You are here: Safehealth Medicine : Dermatology : Ance

ACNE

Acne is an inflammatory disorder of the sebaceous glands and hair follicles of the skin. It is marked by eruption of pimples, plugged pores, and deep-seated lumps that crop up on the neck, face, back, shoulders and even the upper arms.

Acne stems from overactivity in the sebaceous gland and an obstruction in its duct by hypercornification. Sebum is developed from the sebaceous gland through a holocrine process where the gland’s cells fragment into free fatty acids, lipids-glycerides, wax esters, squalene and cholesterol.

Commonly called pimples or zits, Acne Vulgaris affects any age group—teens, adults in their 20s and sometimes even those in their 40s. Acne can be distressing and disfiguring especially serious cases that leads to permanent scarring.

CAUSES

Hormones.
During puberty, hormones called androgens become active and stimulate oil glands, boosting oil production. This clogs pores, resulting in blackheads and pimples. An acne flare-up can also result from hormonal changes that take place during a woman’s menstrual period or when she starts or stops taking birth control pills.  

Genetics.
A person’s skin type and genes may also predispose him to acne.  

Stress.
Stress can worsen acne in two ways. First, stress stimulates the adrenal glands to generate more hormones and second, psychological stress can slow the wound healing capacity of the immune system up to 40%.

Diet.
The chemicals discharged during the metabolism of specific foods directly affect acne-causing factors. Thus, triggering the onset of acne or worsening a pre-existing case. Western diets, which has plenty of fat and dairy aggravates the condition.

Other causes.
Too much washing of the face can irritate the skin and cause acne. Using oily skin care products and cosmetics clogs the oil ducts. 

DIAGNOSIS & SYMPTOMS

A General Practitioner can initially diagnose acne by examining the skin on the face, chest or back. Assessment involves identifying problem spots and how painful and inflamed they are.

The usual symptoms of acne:

1. Recurrent red spots or swellings (pimples)
2. Dark spots with open pores at the middle (blackheads)
3. Bulged spots under the skin without openings (whiteheads)
4. Red lumps filled with pus (pustules)
5. Inflamed fluid-filled lumps under the skin (cysts)

The GP will then inquire about the history of the symptoms, previous medications used (counting over-counter-products), the patient’s use of cleansers and cosmetics, if patient is taking other medications, the patient’s work and leisure activities, and other medical and skin problems. Women are asked about menstrual record, abnormal hair growth, and whether they are sexually active or on the pill.

TESTS & TREATMENT

Test

Topical Therapy:

• Benzoyl peroxide—a useful antibacterial and gentle anti-inflammatory topical agent. It comes in various strengths: 2.5%, 5 % and 10%. Patients are advised to start with the weakest strength and step up gradually.
• Retinoic acid—a kerolytic that can amplify the basal cell mitosis and epithelial turnover. This is available in gel (0.01% and 0.025%) and cream (0.05% and 0.01%).
• Azelaic acid—It is offered as 20% azelaic acid in cream base. It inhibits growth of propionibacteria and reduces the ductal hypercornification. It is a safe treatment even for pregnant women.
• Topical antibiotics—Although less effective than Benzoyl peroxide, they cause less irritation and are more convenient to use. Clindamycin and Erythromycin are recommended for moderate inflammatory acne.
  

Systemic Therapy:

Antimicrobials—These should be administered for six months to make use of their full effect. If one kind doesn’t work, another can be tried until one finds a successful treatment that can be had on a long-term basis.

• Tetracycline—a cheap and effective bacteriostatic agent. The standard dose is 1 gm/day in separate dosages and should be taken on an empty stomach.
• Minocycline and doxycycline—a more effective but more expensive treatment. It can be given as a single daily dose (100 mg/day).
• Erythromycin—the preferred drug for pregnant women.

Hormonal Therapy—Indicated for women with acne and those exhibiting androgen excess (hirsutism and androgenic alopecia). Diane 35 (Dianette) is a combination of anti-androgen, cyproterone with an estrogen, and ethinyl estradiol.

Other Specific Therapy:

• Surgery to remove unsightly scars and permanent cysts
• Comedones extractor to remove blackheads
• Collagen injection of scars
• UVB irradiation

COMPLICATIONS

• Permanent facial scars
• Changes in skin color
• Permanent scarring
• Anxiety and depression

PREVENTIONS

• Choose water-based products for the face and body instead of those with oil or petroleum
• Wash face gently at least twice a day with a sulfur-based soap.
• Cut long hair short and wash it daily to avoid oil and dust from traveling from the hair to the face and neck area.
• Drink a lot of water to cleanse and hydrate the skin
• Do not squeeze pimples as this leads to infection, inflammation and permanent scarring.
• Avoid sun exposure or use sunscreen that is not oil-based
• Take lots of fresh fruits and vegetables

Breathe deeply and try to engage in relaxing activities to alleviate stress

STATISTICS
Frequency in the US:

Five to ten percent of the population or an estimated 14-15 million persons, including 5 million children. The rate of exercise-caused symptoms in persons with asthma has been reported to fluctuate from 40-90%.

Frequency in other nations:

Asthma is common in industrialized countries such as Canada, Australia, England, New Zealand, and Germany where factors such as urbanization, passive smoking, air pollution, and change in exposure to environmental allergens are greater. The occurrence rate of acute asthma in industrialized countries varies from two to ten percent. Recent trends suggest an increase in the prevalence of the disease, particularly in children younger than six years

STATISTICS
These figures are calculated extrapolations of different prevalence rates against the populations of a specific country. They are based on statistics from U.S., U.K. and Canada.