Acne is a condition that occurs in 85% of those between the age of 12–24 years and usually clears in adult life. It would be easy to write acne around mouth conditions off as a common condition that teenagers will ‘grow out of’, but for some, acne spots may adversely affect both their lives in the short and long term. During the teenage years, appearance and body image are all important for the ability to make friends, socialize and gain employment.
Acne Around The Mouth and Chin
Acne may lead to embarrassment and lack of self- confidence that may create problems in all of these areas. Depression and anxiety were noted in 18–44% of patients with acne, and one study reported suicidal thoughts in as many as 6%. Effective acne treatment reduced all of these problems.
Apart from this, the more severe lesions may leave a legacy of unsightly acne scars that will per- sist through life and be difficult to treat satis- factorily and for which treatment is not usually available on the NHS unless the scars are causing severe psychological distress. Early recognition of acne, proper assessment of the lesions and appropriate acne treatment are therefore important to both the present and future prospects of patients.
Aetiology
Acne vulgaris is an inflammatory condition affecting the pilosebaceous glands of the hair follicles in the dermis. It follows follicular hyperproliferation, an excess of production of sebum with plugging of the follicle, the presence of the bacteria Proprionibacterium acnes (which is normally present on the skin), and inflammation.
The initial trigger for acne around mouth conditions are the androgen hormone. It has been found that there is a genetic predisposition, and often there is a family history of the problem. Certain drugs, such as corticosteroids, lithium and some anti-epileptics can also be associated with the development of acne.
Epidemiology
Although most cases of acne vulgaris occur between the ages of 12–24 years, occasionally it persists or develops in adult life. It is more common in teenage boys and modern western societies, but later at the age of 25 years, 12% of women and 5% of men suffer from acne. At 45 years, 5% of both men and women still have the problem. Acne may also be seen in babies during the neonatal period when maternal hormones still have influence.
Acne Management
Acne around mouth conditions conditions can be made do with topical applications and additionally fundamental skin inflammation treatment or systemic acne treatment. Decisions about when to use which option are dependent on the severity of the condition.
Topical Preparations
1. Benzoyl Peroxide
Benzoyl peroxide can be purchased over-the- counter (OTC), in the form of soaps, lotions, creams and gels. These products are effective against P. acnes and can reduce inflammation. However, they are irritant and may cause problems of dermatitis. The application of benzoyl peroxide tends to be once or twice per day, and initially people begin on a lower strength. This strength is increased if it is tolerated well by the patient. Preparations are available as 3.5%, 5% and 10%.
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2. Azelaic Acid
Azelaic acid has antimicrobial and anti-comedonal effects by killing bacteria and decreasing the production of keratin. They are a useful alternative for mild-to-moderate comedonal acne.
3. Retinoids
A retinoid is an anti-inflammatory that acts against the comedones, but patients should be warned that they should use sun protection, as it is known to be associated with sun sensitivities. Retinoids should be applied once a day to dry skin, but less frequently if irritation occurs. It may take several months before a good result is achieved.
4. Antibiotics
A topical antibacterial should be considered if there is an inadequate response to benzoyl peroxide or azelaic acid. Clindamycin or occasionally erythromycin are helpful against P. acnes and also have anti-inflammatory effects, but bacterial resistance may develop and they do not deal with comedones. A gel or solution can be applied once or twice daily.
Management of scars
Treatment of acne scars are not usually available on the NHS and cosmetic surgery is likely to be expensive. Laser therapy and dermabrasion, in which the top layer of the skin is removed, may help mild-to-moderate scars. Ice pick scars may be helped by a variety of punch or other surgical techniques.
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These treatments are not always successful and it is said that only 50–75% feel that their appearance has been improved by these interven- tions. Keloid and hypertrophic scars may improve with potent topical or intralesional steroids. Cryotherapy can be tried but lesions tend to recur and the treatment may leave a scar.
Prevention
Currently, there is no known way of preventing the development of acne around mouth cases; and diet and weight control do not seem to be of any benefit. Once developed, scratching, picking or squeezing spots will more likely lead to scarring.Conclusions
Acne vulgaris is a common problem, especially in the teenage years. Some will be anx- ious and worried about the condition, even in mild cases while others may ignore the whole thing, even when the changes are severe, and treat it as ‘just one of those things’.
For health professionals, the face is obvious to all, even if the patient has no complaint. We are in the position of being able to recognize the problem, assess the severity and advise appropriate acne treatment, even when acne is not the main complaint. Such intervention may help to reduce the severity of the condition and improve the legacy of marred appearance, not only at the time, but also in their later years.
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