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ACNE

The human skin has tiny holes called pores (follicles), these can become blocked by oil, bacteria, dead skin cells, and dirt. When this occurs, things like pimple, boil or blackhead may develop. If the skin is repeatedly affected by this condition, one may develop acne.

Acne is a skin condition that occurs when the hair follicles become plugged with oil and dead skin cells. It often causes whiteheads, blackheads or pimples, and usually appears on the face, forehead, chest, upper back and shoulders. Acne is most common among teenagers, though it affects people of all ages.

Effective treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others crop up.

Although the condition is not life-threatening, it can be painful, especially when it's severe. It can also cause emotional distress because acne that appears on the face can affect a person's self-esteem and, over time, may even cause permanent physical scarring. The earlier treatment is begun, the lower the risk of such problems.

CAUSES OF ACNE

Acne occurs when the pores of the skin become blocked with oil, dead skin, or bacteria. Each pore of the skin is the opening to a follicle. The follicle is made up of a hair and a sebaceous (oil) gland.

The oil gland releases sebum (oil), which travels up the hair, out of the pore, and onto the skin. The sebum keeps the skin lubricated and soft.

One or more problems in this lubrication process can cause acne. Acne occur when:

  • Too much oil is produced by the follicles,
  • Dead skin cells accumulate in the pores,
  • Bacteria build up in the pores.

These problems contribute to the development of pimples. Pimples appear when bacteria grows in a clogged pore and the oil is unable to escape.

Acne typically appears on a person's face, forehead, chest, upper back and shoulders because these areas of skin have the most oil (sebaceous) glands. Hair follicles are connected to oil glands.

The follicle wall may bulge and produce a whitehead. Otherwise, the plug may be opened to the surface and darken, causing a blackhead instead. A blackhead may look like dirt stuck in pores whilst in actual fact the pore is a congestion of bacteria and oil, which turns brown when exposed to air.

When blocked hair follicles become inflamed or infected with bacteria, pimples develop. Pimples are raised red spots with a white center.  There are other pores in the skin, which are the openings of the sweat glands, however these are usually not involved in acne.

SYMPTOMS OF ACNE

Symptoms of acne vary depending on the severity of the condition but may include:

  • Painful, pus-filled lumps that occur beneath the surface of the skin (cystic lesions)
  • painful lumps beneath the surface of the skin (nodules) – usually Large and solid,
  • closed plugged pores (Whiteheads)
  • open plugged pores (Blackheads)
  • Small red, tender bumps (papules)
  • Pimples (pustules) - these are papules with pus at their tips

SOME FACTORS THAT MAY WORSEN ACNE

There are some factors that can trigger or aggravate acne:

  • Diet - Studies have established that certain dietary considerations, such as skimmed milk, and foods rich in carbohydrate (such as bread, and chips) may actually worsen acne. A study has showed that eating chocolate was related to a worsening of symptoms.
  • Hormones - Androgens (for example) are the hormones that increase in boys and girls during puberty. It causes the sebaceous glands to enlarge and make more sebum.

Hormonal changes that are related to pregnancy and the use of oral contraceptives can also affect production of sebum.

Low amounts of androgens circulate in the blood of women and can worsen acne.

  • Certain medications - Examples include drugs that contain corticosteroids, testosterone or lithium.
  • Stress - Stress can make acne worse.

Contrary to widely held views, these factors have little effect on acne:

Greasy foods – The eating of greasy food has very little or no effect on occurrence of acne. Working in a greasy area, such as a kitchen however does because the oil can stick to the skin and block the hair follicles.

Hygiene - Acne is definitely not caused by dirty skin. Studies reveal that scrubbing the skin too hard and the use of harsh soaps or chemicals irritates the skin and makes acne worse.

Cosmetics - Cosmetics, especially the use of oil-free makeup doesn't clog pores and does not necessarily worsen acne. Oil-free cosmetics do not interfere with the effectiveness of acne drugs.

WHEN TO SEE A DOCTOR

In the event that self-care remedies do not clear a person's acne, seeing a primary care doctor immediately is imperative. The patient may want to seek medical treatment from a doctor who specializes in the skin (dermatologist). Such a doctor can prescribe stronger medications if the acne persists or is severe.

For many women, acne can persist for very long periods, with flares that may be common a week before menstruation. These acne flares tends to clear up without treatment in women who use contraceptives.

In some older adults, sudden onset of severe acne may signal underlying diseases that require medical attention.

RISK FACTORS

Risk factors for acne include:

  • Age - People of all ages can get acne, but it is a condition that is most common in teenagers.
  • Family history - If both of one's parents had acne, he/is likely to develop it, too. Genetics plays a huge role in acne.
  • Greasy or oily substances - Acne may develop where the skin comes into contact with oily lotions and creams or with grease in a work environment e.g. a kitchen.
  • Hormonal changes - Such changes are common in teenagers, women and girls, and people using certain medications, especially those that contain corticosteroids and androgens.
  • Friction or pressure on the skin - This can be caused by items such as helmets, tight collars and backpacks, bracelets etc.
  • Stress – Stress on its own does not cause acne, however it may make it worse.

ACNE DIAGNOSIS

If a patient has symptoms of acne, the doctor can make a diagnosis by examining the skin. The doctor will identify the types of lesions and their severity to determine the best treatment.

TREATMENT

In case, over-the-counter (nonprescription) acne products did not help a dermatologist can help to:

  • Make scars less noticeable
  • Avoid scarring or other damage to the skin
  • Control the acne

Acne medications work by reducing production of oil, they help prevent scarring by speeding up skin cell turnover, fighting bacterial infection and/or reducing inflammation. With most of the prescription drugs that treats acne, the skin may get worse before it gets better. The results may not be seen for about eight weeks.

Depending on age, the type and severity of the acne, as well as what the patient is willing to commit to, the doctor will recommend a treatment regimen. E.g. a patient may need to wash and apply medications to the affected skin twice a day for several weeks. Often times, topical medications are used in combination with oral medications.

Pregnant women however, will not be able to use oral prescription medications for acne.

Topical medications

Topical medications are ointments, creams, and solutions that are applied to the skin. Some of the most common topical prescription medications for acne are as follows:

  • Retinoid and retinoid-like drugs – They are manufactured as creams, gels and lotions. Retinoid drugs are generally derived from vitamin. The medication is applied in the evenings. The initial frequency is three times a week, it then becomes daily as the skin becomes used to it. Its work is to prevent the plugging of the hair follicles.
  • Antibiotics – They kill excess skin bacteria and reduces redness. Our doctors are most likely to recommend the use of a combination of retinoid and an antibiotic for the first few months of treatment. The antibiotic is applied in the morning and the retinoid in the evening. Topical antibiotics alone as treatments are not recommended.
  • Salicylic acid and Azelaic acid - Azelaic acid is one that occurs naturally and is found in whole-grain cereals and animal products. It has antibacterial properties. An Azelaic acid cream seems to be as effective as many conventional acne treatments if it is used twice a day for at least four weeks. It has been found to be even more effective when used in combination with erythromycin. The possible side effects though rare, may include skin discoloration and minor skin irritation. Salicylic acid works to prevent plugged hair follicles and is available in varying forms either as creams to be washed off, and creams to be left on products.
  • Dapsone – For inflammatory acne, Dapsone gel is recommended especially in adult females with acne. Possible side effects include redness and dryness of the skin.

Oral medications

Oral medications are the route most preferred by patients and are one of the most commonly used routes of medication administration by providers. Most oral preparations are taken by mouth, swallowed with fluid, and absorbed via the gastrointestinal tract.

  • Antibiotics - For moderate to severe acne, oral antibiotics may be needed to reduce bacteria and fight inflammation. The first choice for most people in the treatment of acne is tetracycline. To prevent antibiotic resistance, oral antibiotics should be used for the shortest time possible.

For achieving the best results, oral antibiotics are best used with topical retinoids and benzoyl peroxide. Studies have found that this combination may reduce the risk of developing resistance to antibiotics.

  • Combined oral contraceptives - They are products that combine estrogen and progestin. The benefit of this treatment may not be seen for a few months, so it may help to add other acne medications from the first few weeks.

Oral contraceptives have as common side effects, weight gain, breast tenderness and nausea.   

  • Anti-androgen agents - These works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness and painful periods.
  • Isotretinoin - This happens to be is a powerful drug for patients whose severe acne does not respond to other treatments.
  • Oral Isotretinoin - A very effective for treatment but its potential side effects are a huge disincentive because of this, doctors need to closely monitor anyone they treat with this drug.

The potential side effects include an increased risk of depression and suicide, and severe birth defects. In fact, Isotretinoin comes with such serious side effects that people using Isotretinoin must necessarily participate in an approved and monitored risk management program.

HOW CAN ACNE BE PREVENTED?

It's difficult to prevent acne. But the following steps can be taken at home to help prevent acne after treatment;

  • Wash face twice a day with an oil-free cleanser
  • Reduce stress
  • Shower after exercising
  • Use an over-the-counter acne cream to remove excess oil
  • Avoid makeup that contains oil
  • Remove makeup and clean the skin thoroughly before bed
  • Avoid tight-fitting clothing
  • Eat a healthy diet with minimal refined sugars

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