Acne vulgaris is a skin disorder of the sebaceous follicles that commonly occurs in adolescence and early adulthood. It can have severe psychological effects and can leave the patient with severe skin scarring. Let’s first understand the anatomy of Skin for us to develop a better understanding of Acne Pathogenesis (H2).

Skin is majorly composed of three layers. Epidermis, Dermis, and Hypodermis.

Let’s decode them all.

Epidermis: The outermost layer of the skin which is majorly composed of epithelial cells , further divided into several layers.

• Stratum corneum (outermost layer)
• Stratum granulosum
• Stratum spinosum
• Stratum basale (deepest layer)

Dermis: This layer lies beneath the epidermis and is majorly composed of

connective tissues, collagen, and elastin fibers thereby providing structural integrity and elasticity to the skin.

Hypodermis: The deepest layer of the skin that contains fat and provides padding which further acts as insulation to the body.

Appendages

Hair Follicles: Hair follicles are formed by the invagination of the epidermis into

the dermis and form hair that shows up on the skin surface.

Sweat Glands: Sweat glands produce sweat to help maintain the body temperature along with pushing out the body waste.

Sebaceous Glands: Sebaceous glands are the glands connected to the hair follicles that secrete sebum (oil) to help lubricate the skin. Excessive sebum production can lead to oily skin and acne, while decreased production can result in dry skin.

Pilosebaceous Units: The hair follicle, Hair shaft, and Sebaceous gland are collectively called Pilosebaceous units.

Acne Vulgaris

As discussed above, Acne vulgaris is one of the most common inflammatory skin conditions.

How Does Acne Happen?

The mechanism behind acne being formed is usually and simply the pores getting clogged due to excess sebum secretion, bacteria, and dead skin cells. Excess of this sebum production may be influenced by multiple factors like genetics, pregnancy, puberty, hormonal fluctuations, certain disorders, and certain medications. The major pathogenic factors involved are:

• Hyperkeratinization
• Obstruction of sebaceous follicles resulting from abnormal keratinization of the infundibular epithelium

• Stimulation of sebaceous gland secretion by androgen
• Microbial colonization of pilosebaceous units by Propionibacterium acnes, which promotes perifollicular inflammation.

The clinical presentation of acne can range from a mild comedonal(Blackheads, Whiteheads) form to severe inflammatory cystic acne of the face, chest, and back.

Pathogenesis Of Acne Vulgaris:

Hair Follicle Blockage:

• Acne begins with the formation of a microcomedone, which is a small plug in the hair follicle composed of excess sebum and dead skin cells.

• The microcomedone can develop into a comedone, which can be open (blackhead) or closed (whitehead), depending on whether the follicle opening is dilated or not.

Proliferation of Propionibacterium acnes (P. acnes):

• P. acnes, a type of bacteria that normally resides on the skin, proliferates within the blocked follicle due to the presence of sebum and dead skin cells.

• P. acnes metabolizes sebum and produces inflammatory mediators, contributing to inflammation within the follicle.

Inflammation:

• As P. acnes proliferates, it triggers an inflammatory response in the surrounding tissue.

• Inflammation leads to redness, swelling, and pain associated with acne lesions.

Formation of Papules and Pustules:

• Inflammatory acne lesions, such as papules and pustules, develop as a result of the immune response to P. acnes and the release of inflammatory mediators.

• Papules are small, red bumps without pus, while pustules are inflamed lesions filled with pus.

Nodule and Cyst Formation:

• In severe cases, inflammation can lead to the formation of nodules and cysts, which are larger and deeper inflammatory lesions.

• Nodules are firm, painful lumps beneath the skin surface, while cysts are pus-filled, painful lesions.

Potential Scarring:

• Severe inflammation and tissue damage can result in the formation of acne scars, which may be depressed (atrophic) or raised (hypertrophic).

• Scarring occurs due to the body’s attempt to repair the damaged tissue.

Factors Contributing to Acne Pathogenesis:

• Hormonal Changes: Androgens stimulate sebum production, leading to an increased risk of acne during puberty, menstruation, and hormonal imbalances.
• Genetics: Susceptibility to acne can be inherited.
• Diet: High glycemic index foods and dairy products may exacerbate acne in some individuals.

Types of Acne:

How to identify the types of Acne and how to treat them further? Well, Acne can be categorised into two major types:

Non-inflammatory & Inflammatory

Non-inflammatory acne can be called Comedones. They appear due to the clogging of hair follicles and pores and are of 2 major types.

Blackheads also known as Open Comedones open at the surface of the skin and result from the pore-clogging, as the name suggests they appear to be black.

Whiteheads also known as Closed Comedones are raised bumps that are

closed at the surface of the skin and also result from clogged pores from opening.

Inflammatory Acne:

They are majorly caused by excess sebum production and accumulation of dead skin layers and are more likely to cause scarring on the skin.

How to Identify the Type of Inflammatory Acne:

Papules: Comedones when they become inflamed and have a distinct red/purple colour, often painful.

Pustules: They appear like whiteheads with a reddish ring around their periphery, It is puss-filled and is sensitive to touch.

Nodules: Nodules are firm, large, inflamed, and seated deep beneath the epidermis. It is painful and does cause scarring.

Cysts: Large, painful, pus-filled acne that goes deeper than the nodules in the dermal layers are called cysts.

Acne Conglobata: A most severe form of acne that is characterized by the mesh of nodulocystic acne beneath the skin surface in both men and women (suffering from Polycystic Ovarian Syndrome).

Acne Mechanica: Commonly called “sports-induced acne” it is caused by the pressure and friction against the skin by helmets or headgear.

How To Find Out The Severity Level Of Acne?

• Mild Acne: The common blackheads and whiteheads are the mildest form of acne that can be cleared up with the use of simple over-the-counter products.

• Moderate Acne: Pustules and Papules are the moderate forms of acne that are slightly stubborn to get cleared up by topical over-the-counter products and giving proper medical attention under medical supervision might help better.
• Severe Acne: The cysts, nodules, and nodulocystic acne are the most severe forms of acne. It should be addressed only under the supervision of a dermatologist.

Ingredients To Help Manage Acne:

Salicylic Acid:

One of the most effective ingredients to help with acne has to be this acid from the Beta Hydroxy Group of Acids. Salicylic acid is a boon for oily and acne-prone individuals as it controls excess sebum production, checks on microbial growth, unclogs pores by penetrating deep in your pores, and breaks down dead skin cells(keratolysis) thus bringing out rejuvenated, smooth skin.

Our L’emollis Clear Face Gel is formulated with strong Salicylic Acid which helps in mild exfoliation and intense hydration by the action of aloe vera, allantoin, and hyaluronic acid making it a super hydrating exfoliator for acne-prone skin.

Benzoyl Peroxide:

Benzoyl Peroxide helps in reducing the inflammation very effectively for inflammatory acne.

Note: It is important to acknowledge that Benzoyl Peroxide won’t be of help in non-inflammatory acne as it is an anti-inflammatory agent.

Adapalene: It is an FDA-approved Retinoid that helps effectively to get rid of both inflammatory acne and non-inflammatory acne. It helps clear acne by promoting skin cell turnover and reducing inflammation in the skin.

Retinoids: Retinoids are the most effective sort of molecule and can be administered both topically and orally depending on the severity of the acne strictly under the supervision of a registered dermatologist.

All the above treatments, however, are helpful in effectively managing acne, it may cause skin dryness post-acne treatment, as the oral retinoids tend to shrink the sebaceous glands leading to less secretion of sebum and thereby the skin is devoid of its natural moisturising factors necessary for skin health, Apple Therapeutics has bridged this gap of post-isotretinoin treatment to help alleviate dryness with the help of Acnin Oil-Free Ceramide Moisturizer.

Alpha Hydroxy Acid: Alpha hydroxy acids like Lactic Acid, Glycolic Acid, and Tranexamic Acid help in surface-level exfoliation, regulate sebum production, intervene in bacterial growth, and help decrease hyperpigmentation. Lactic Acid is one of the most well-tolerated skincare ingredients and helps in the management of acne and associated scares. Our Azalea Face Wash is formulated with Lactic Acid and helps reduce acne and comedones by 78%.

Quaternium-73 or Pionin: Quaternium-73 is one of the novel skincare ingredients that has a broad-spectrum antimicrobial agent and skin brightening properties.

Acnin Face Pack has a Quaternium-73 as one of its key ingredients and helps fade acne spots and controls acne, it also has oil-absorbing and sebum-regulating clays like Kaolin and Bentonite. It also has tea-tree oil that also has a natural broad-spectrum anti-microbial action.

Natural Ingredients That Help Manage Acne

Tea Tree Oil: Tea tree oil has broad spectrum anti-microbial action and helps in the effective management of Acne. As mentioned above Acnin Face Pack has tea tree oil in it as its one of the key ingredients.

Neem: Neem also has anti-inflammatory activity thereby helping in reducing skin inflammation, it also soothes skin and helps manage effectively.

Aloe Vera: Aloe vera is one of the most widely used skincare ingredients; its hydrating and anti-inflammatory effects that helps soothe and calm irritated and inflamed skin and has pore unclogging action.

Our L’emollis Anti-Acne Natural face wash has Neem as its key ingredient along with Aloe Vera thereby helping in imparting anti-microbial action along with pore unclogging features thereby effectively helping manage active acne in 15 days.

Dandruff And Acne: The Less Talked About Correlation

There isn’t a direct relation between Acne and Dandruff but it is a well-established fact that dandruff has a role to play in the pathogenesis of Acne, mostly fungal

Acne

Here’s how:

Dandruff is often caused by an overgrowth of a yeast-like fungus called Malassezia on the scalp, which feeds on oils produced by the hair follicles. This overgrowth can lead to excessive oil production on the scalp, known as sebum. When this excess oil comes into contact with the skin on the face or body, it can clog pores and contribute to acne formation. The presence of dandruff can lead to inflammation on the scalp, which may exacerbate existing skin conditions like acne. Scratching the scalp due to dandruff can transfer microorganisms, dead skin cells, and oils from the scalp to the face and other parts of the body. This transfer of bacteria and oils can potentially worsen acne or trigger breakouts in individuals prone to acne.

To prevent acne associated with dandruff, it’s essential to treat the underlying dandruff condition. Using anti-dandruff shampoos containing ingredients like Piroctone Olamine, Ketoconazole, or Salicylic acid can help control dandruff and reduce its potential impact on acne.

Apple Therapeutics has formulated Trigaine AD for efficient control of resistant dandruff formulated with Piroctone Olamine, Ketoconazole, or Salicylic acid

for effective management. It kills, chelates resistant dandruff and debrides hair.

Nutritional Supplements For Acne Management:

Several studies have suggested the role of L-cysteine, L-methionine, and Biotin in effective acne management as they cumulatively help reduce inflammation.

Tricovit Forte is fortified with 5 mg Biotin, and L cysteine ‘100 mg mitigates UV induced DNA damage.

Acne management has to be holistic and it’s important to look into the root cause of it to help manage it effectively, our product range has been carefully created for the different stages of Acne therapy starting from the active acne wherein patients may choose L’emollis Anti-Acne Natural Face Wash, L’emollis Clear Face gel, along with oral/systemic supplementation of L-Cysteine, L-Methionine along with Biotin all of which are available in Tricovit Forte and Acnin Face Pack for the weekly skincare regimen, Apple Therapeutics also has Post-Acne Treatment range to help manage the aftermath of the drying acne treatment along with reducing hyperpigmentation and skin scarring, products like Acnin Oil-Free Moisturizer helps in alleviating post-acne dryness and ensures healthy post-acne skin.