Acne

Acne is a disease that affects the skin’s oil glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows. Most pimples are found on the face, neck, back, chest and shoulders. Acne is nota serious health threat, but it can cause scars.

Acne is the most common skin disease. People of all races and ages get acne. But it is most common in teenagers and young adults. An estimated 80 percent of all people between the ages of 11 and 30 have acne outbreaks at some point. Some people in their forties and fifties still get acne. In contrast, women are more likely to have intermittent acne due to hormonal changes associated with their menstrual cycle and acne caused by cosmetics. While most people outgrow their acne by their 20’s some, especially women, have acne well into adulthood.

What is Acne?

Clinically, acne is described as a disease of features known as pilosebaceous units (PSUs). Found just under the skin, PSUs are numerous on the face, upper back, and chest, and contain sebaceous glands that are connected to hair follicles. The sebaceous glands produce sebum, an oily substance that empties onto the skin via the hair follicle. Acne is partly the result of the actionof hormones on the skin’s oil glands and the hair follicles.

Following Factors affect acne formation –

• Increases in sex hormones called androgens that occur in both boys and girls during puberty. Androgens cause sebaceous glands to enlarge and make more sebum in hair follicles
• Hormonal changes related to pregnancy or to starting or stopping use of birth control pills
• Genetics

Types of Acne

Every mark on the skin produced by acne is a type of lesion. The mildestcases of acne produce blackheads andwhiteheads.The color of these is determined by whether the plugged follicle remains open or closed. If it is closed, it is a whitehead. More troublesome acne lesions include

• Papules – inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
• Pustules (pimples) – white or yellow pus-filled lesions that may be red at the base
• Nodules – large, painful, solid lesions lodged deep within the skin
• Cysts – deep, painful, pus-filled lesions that can cause scarring

 

Causes

Acne appears when a pore in our skin clogs. This clog begins with dead skin cells. Normally, dead skin cells rise to surface of the pore, and the body sheds the cells. When the body starts to make lots of sebum (see-bum), oil that keeps our skin from drying out, the dead skin cells can stick together inside the pore. Instead of rising to the surface, the cells become trapped inside the pore. Following factors also play a key role –

• Dirt – Blackheads are oxidized oil, not dirt. Sweat does not cause acne and is produced by entirely separate glands in the skin. On the other hand, excessive washing can dry and irritate the skin.
• Stress – Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.
• Heredity – If one of the parents had severe acne, it is likely that the child’s acne will be more difficult to control.
• Pressure – In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can aggravate acne.
• Drugs – Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes sometimes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid). Most cases of acne, however, are not drug related.
• Occupations – In some jobs, exposure to industrial products like cutting oils may produce acne.
• Cosmetics – Some cosmetics and skin-care products are pore clogging (“comedogenic”). Of the many available brands of skin-care products, it is important to read the list of ingredients and choose those which have water listed first or second if you are concerned about acne. These “water-based” products are usually best for those with acne.
• The hormone increase in teenage years (this can cause the oil glands to plugup more often)
• Hormone changes during pregnancy
• Starting or stopping birth control pills

In some cases oily food also play certain role in the formation of acne.

 

Symptoms

Person who has acne can have any of these blemishes:

• Blackheads
• Whiteheads
• Papules
• Pustules (pimples)
• Cysts
• Nodules

Acne can cause more than blemishes. Studies show that people who have acne can have –

Low self-esteem – Many people who have acne say that their acne makes them feel bad about themselves. Because of their acne, they do not want to be with friends. They miss school and work. Grades can slide, and absenteeism can become a problem because of their acne.

Depression – Many people who have acne suffer from more than low self-esteem. Acne can lead to a medical condition called depression. The depression can be so bad that people think about what it would be like to commit suicide. Many studies have found that teens who believe that they have “bad” acne were likely to think about committing suicide.

Dark spots on the skin – These spots appear when the acne heals. It can take months or years for dark spots to disappear.

Scars (permanent) – People who get acne cysts and nodules often see scars when the acne clears.

 

Treatment

Medications

Medications are applied to the skin and are often used to treat mild to moderate acne. Some common medications are:

• Benzoyl peroxide is available by prescription and in lesser strengths over the counter. It is usually applied once or twice a day to work best against pustules. It can be irritating if used around the eyes and mouth. It should be used carefully since it can bleach skin and clothing. If they are used excessively, benzoyl peroxide can cause drying and redness.
• Salicylic acid is effective in treating non-inflammatory acne lesions. Salicylic acid helps correct the abnormal shedding of skin cells and unclogs pores to resolve and prevent lesions. It has no effect on oil production or bacteria. Like benzoyl peroxide, salicylic acid must be used continuously. Salicylic acid is found in many over-the-counter acne products, including lotions, creams and pads. It may be irritating to the skin.
• Retinoids are derivatives of vitamin A and have been a mainstay in acne treatment for 25 years. They decrease the stickiness of plugged sebaceous glands. They work best against blackheads and reduce papules and non-inflamed pimples. They are to be used once per day at bedtime; if overused, they can cause drying. Retinoids can make skin more sun sensitive. Using sunscreen is recommended. Common names are Retin A, Differin, or Tazorac.
• Topical antibiotics come in solution, gel, or cream form. They help reduce the amount of bacteria on the surface of the skin thereby preventing inflammation and the formation of new pimples. They are to be applied to the skin twice a day.
• Azelaic acid is used to treat mild to moderate acne. It is believed that azelaic acid clears acne by reducing the populations of bacteria, decreasing the abnormal shedding of skin cells and reducing inflammation. Side effects may include skin dryness and lightening of the skin where applied.
• Antibiotics are used for mild-to-moderate and moderate-to-severe acne. They work to reduce bacteria thereby reducing inflammation.are used for mild-to-moderate and moderate-to-severe acne. They work to reduce bacteriathereby reducing inflammation.
• Oral contraceptives have been shown to effectively clear acne in women by decreasing circulating malehormones called androgens, thereby decreasing sebum (oil) production.

Laser Therapy – Light and laser therapies can be used for thetreatment of acne. Examples include visiblelight, pulsed-dye laser, and photodynamictherapies. There is insufficient evidence torecommend the routine use of these therapiesfor the treatment of acne.2 Studies of theseproducts typically lack controls, have smallsample sizes, are short term, and do not comparethese therapies with validated pharmacologictreatments. There are no established guidelineson the optimal dosing, device, timing, and frequency tobe used.

 

 

 

Alternative Medicine

Antioxidants

Vitamin C, or ascorbic acid, is a water-soluble vitamin that can be used. Antioxidants are commonly thought to have a role in treating aging skin or in cosmetic application, but randomized, controlled trials have found that topical application of a stable precursor of ascorbic acid is effective in reducing acne lesion counts, both alone or, in combination with a topical retinoid.Because vitamin C is notoriously unstable, it is advisable to consider the formulation when used for this application.

Nicotinomide, also known as niacinamide, is a water-soluble B vitamin. Numerous studies have investigated the use of nicotinamide both topically and orally for acne and reasonable evidence exists for the use of this agent topically in the treatment of acne. It has performed equally or superiorly to topical clindamycin in some studies. Nicotinomide has also been shown to inhibit IL-8 production in vitro, potentially explaining its anti-inflammatory properties in the skin.

Tea tree oil is commonly used as a topical antimicrobial agent. The antiseptic properties of tea tree oil are thought to be due to its ability to disrupt the bacterial membrane. Topical tea tree oil has been shown to be superior to placebo, and comparable in efficacy to benzoyl peroxide.

Probiotics are another dietary modification worth considering in the treatment of acne. These live microorganisms are associated with a number of beneficial effects in the body. Not only have probiotics been shown to mitigate some of the adverse effects of long-term oral antibiotic therapy, but they may also potentially offer a reduction of inflammation in acne by decreasing the release of inflammatory cytokines.

Alpha hydroxy acid is a natural acid found in citrus fruit and other foods. When applied to the skin, alpha hydroxy acid helps remove dead skin cells and unclog pores. It may also improve the appearance of acne scars. Side effects include increased sensitivity to the sun, redness, mild stinging and skin irritation.

Azelaic acid is the naturally occurring acid is found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many other conventional acne treatments when used twice a day for at least four weeks. It’s even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding.

Bovine cartilage creams applied to the affected skin twice a day, may be effective in reducing acne.

Zinc in lotions and creams may reduce acne breakouts.

Aloe vera was combined with a conventional acne drug (tretinoin) and tested for eight weeks on 60 people with moderate acne. The combination approach was significantly more effective than tretinoin alone.

Brewer’s yeast, seems to help decrease acne. Brewer’s yeast is the only item in this list that’s taken orally. It may cause flatulence.

 

Reference

http://www.webmd.com/skin-problems-and-treatments/acne/

http://www.bpac.org.nz/BPJ/2009/April/docs/bpj20_acne_pages_7-16.pdf

http://www.niams.nih.gov/health_info/acne/acne_ff.pdf

http://www.mayoclinic.org/diseases-conditions/acne/basics/definition/con-20020580

http://www.aafp.org/afp/2012/1015/p734.pdf

https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a—d/acne/who-gets-causes

https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a—d/acne/who-gets-causes