It occurs mainly during adolescence, however acne can occur at any age. It is an inflammation of the hair sebaceous units on the face and the body. Dead cells and sebum accumulate causing ductal barrier. In some cases, this process stops there, resulting in the first symptoms of acne: black and white heads. (Comedonal acne) This type is known as “non-inflammatory acne”.

 

In more severe cases, the bacteria found in the trapped sebum multiply causing aseptic inflammation of the skin and, in combination with the effect of hormones in people with genetic background, leading to the appearance of red blisters (pustular acne) or deeper and painful lesions, such as cysts and nodules (nodular acne).This type is known as “inflammatory acne”.

– Is acne a common skin condition?

90% of the population will experience skin imperfections due to acne, at some point in their lives. It is the 8th most common skin condition worldwide. And the number 1 dermatological issue that we treat as dermatologists in our clinics. Our lifestyle, the daily stress, the pollution of the atmosphere and our diet have contributed to the increase of acne cases.

– What causes acne?

Acne may be associated with genetic predispositions, but it may also be associated with:

• Age, gender, ethnicity (more common during adolescence and heavier cases when it comes to boys)
• Hormonal agents
• Diet and stress
• Pollution and climate
• Wrong use of cosmetic products
• Medicinal products, e.g. hormonal preparations, cortisone

The main mechanism of pathogeny is the overproduction of sebum leading to the obstruction of the skin pores. The non-inflammatory acne, in combination with the effect of the skin bacteria and in particular with pustular acne, leads to inflammation, and inflammatory acne with cysts and nodules. It is not caused by an infection or lack of skin hygiene and it is not contagious.

– What is the clinical picture of adolescents who develop acne?

The hormonal changes that occur during adolescence, combined with the genetic burden and the increased sebum production that normally occurs at these ages, trigger the appearance of acne. The most often cases are the ones in the face with the appearance of closed or open comedones, which are known as white or black heads. When acne lesions develop inflammation due to the effect of skin bacteria, then appears the most difficult clinical picture of inflammatory acne with red lesions and pustules, the known pimples with pus, cysts and painful nodules that need immediate treatment because otherwise they will create scars on the skin.

– Acne during adolescence has particularly significant psychological effects on the lives of adolescents.

The problem of acne and the changed aesthetic of the adolescent can cause insecurity. It can also change the mood and the performance on daily things, while causin negative emotions. For all these reasons, acne requires a systematic dermatological examination and monitoring by a specialist. In order for all the pathogenic and aggravating factors to be evaluated.

 

In Tzouma Clinic, our goal is the holistic approach and the consideration of all these factors, in combination with the appropriate treatment according to the patient’s age, clinical picture and personality. It is the only way to achieve excellent and stable results and not strain the psychology of an adolescent.

– But are there any general rules that adolescents could follow in order to help their acne along with their treatment?

In any case, the adolescents should visit a specialist doctor. This is why the dermatologist is needed, in order to give him instructions and advice suitable for his/her skin. Also, in order for all the necessary laboratory tests, such as hormonal testing, to be done and for the appropriate treatment to be received on time. However, there are some general rules that all adolescents should follow to help reduce exacerbations, speed up the action of the treatment, and reach the goal in the shortest time possible.

The general rules are:

• The patient should wash his/her face early in the morning, when he/she wakes up. He/she also repeat this process late at night, before bedtime, with a mild cleansing soap suitable for his/her skin. This way, the excess sebum and bacteria get away from the face. However, the frequent washing of the skin cannot remove blackheads. These are sebum trapped inside the sebaceous glands – pores. Cleansing the face with the appropriate soap removes the surface oil and slows down the accumulation of sebum. It is always an important step alongside treatment.
• Don’t pick the pimples. This causes not only scars, but also bacterial spread.
• Don’t let anyone give up treatment too quickly. Adult acne is multifactorial and the body needs time to respond to the treatment regimen.
• Do not use too many products within a short period of time. The skin cannot respond so quickly and show the effects of treatment immediately. On the contrary, irritation can be caused.
• It is proven to help reduce stress and outbreaks. Stress, as a biological process, is characterized by the release of hormones, such as cortisol, which increases the oiliness of the skin. Oil clogs the pores and thus, acne appears.
• The adolescents should eat healthy and drink 8 glasses of water per day, in order to get clean skin. The water rinses the toxins and makes the skin bright and clean.

– Does the patient’s diet play an important role in acne? What kinds of food should an adolescent avoid to help his/her acne?

Diet is an important aggravating factor for acne. That’s why children, from a very early age, should learn to follow a balanced diet. Not only to avoid acne, but also for their health, in general.

They should avoid:

• Foods with a high glycemic index, such as white bread, white rice, cereals, pasta and, of course, sweets. These lead to a postprandial increase in insulin and a worsening of acne, which is by nature a disease with excessive insulinotropic activity.
  Chocolate is also thought to exacerbate acne, but that does not seem to affect all people, according to a study published in the Journal of Clinical and Aesthetic Dermatology. Dark chocolate, with less sugar and milk, can be a better choice, if you’re trying to control your acne.
• Cow’s milk products affect the hormonal system. So, they are directly linked to the appearance of acne. Dairy products boost testosterone and androgen production. At the same time, they increase the levels of insulin in the blood, such as sugar and carbohydrates. They also have exogenous hormones, that are given to the animals in order to achieve the milk production.
• High-fat meals, and mainly junk food and trans fats are the worst for pustular acne, as they increase the bacteria that cause acne and, therefore, worsen acne, especially when they are consumed in the evening.

– Are there foods that help reduce acne flares?

Of course, there are also some foods that can improve the acne, along with the appropriate treatment.

• Omega-3 fatty acids

  Omega-3 fatty acids have a very strong anti-inflammatory action. Good sources include: all oily fish and nuts, etc.

• Vitamin A

  Vitamin A appears to contribute significantly to the control of the keratinization rate. Good sources include: all coloured fruits and vegetables, fish oils, etc.

• Vitamin E and C

  Vitamin E and vitamin C seem to have a calming effect on the skin, due to their strong antioxidant action, and they work better together. Good sources include: fruits, mainly citrus fruits and vegetables for the vitamin C and nuts and all green leafy vegetables for the vitamin E etc., for example, spinach.
  

• Zinc (Zn)

  Zinc (Zn) seems to inhibit the growth of the acne bacterium, by creating an unfavourable environment. Good sources include: nuts, poultry etc.

• Selenium (Se)

  Selenium (Se) has antioxidants, which appear to protect the skin effectively from the effect of free radicals. Good sources include: tuna, salmon, eggs, brown rice, etc.

• Hydration

  Adequate hydration seems to contribute to both the prevention and the progression of this skin disease.

• Low-glycemic food, non-milk substitutes

  Such as rice milk, almond milk, soy milk, tofu etc. Foods with low glycemic index reduce inflammation, such as legumes, nuts, vegetables – oily foods and salads (raw or cooked as little as possible), lean meats, especially fish, chicken and turkey, olive oil, whole grains and all their derivatives, e.g. whole grains pasta.

– What are the treatments for acne?

Prior to any treatment, Tzouma Clinic dermatologists receive a complete medical history. Where necessary, they also prescribe a series of laboratory tests. All patients with acne are being examined and have their skin analyzed. This is done with the special UV scan FotoFinder device.

 

This device enables us to control what is under the surface of the skin, what we can’t see with the naked eye. At the same time, it gives us the ability to compare the skin visit by visit and evaluate the course of treatment accurately and reliably.

Based on the patient’s clinical picture:

• Topical Medications

  They consist of various cosmetic or pharmaceutical products for cleansing, care, or other use, with very specific actions such as: keratolytic, anti-inflammatory, antibiotic, and sebum regulating.

• Systemic (oral) Medications

  Systematic treatment aims to reduce sebum production and inductively to limit the formation of comedones. In the past, antibiotics such as minocycline, tetracyclines, doxycycline etc. were used. Nowadays, due to its particularly good therapeutic effects, isotretinoin is more widely used. It is a super derivative of vitamin A.

However, there are many side effects, both predictable and not, of treatment with isotretinoin. These include skin dryness, cheilitis, dry eye, dry mouth, increased risk of metabolic syndrome and diabetes mellitus, hypercholesterolaemia, hypertriglyceridaemia and increased transaminases (liver enzymes).

 

For these reasons, systematic monitoring by the treating dermatologist is necessary as well as the frequent laboratory testings during treatment. Concerning the treatment with isotretinoin, it is more than necessary to comply with the nutritional guidelines mentioned above, in order to prevent or mitigate possible adverse reactions from the treatment, associated also with the nutritional behaviour.

– Are there any acne treatments without medications?

At Tzouma Clinic, there are specially designed protocols from our dermatologists in order to treat acne without medications. These protocols are personalized and adapted to the clinical picture and severity of each case.

– Is there a way to fix the acne scars?

The important thing for all adolescents who develop acne is to know that they must follow the treatment recommended by their dermatologist consistently, in order to prevent the appearance of scars as well. At the same time, they should follow a daily routine of taking good care of their skin and eating well, so as to reach their goal easily and maintain it. However, if acne scars make their appearance, there are modern therapeutic protocols to treat them.

 

The PicoSure Laser and the Fraxel Laser are two officially approved by the FDA Laser types used for this purpose. Their effectiveness is better, if they are being used as soon as the scars appear. At Tzouma Clinic, we have created a therapeutic protocol with a combination of the world’s leading technologies: Fraxel Laser, PicoSureLaser, CO2 Laser, PRP and micro-needling, in order to cope with the problem of acne scars safely and effectively. The protocol is personalized and created by the dermatologists at Tzouma Clinic exclusively for each patient, in order to focus on their own case accurately.

Acne has now a solution!