Acne is not an insignificant disease compared to other chronic diseases.53 Even if acne is not associated with severe morbidity, mortality or physical disability, it can nevertheless have significant psychological and social effects. Reducing the psychosocial impact of acne is considered one of the the guiding principles for its clinical management. Effective and safe treatments for acne are available today, but there are still many who do not consider acne a problem that needs to be addressed. All the above effects of acne highlight the importance of prompt and proper treatment as well as psychiatric control and patient support. with acne. The improvement of acne after appropriate treatment has been shown to lead to increased self-esteem, self-confidence and social functioning.

The social, psychological, and emotional harm that can result from acne, especially in its more severe clinical forms, has been reported to be similar to that associated with epilepsy, asthma, diabetes, musculoskeletal pain, or arthritis. patients may be more prone to depression, anxiety, social withdrawal and anger, not to mention that acne scars can lead to lifelong self-esteem issues.

The relationship between the severity of acne and the emotional distress it causes is poorly understood. A student study showed that acne patients experienced a worsening of their disease during exams. An increase in acne severity was significantly associated with increased levels of stress (p < 0.01). A recent questionnaire-based study of 1,560 adolescents in Greece found a positive correlation between acne and self-reported stress. respondents themselves (P <0.0001) .

It is generally considered that there is a linear relationship between the clinical severity of acne and the deterioration of quality of life. However, this worsening also depends on a person's ability to cope with the various problems as there are people with an objectively minor acne problem who may experience severe subjective dysfunction, greatly affecting their quality of life.17 Thus, acne can to have a major impact on patients' lives, often independent of its severity.

THE heavy acne it is associated with increased depression, anxiety, poor self-confidence, and poor self-esteem.19,20 Psychiatric symptoms are more common in more severe acne and in the advanced stages of adolescence.
THE acne it is associated with an increased risk of depression, anxiety and suicidal tendencies, and there are some interesting gender differences.

It has been suggested that patients with moderate to severe acne suffer from poor body image, low self-esteem, social isolation and activity limitation. As an emotional impact, increased levels of anxiety, anger, depression and frustration are also reported. In a study of 615 school-age children with acne, adolescent girls were found to be more vulnerable than boys to the negative psychological effects of acne, and stress levels were higher.27 Considering the fact that acne causes psychological distress, it may also affect the social, professional and academic performance of adolescents.

In addition, suicidal ideation (about 6% -7% in acne patients) and suicide attempts related to the negative psychosocial effects of acne have also been recorded. A study involving 480 patients with various skin diseases revealed that the highest incidence of depression and suicidal ideation was found in patients with severe forms of acne and severe psoriasis, while patients with mild and moderate forms of acne were at the same levels as people suffering from atopic dermatitis, moderately severe forms of psoriasis and alopecia areata.

Acne negatively affects quality of life, and there is not always a correlation between the severity of acne and its impact on quality of life. The magnitude of anxiety and depression is proportional to the degree of deterioration of quality of life due to acne. Patients with greater social sensitivity experience poorer quality of life compared to other patients with the same severity of acne. Anger, similarly, was associated with poorer quality of life and less satisfaction with treatment, independent of other variables.

Studies on the psychosocial impact of acne have documented dissatisfaction with appearance, embarrassment, self-esteem, and lack of self-confidence in acne patients. Social dysfunction has also been observed, including concerns about social relationships with the opposite sex, public appearances, interacting with strangers, and professional opportunities. In addition, acne is associated with anxiety, depression, feelings of anger, and decreased body satisfaction. shown to be negatively associated with the intention to participate in sports and exercise, perhaps as a result of the fear experienced by acne patients of the criticism they will receive from those around them. In a study among schoolchildren in Scotland, 10% avoided swimming and other sports because of the embarrassment caused by acne. Acne has also been shown to negatively affect school and extracurricular activities. Self-esteem issues are also likely to be behind higher unemployment rates among acne sufferers, however there is also a bias that acne sufferers are more likely to be rejected by a prospective employer. There are also studies that report that up to 20% of teenagers with acne experience problems forming relationships because of their acne, or express concerns about socializing, appearing in public, and interacting with the opposite sex. Acne and the effects it causes on the appearance and therefore also on the self-confidence of the patients seem to be related to the depression, social withdrawal and anger that they experience.

It can create a vicious cycle: it is not only acne that can lead to emotional distress, but the stress caused to an acne patient can worsen the skin condition itself at a time when patients are less able to face additional stress.

During adolescence, the incidence of acne increases with age and growth. In girls, the onset of menstruation is associated with an increased incidence of acne. The only relationship between gender and acne in the literature is that quality of life and sexual satisfaction worsens in women with PCOS and acne.

The effect of acne on a particular patient is not always easy to quantify clinically. It has been reported that both women and men find the appearance effects of acne to be the most bothersome aspect of their disease, and the negative effects of acne occur in both older and younger patients. Even mild acne can be a significant problem for some patients, impairing their quality of life and, in some cases, their social functioning.

Contrary to what many believe, diet does not cause acne. That's why no diet, however strict, is going to "cleanse" a person suffering from acne. However, acne sufferers report that eating certain foods makes their acne worse. Sugar and simple carbohydrates can trigger acne breakouts. The foods you should watch out for are the following:

– Fatty foods such as Potatoes, Pizza, French fries and cookies

– White bread, pasta and potatoes (starchy foods)

– Carbonated soft drinks (lots of sugar)

– Probably dairy products

These foods increase blood glucose levels, resulting in insulin secretion. Insulin promotes increased oiliness of the skin and thus the pores become clogged.

Also, sudden weight gain can worsen acne.

Each acne patient must be treated as an individual case. But in general, for one mild acne local treatment is sufficient (along with some changes in the way of facial care), while in moderate and serious acne needs systemic treatment (pills) and/or a combination of local and systemic treatment. In cases of existing acne hormonal problem causing and aggravating it, this must be addressed first, otherwise the acne treatment will never be effective enough.

The biophotonic treatment system of the Canadian company KLOX is a new innovative treatment for the treatment of severe cases of acne. It is aimed at severe cases of acne who do not wish to be treated with isotretinoin pills (pill treatment requires monthly laboratory tests, dietary restrictions and avoiding alcohol. Also, avoiding pregnancy for at least 1 year). In contrast, the KLOX "lamp" treatment (a multi-LED lamp that produces blue light with a wavelength of 446nm) uses a chromophore gel (which acts as a wavelength converter) which converts the blue light emitted by the lamp into a blue range , green yellow and red wavelengths of light which cause the release of oxygen free radicals which work therapeutically. Blue light also kills propionate acne bacteria by activating the bacteria's porphyrins. This treatment does not require the controls and limitations that treatment with isotretinoin pills has and can be done at any age.

The treatment lasts a total of 12 weeks (24 treatment sessions) and requires two sessions per week (which must be separated in time, e.g. Monday and Thursday), while each session lasts only 30 minutes!

Acne is not caused by insufficient cleanliness of the skin! So washing your face alone cannot cure acne. But washing the face (with special cleansing products for skin with acne) is an integral part of the treatment because it removes excess oil from the skin. If there is a greasy film on the face, no local treatment (creams, gels) can penetrate and be effective. Also the skin is "clogged" and the acne itself worsens.

The treatment lasts a total of 12 weeks (24 treatment sessions) and requires two sessions per week (which must be separated in time, e.g. Monday and Thursday), while each session lasts only 30 minutes!

"Deep" cleansing of the face helps a lot in treating acne breakouts. Cleansing may be called deep but it is not deep, it is affected only the epidermis. After the impurities are removed with emulsion and lotion, the face is exfoliated to remove dead cells and to better extract sebum. With the help of steam from a special machine, we open the pores with gentle movements and finish the treatment with a suitable antiseptic and soothing mask. In cases of cystic acne, we avoid deep cleaning because the pressure can lead to the opening of the cyst inwards and movement of the inflammation inside the skin. For this reason, cleaning should only be done by a trained beautician or dermatologist. After deep cleaning, the oil on the skin is reduced, the hair follicles ("pores") are cleaned so the skin does not become inflamed, the skin breathes better and responds better to treatments with topical anti-acne drugs and skin cosmetics

The treatment lasts a total of 12 weeks (24 treatment sessions) and requires two sessions per week (which must be separated in time, e.g. Monday and Thursday), while each session lasts only 30 minutes!

Stress appears to play a role in the onset or worsening of acne, as stress hormones (mainly cortisone) along with testosterone cause an increase in sebum production.

The treatment lasts a total of 12 weeks (24 treatment sessions) and requires two sessions per week (which must be separated in time, e.g. Monday and Thursday), while each session lasts only 30 minutes!

Yes, there are forms of acne that either continue into adulthood (there was severe acne during adolescence) or start from scratch in adulthood. In cases where acne starts at an older age, a hormone test should be done (to rule out conditions such as cysts and ovarian tumors). In the case of polycystic ovary syndrome there is an increased production of androgens which lead to the appearance and worsening of acne. Many women experience a flare-up of acne around the age of 30 when they stop taking birth control pills because they want to have children (the birth control pills didn't let the acne flare up). Other causes are the use of inappropriate cosmetics (e.g. "heavy" cosmetics for mature skin at younger ages) which cause or worsen acne, "painting" for many hours every day, especially if the woman does not wash her face thoroughly before falling for sleep. Also overweight and obese women have increased androgen production in excess adipose tissue (which converts estrogen to androgens)

Many patients report an improvement in their acne during the summer months and especially during their holidays at the sea. The sun can help reduce acne thanks to its mild anti-inflammatory action. Tanning also hides many of the acne scars and a false improvement appears! Also, the improvement of acne during the summer can be related to other reasons such as the iodine of the sea water, the reduced stress of the holidays, etc. But before deciding whether the sun really helps, we must always take into account the immediate and long-term risks for the skin that sun exposure hides (increased risk of skin cancers, premature aging of the skin). In addition, most acne treatments increase the skin's sensitivity to UV radiation and should not be combined with excessive sun exposure.

For acne patients there are today specialized lines of skin cosmetics which are best to look for in pharmacies. In general, we should prefer products that have the label "oil free product" or "for oily acne-prone skin". This applies to all products related to the face such as cleansers, sunscreens, moisturizers, make up, etc.

We advise our patients, as much as possible, not to touch the acne lesions with their hands. This is because the pressure pushes some of the inflammatory contents of the lesion deeper into the skin. In other words, we ourselves carry the problem deeper into the skin! As you know, the deeper acne is, the more difficult it is to treat and the greater the chances of leaving behind scars (acne scars).

In addition to traditional treatments (dermabrasion with microcrystals, chemical peeling) today we have specialized targeted treatments that destroy the acne scar (which is located inside the skin under the "pimple" we see. This destruction is done with the fractional CO2 laser either with fractional RF (radiofrequency) or with microneedling. In the same session we also apply autologous PRP mesotherapy which offers growth factors for faster skin regeneration. The treatment of this serious aesthetic problem must be done when we have treated the active phase of acne and always during the months with limited sunshine.

Acne is a chronic problem and the effect of treatment cannot be extremely immediate. It usually takes at least 4 weeks for topical treatment to start showing its effect. But even systematic treatment with pills requires a corresponding period of time. Acne patients should know this and not rush and get discouraged during their treatment.

Acne treatment should be varied only after consultation and supervision by the dermatologist. Patients who abruptly stopped the treatment on their own initiative, very soon found themselves with a new flare-up of their acne. Also, the dermatologist knows which treatments are suitable for maintaining the good result, which treatments are suitable for summer, etc.

Research indicates that dairy products, and especially milk, contribute to the onset and worsening of acne. Further research is needed to confirm the exact link between the two, however it is possible that the hormones found in cow's milk are triggering the symptoms. This hypothesis is based on studies carried out on the milk - which contained hormones - of pregnant cows. This milk contains increased levels of progesterone and other steroid hormones which stimulate the sebaceous glands and worsen acne.

DThere is no scientifically proven study that proves that chocolate causes acne. Of course, the consumption of any food that is rich in fat and sugar (foods with a high glycemic index), such as chocolate, is related to the appearance of acne. Cocoa, on the other hand, seems to improve acne because unlike milk chocolate, it does not contain butter, sugar and whole milk, but contains ingredients that help with the proper functioning of hormones and the appearance of the skin. In conclusion, chocolate as food it is guilty because it belongs to the category of fatty and sweet foods. The rest of the foods belonging to this category are equally guilty. Prefer dark rather than milk chocolate or white chocolate. Dark chocolate or couverture contains flavonoids (which are antioxidants) because of the cocoa it contains unlike milk and white.