field of acne.
It should be noted that the use of lasers does not replace the previously mentioned acne treatments but complements them, offering an optimal approach to the problem.
At our center, we offer the following types of lasers for the treatment of acne:
Smoothbeam laser (1450nm diode laser): The Candela Smooth Beam Laser is a high-power pulsed diode laser with selective absorption in water. The application is based on the pioneering method LASER (Laser Assisted Skin Renewal – Collagen Remodelling). It causes mild thermal damage, stimulating the skin’s natural “healing” response with the production of collagen and elastin. Its mechanism of action involves increasing the temperature of the water surrounding the sebaceous gland, leading to its shrinkage and reduced sebum production. The treatment is repeated every 3-4 weeks.
Pulsed-dye laser system: As previously mentioned, the bacterium P. acnes plays a central role in triggering inflammation in acne. This bacterium produces porphyrins, which are the target of the laser. The laser beam is selectively absorbed by the porphyrins, neutralizing P. acnes. At the same time, the laser beam is also absorbed by hemoglobin, leading to a reduction in erythema, which characterizes both active acne and its residual elements. The treatment is repeated every 3-4 weeks.
Fractional laser for treating acne scars after the resolution of acne: Depending on the extent, depth, and fibrosis of the scars, the following types are used:
Fractional Er.YAG. Laser (2940 nm)
Fractional CO2 Laser (10600 nm)
Fractional CO2 Laser + RF (we have the first one in Greece)
It is very important that while the patient is undergoing acne treatment, they use appropriate cosmetic products. Products that can be safely used by individuals with acne are those labeled as “non-comedogenic.” In any case, it is advisable to consult your treating dermatologist regarding the products that are suitable for you, as these may vary from person to person, depending on the type and severity of the acne, as well as the prescribed treatment.
There are many myths about the association between acne and certain foods. Recent studies suggest that consuming foods with a high glycemic index may be linked to the development of acne. However, the exact effect of diet on acne has not yet been clarified, and further investigation into this area would be helpful.
After the appearance of acne, it is advisable for the patient to be cautious about any procedure that could cause injury to the affected area. It is possible for a man to shave carefully, avoiding the inflammatory lesions.