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Offline sithari

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Health Watch (Acne In and Out)
« on: September 05, 2006, 10:02:54 PM »
Health Watch
Acne - In and out
This detailed article on Acne by Senior Registrar Dermatology Unit NHC Dr. Sharnika Abeykirthi answers many questions on Acne sent to us by our readers in the course of last month and earlier.

Acne (or pimples) is an inflammatory disease of the pilosebacious unit. This unit consist of the sebum or oil secreting gland and a hair follicle. Acne is an extremely common condition affecting almost 80% of adolescents and young adults. It usually starts in adolescence and frequently resolves by mid twenties. Acne develops earlier in girls than boys.

A peak in severity occurs between 14-17 yrs in girls and 16-19 yrs in boys. Thereafter the acne resolves slowly. Although most people are free of acne in their late twenties there are few unfortunate ones. At the age of 40 yrs significant lesions are still present in 1% of males and 5% of females.

What causes acne?
There are 4 main factors contributing to the formation of acne.

1) Increased sebum production

In patients with acne, the sebum producing glands are larger and more responsive to different stimuli than the normal people. Hence these people produce more sebum than others.

2) Abnormal proliferation and shedding of cells at the opening of the pilosebaceous gland. (The unit which comprises the hair follicle and the sebaceous gland)

Because of this, the follicular opening is blocked and various substances accumulate within the gland and form a microcomedone.

Later these microcomedones turn into closed and open comedones which are also known as white heads and black heads respectively.

These comedones are the ones that later become acne.

3)Bacterial proliferation

A bacteria called Propionibacterium acne plays a role in formation of acne. But it is important to remember that acne is not infectious.

4)Inflammatory mediators

Acne act on the various substances within the blocked follicle and produce inflammatory mediators. The follicles rupture and these mediators are released causing acne.What other factors influence the formation of acne?

Genetic factors
This means that the tendency for you to get acne is influenced by, whether one or both of your parents have acne or not, not only that, the severity of acne, their distribution, scarring, response to treatment and the age at which their acne resolved could all be genetically determined. So if you have a parent who had severe scarring acne which persisted even at forty you should be extra cautious about your own acne.

Androgen is the main hormone that causes acne. Increased androgens causes increased sebum secretion which lead to the formation of comedones and thereby cause acne. In addition, growth hormones and progesterone can also exacerbate acne.

Premenstrual flare
About 70% of women complain of a flare of their acne 2-7 days before their periods. This is partly due to the effect of hormones. On the other hand, due to the fluid retention during this time, the follicles get blocked and cause exacerbation of acne.

Acne can get worse during periods of excessive sweating. This is especially seen in people who live or work in hot humid environments.

Certain occupations are linked with formation of acne. Eg. Cooks can get acne due to working in hot environment. People dealing with oil can develop a special form of acne.

There are certain studies that have shown relationship between acne and the number of cigarettes you smoke daily.

Certain drugs can aggravate acne. These include steroids, androgens, certain contraceptive pills, antiepileptic drugs, iodides, lithium etc.

What about diet?
It is very common to hear that certain foods like chocolates, fatty foods are blamed for exacerbating acne. But scientific proof for this is lacking. There are some trials that have shown that Western civilization food habits give a high blood glucose index which triggers your insulin secretion and thereby influence androgen secretion.

This in turn can cause acne. The best advice you can give an acne patient is, that can eat anything they want in moderate amounts. "Eat sensibly", contain all the advice that should be given.

How does acne present?
Acne can present itself in a in number of different ways. The initial presentation is with multiple comedones (what we commonly call white heads and black heads) These lesions become inflamed and cause papules, pustules and in some people nodules. Nodules are common in males. Acne not only affects your face, but chest, back and upper arms as well.

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« Last Edit: September 09, 2006, 10:27:08 AM by sithari »
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Offline sithari

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About Skin care
« Reply #1 on: September 07, 2006, 11:21:18 PM »
What are the different types of acne?
These patients present with multiple comedones. This is due to exposure to certain toxics, chlorinated hydrocarbons etc.

Cosmetic acne
This type of acne is seen in females, especially those who had acne in their adolescence and have used cosmetics for a long time. Sometimes when you start using a newer cosmetic which is comedogenic, you will notice a flare up acne.

Pomade acne
Greasy preparations used to defreeze curly hair can cause acne specially comedones around the forehead.

Mechanical acne

This type of acne occurs at the site of physical trauma. eg. At the chin of violin players, due to the friction of head bands, tight bra straps.

If you have acne together with excessive hair on your face.

In this context, you should consult a doctor, especially if you are abnormally fat or have menstrual irregularities, because you may be having an underlying endocrine disorder. There are certain diseases that can mimic acne. eg. Rosacea. Your doctor will be able to differentiate these conditions.

Why you should take acne seriously and seek treatment early?

Because it is no longer a common natural thing that can occur to most of us during our adolescence. It is a disease that can end up in permanent disfigurement due to pigmentation, scarring and keloid formation.

If you seek treatment early, the disease can be cured and prevent complications. So you should not hesitate to go to a doctor for treatment early because there are number of treatment modalities available for acne now.

Some myths about acne Acne is infectious
Some people believe that by kissing a person who has acne, sharing the same towel can cause acne. This is not true. Although acne is cause by a bacteria it is not infectious.

Eating oily foods can cause acne Increased sebum or oil secretion by sebaceous glands cause acne. But oily foods only increase your blood lipid levels and these lipids do not pass into the sebaceous glands. So oily foods cannot cause acne. Acne patients needs to wash to their skin thoroughly and frequently.

Many people believe that acne is related to poor hygiene. So they wash their face excessively and frequently.

But there is no evidence that lack of washing is associated with acne or frequent washing improves the condition. But of course if you wear make up, it is important to wash them off as soon as possible.

How do you manage acne?

Management of acne depends on your age, sex, type of acne and its severity.

General measures
Diet: As I have mentioned earlier eat anything in moderate amounts is the best advice one can give.

Skin care
Patients should cleanse their acne skin areas twice daily with medicated antiacne soap. Avoid rough clothes and other scrubbing materials. Acne patients should cleanse their skin gently. Moisturizers can be useful for people with dry skin.

In addition, acne patients should use noncomedogenic skin care products and cosmetics.

In general lotions and oilbased products are more comedogenic than gel based products.

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Re: Health Watch (Acne In and Out)
« Reply #2 on: September 09, 2006, 10:27:43 AM »
Acne - in and out
Dr. Sharnika Abeykirthi

Senior Registrar Dermatology Unit NHC

Treatment methods

* Topical therapy

* Oral therapy Physical methods

Topical therapy
Wide variety of topical creams are available in the market. Some of them do not even mention the ingredients in it. The choice of therapy depends on your acne grade and several other factors. So it is very important that you consult your doctor prior to starting treatment. Some of the widely recommended and scientifically proven anti acne creams are-

1. Topical antibiotics

Available as creams or lotions. Has an antimicrobial effect. So it acts against propionibacterium acne.

These include erythromycin, clindamycin etc.

2. Benzoyl peroxide

Available in concentrations of 2.5, 4, 5 or 10% This also has an antimicrobial effect.

3. Azaleic acid

This has an antimicrobial as well as anticomidonal effect. It also reduces the marks (or pigmentation) seen in some acne patients.

Topical retinoids
This is a very effective treatment for acne. It has an antimicrobial, anti inflammatory as well as anticomidonal effect. It also reduces scarring. It is available as retinoic acid, Isotretinoin and adapalene.

As these have several side effects, it is very important that you should be under a doctor's supervision during treatment. Especially retniod drugs should not be used during pregnancy and lactation.

Oral therapy
When you are unable to control with topical therapy or for moderate to severe acne, oral therapy is given.

1. Antibiotics

eg. tetracycline, erythromycin

2. Hormonal treatment

Antiandrogenic hormones are used. Can also be used as a contraceptive method. Should not be used in males.

3. Oral Isotretinoin

This is the most effective antiacne therapy. But unfortunately because of its high cost and side effects, isotretinoin is not widely used in Sri Lanka.

It should be used with caution in women of child bearing age as it may lead to birth of deformed babies.

4. Other therapies like dapsone, zinc, Vitamin A are occasionally used.

Physical modalities
Physical modalities are used as an adjuvant to topical and oral treatment.

Comedone extraction is one such method. As this procedure is painful, it should be done by a skilful person. Although hot compresses help to remove comedones, facial saunas and heat can worsen acne. Cryotherapy with liquid nitrogen as well as intralesional steroids can be used for nodular lesions and keloids. Dermabrasion is useful for scars but it has its own side effects.

Whatever the treatment used, as acne is a chronic disease, the treatment should be long term. Even after you are free of acne sometimes maintenance treatment may be needed until you pass the age you are prone to get acne.

Doctor's advice
As acne is a chronic disease patience is important. Because your tendency to get acne persists for sometime, you should continue treatment as long as your doctor tells you.

It is important for you to realise that even if you have mild acne it will persist for about 5 years and if you have severe acne, it could be more than 10 years. With standard therapy little improvement is seen after one month. Sometimes acne can get worst initially even with treatment. So you should realize this and continue to follow your doctor's advice and the treatment given.

Finally if you have acne, don't just apply anything and everything you get hold of. It's a common disease which can be cured. So hurry up and get your doctor's advice.

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