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Acne

Definition


Disease: Acne Acne
Category: Dermatological diseases
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Disease Definition:

Because acne usually occurs in teenagers, it is probable that hormones play a role in its development. However, this doesn't mean that only teenagers develop acne. Some adult women experience mild to moderate acne because of hormonal changes associated with their menstrual cycles, starting or stopping birth control pills or pregnancy.

Also called pimples, zits and blemishes, acne can be distressing and annoyingly persistent. Acne lesions usually heal slowly, and when one begins to resolve, others seem to appear. Acne can take months or years until it's successfully treated and depending on its severity, it can cause emotional distress and lead to scarring of the skin.

Fortunately, effective treatments are available. For mild cases, it usually involves self-care measures, for instance daily washing of the skin with a gentle cleanser and using an over-the-counter acne cream. For severe cases, it usually involves one or more prescription medications. Prevention strategies can help keep the skin clear of breakouts, once acne is under control.
 

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Acne usually appears in the areas of the skin with the largest number of functional oil glands, such as the face, neck, chest, back and shoulders. It can appear as:

Papules:
These small red and tender bumps signal inflammation or infection in the hair follicles.

Pustules:
They're similar to papules, but are red tender bumps, with white pus at their tips.

Cysts:
These boil-like infections can cause scars, and are pus-filled, painful lumps beneath the surface of the skin.

Comedones:
Comedones are also called whiteheads and blackheads. When these comedones are open at the skin surface, they're called blackheads because of the dark appearance of the plugs in the hair follicles. When they're closed, they're called whiteheads, which are slightly raised and skin-colored bumps. Comedones are created when the openings of hair follicles become clogged and blocked with dead skin cells, oil secretions and sometimes bacteria.
 

Causes:

Some of the factors that contribute to the formation of acne are:
 

  • Bacteria buildup.
  • Overproduction of sebum (oil).
  • Irritation of the hair follicles of the skin as a result of irregular shedding of dead skin cells.


When the hair follicles become stuffed with oil and dead skin cells, acne occurs. Each follicle is connected to sebaceous glands, which send out an oily substance called sebum to moisturize the hair and skin. Naturally, Sebum travels up along the hair shafts and then out through the opening of the hair follicle onto the surface of the skin. When an excessive amount of dead skin cells and sebum is produced by the body, these two build up in the hair follicle and appear together as a soft plug. This plug may be open to the surface and darken, resulting in a blackhead, or it may cause the follicle wall to bulge and produce a whitehead.

When blocked hair follicles become inflamed or infected, raised red spots with a white center may appear, known as pimples.
Cysts appear when blockages and inflammation that develop deep inside the hair follicles produce lumps beneath the surface of the skin.

Other pores in the skin aren't usually involved in acne, such as the openings of the sweat glands onto the skin.

Some factors, such as hormonal changes, bacteria, certain medications and heredity play a role in the increased production of sebum that leads to acne, but the primary cause for it is still not known.

Dirt doesn't cause acne to appear; additionally, foods have only a little effect on acne contrary to what some people think. However, cleansing the skin with harsh soaps or chemicals and scrubbing it too hard irritates the skin and may end up making the acne worse.
 

Complications

Complications:

None

Treatments:

When using prescription acne treatments, , and the skin may get worse before it gets better and the results may not appear for four to eight weeks.

Reducing oil production, fighting bacterial infection, speeding up cell turnover and reducing the inflammation are how the treatments for acne work. A person may be recommended oral or topical medications. Pregnant women should avoid using oral prescription medications, particularly during the first trimester.

Acne treatments include:

Skin surgery:
Also called punch excision, this a minor procedure that cuts out individual acne scars. The hole left at the scar site is repaired by stitches or a skin graft.

Laser and light therapy:
Without harming the skin's surface, laser and light based therapy reaches the deeper layers of skin. It is thought to damage the oil glands (sebaceous), making them produce less oil. These therapies may be good treatment choices for people with both active acne and acne scars because they improve skin texture and lessen the appearance of scars. Light therapy targets the bacterium that causes acne inflammation.

Antibiotics:
Sometimes, these medications should be used for months, in combination with topical products. These prescription oral antibiotics could be useful to fight inflammation and reduce bacteria for both moderate and severe acne.

Oral contraceptives:
Although birth control pills may have other side effects that should be discussed with a doctor, however, it has shown to improve acne in women, especially the ones that contain a combination of norgestimate and ethinyl estradiol.

Isotretinoin:
Isotretinoin is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments, such as antibiotics. This medicine is reserved for the most severe forms of acne. Although it's very effective, but it has the possibility of severe side effects, so people who take it should be monitored closely by a dermatologist. It shouldn't be taken by pregnant women or those who may become pregnant during the course of treatment or within several weeks of concluding treatment, because it is associated with severe birth defects. Women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive prescription of the drug because of its serious potential side effects. Even though cause and effect hasn't been proved, studies have reported the development of inflammatory bowel disease with Isotretinoin use. This medication may also increase the levels of triglycerides and cholesterol in the blood and increase liver enzyme levels.

Dermabrasion:
This method involves removing the top layer of skin with a rapidly rotating wire brush, and it may result in the complete removal of surface scars and the less visibility of deep acne scars, however, it may cause pigmentation changes in people with darker skin. It is usually reserved for cases of severe scarring.

Microdermabrasion:
It is a brand new treatment, in which a hand-held device blows crystals onto the skin. These crystals gently polish or abrade the skin's surface and then a vacuum tube removes the crystals and skin cells. In this procedure the skin isn't damaged because only the surface cells are removed, but the results are subtle and scars may still be noticeable even after several sessions.

Soft tissue fillers:
To make the scars less noticeable by filling out or stretching the skin, collagen or fat is injected under the skin and into the scars. Because the results are temporary, this injection should be periodically repeated.

Topical treatments:
Over-the-counter lotions are generally very mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as their active ingredient, which may dry up the oil, kill bacteria and promote sloughing of dead skin cells. In case of having very mild acne, these products can be very helpful. In order to get a stronger prescription lotion if the acne doesn't respond to these treatments a person should see a doctor or a dermatologist. Examples of topical prescription products derived from vitamin A are tretinoin and adapalene . These prescription medications promote cell turnover and prevent plugging of the hair follicles. Also, a number of topical antibiotics are available, which work by killing excess skin bacteria. Often, to achieve optimal results, a combination of such products is required.

Acne scar treatment:
Certain procedures could be used to diminish scars left by acne, such as dermabrasion, fillers, intense light therapy and laser resurfasing.

Cosmetic procedures:
Microdermabrasion and chemical peels may help control acne. These procedures are traditionally used to lessen the appearance of fine lines, minor facial scars and sun damage, and are very effective in controlling acne, especially when used in combination with other acne treatments.

Light source, laser and radiofrequency treatments:
In laser resurfacing, a laser beam will destroy the outer the epidermis, which is the outer layer of the skin, the dermis, which is the underlying skin, will be heated, allowing a new skin to form as the wound heals. Pulsed light sources, radiofrequency devices and less intense lasers (also called nonablative lasers) heat the dermis and cause new skin formation without injuring the epidermis. Acne scars may appear less noticeable after several treatments, and although its recovery time is shorter, it needs to be repeated more often and the results are subtle.

Prognosis:

Not available

Expert's opinion

Expert's Name:
Certificate:
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Expert's opinion:

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