How do we get Acne?
Acne is chronic or recurrent skin disease presenting with non-inflammatory and/or inflammatory lesions.
It can have significant psychosocial implications for the patient, leading to social anxiety and decreased self-esteem. Acne, in its more severe forms, can cause permanent scarring and disfigurement.
Simply put, The holes in your skin are blocked by bacteria, dead skin, or oil. When this occurs, you see the pimple or the zit pops up on your skin.
What causes Acne?
Acne is a multifactorial process. It occurs by hypersensitivity of the sebaceous glands to normal circulating levels of androgens, which are aggravated by Propionibacterium acnes and inflammation.
Some of the causes include:
- Medications use, steroids are common ones
- Stress
- Sweating
- Smoke and pollution
- Hormonal changes (period, pregnancy, etc.)
- Cosmetics
Symptoms
Acne lesions range from comedones to papules and pustules, cysts and/or nodules.
But lets first understand some definitions.
- Comedones: small, flesh-colored, white, or dark bumps that give skin a rough texture.
- Papules: Small, red, raised bumps caused by inflamed or infected hair follicles.
- Pustules: Small red pimples that have pus
- Nodules: Solid painful lumps beneath the surface of the skin
- Cysts: Large lumps found beneath the skin containing pus and are usually painful
Now that we understand these terminology, lets get back to the symptoms.
Most acne occurs on the face but is also common on the neck, shoulders, back, and upper chest. Anabolic steroid use typically causes acne on the shoulders and upper back.
There are three levels of acne severity:
Mild acne which is inflammatory lesions that are mostly superficial with small papules and pustules. Usually does not leave scars
Moderate acne have more blackheads, whiteheads, pimples and pustules.
Severe acne have either very large numbers of blackheads and whiteheads, pimples, and pustules or cystic (deep) acne. In cystic acne, people have cysts that are large, red, painful, pus-filled nodules that may merge under the skin into larger, oozing abscesses.
Treatment
Non prescription medications way
Before seeing a physician, people frequently use over-the counter therapies. Such treatments may be more accessible, cosmetically elegant, less expensive and less irritating than prescription therapies
Benzoyl peroxide
Benzoyl peroxide of concentrations 2.5% or 5%, which treats and prevents acne by killing the bacteria beneath the skin. It is effective usually against mild to moderate acne.
Salicylic acid 2%
Salicylic acid is moderately effective but less potent than a topical retinoid in acne therapy. It helps prevent pores from getting plugged.
Prescription medications way
Treatment selection is based on disease severity, patient preference, and tolerability.
Topical Therapy
- Topical retinoids indicated for acne of any severity and for maintenance therapy
- Azelaic acid is antimicrobial and comedolytic available 15% or 20% gel. Also used in post inflammatory pigmentation of acne.
- Topical benzoyl peroxide is now available in combination with adapalene, which serves as comedolytic as well as antibiotic preparation. It comes in 2.5%, 4%,and 5% concentration in gel base.
- Topical antibiotics do not use it alone, either with benzoyl peroxide and/or topical retinoids.
Systemic therapy
Antibiotics
When topical agents are insufficient or not tolerated, or in cases of moderate to severe acne, especially when the chest, back and shoulders are involved, systemic antibiotics are often considered the next line of treatment.
Hormonal therapies
Hormonal agents provide effective second-line treatment in women with acne regardless of underlying hormonal abnormalities. It is not necessary to demonstrate androgen excess to achieve a benefit from antiandrogen therapy.
The oral antiandrogen spironolactone added if oral contraceptives are not effective.
Isotretinoin (Accutane)
It is the last resort for acne and also the most effective treatment.
Indications for isotretinoin include scarring disease, severe nodulocystic acne and less than 50% improvement with oral antibiotics or hormonal therapies after four months.
Cautions
Before a patient starts oral isotretinoin therapy, baseline blood work is recommended.
Testing includes serum blood lipid measurements, complete blood count and differential, liver enzyme tests and blood glucose levels (and a pregnancy test for women of child-bearing age).
These tests should be repeated at monthly intervals during treatment.
In women of childbearing age, two forms of birth control to be used during and for one month after therapy, unless the patient has had a hysterectomy or is sexually abstinent.
Side effects:
- Dry nose, mouth and lips.
- Photosensitivity.
- Joint and muscle pain.
- Increase of triglycerides.
- Monitor mental health.
Some tips to deal with Acne
- apply topical preparation to the whole affected area not only to individual lesions
- use oil-free products
- eat healthy balanced diet
- reduce stress
- apply sunscreen before exposing to the sun
- do not touch or squeeze the pimple
Conclusion
Acne is an extremely common skin condition. Despite not directly endangering life it can have a devastating physical and psychological effect on the lives of vulnerable adolescents.
For the most part, most patients have a good outcome after treatment with no scars. However, if scars occur, contact your physician about the treatment option to treat it.
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