ACNE VULGARIS (PIMPLES)

Acne is a common chronic disorder affecting the hair follicle and sebaceous gland, in which there is blockage of the follicle (with oil and dead skin cells) and inflammation. There are several variants with the commonest been acne vulgaris.Vulgaris is the medical term for "common". It is given this name to distinguish it from less common forms of acne. You may call acne "pimples", "spots" or "zits".

Acne affects males and females of all races and ethnicities but males are more predisposed in developing severe acne. It is common in adolescents and young adults, with 85% of 16-18 year olds affected. However, it may occur in children and adults of all ages.

Acne usually appears on the face, neck, chest, back and shoulders. These are seborrheic areas with high amount of sebum. It is a cause of emotional distress, reduced self esteem and in extreme cases depression and suicide and causes scar on the skin. Acne can be persistent despite effective treatment. Early treatment is the key because it lowers the risk of physical and emotional damage.. Acne tends to improve after the age of 25 years but may persist, especially in females.

CAUSES

Acne is due to a combination of factors. The following factors predispose/aggravate acne.

1.            Family history - Genetics plays a role in acne. If both parents had acne, you're likely to develop it, too.

2.            Hormones - Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum, predisposing to acne. Hormonal changes related to pregnancy, menstruation, use of oral contraceptives, corticosteroid or lithium also can affect sebum production.

3.            Drugs - Use of oral contraceptives, steroids, exogenous androgenic hormones, anticonvulsants, lithium, and others also affect sebum production and worsen acne.

4.            Infections-priopionibacterium acne is the bacterium implicated in acne; though Staphylococcus aureus is discovered to play some role.

5.            Diet - Dairy products and carbohydrate-rich foods may trigger acne. Chocolate has long been suspected of making acne worse. Some has associated roasted groundnut and beverage like coffee with acne.

6.            Greasy or oily substances - Acne may develop in areas where the skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats. 

7.            Climate-excessive heat and humidity aggravates acne

8.            Friction or pressure on your skin. This can be caused by items such as telephones, cell phones, helmets, tight collars and backpacks

9.            Conditions like polycystic ovarian disease, Cushing’s disease and application of occlusive dressing can all worsen acne.

 10.        Other factors like stress, anxiety emotional tension and adversely affect the course of acne.             

FEATURES

Acne is often confined to the face but it may involve neck, chest and back. It is characterized by:

• Whiteheads (closed plugged pores)
• Blackheads (open plugged pores — the oil turns brown when it is exposed to air
• Small red, tender bumps (papules)
• Pimples (pustules), which are papules with pus at their tips
• Large, solid, painful lumps beneath the surface of the skin (nodules)
• Painful, pus-filled lumps beneath the surface of the skin (cystic lesions) 
•  

TREATMENT

The drug the doctor recommends depends on the type and severity of the acne. It could be applied to the skin (topical medication) or taken by mouth (oral medication). It can take many months or years for acne to clear up completely.

TOPICAL MEDICATIONS

Ø Benzoyl peroxide.

Ø keratolytics (salicylic acid)

Ø Retinoid - these are vitamin A derivative-tazarotene, tretinoin. It works by preventing plugging of the hair follicles.

Ø Antibiotics - These work by killing excess skin bacteria and reducing redness e.g. clindamycin; erythromycin

Ø Dapsone

ORAL MEDICATIONS

Ø Antibiotics - For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation.  Choices for treating acne include tetracyclines.

Ø Combined oral contraceptives - useful in treating acne in women and adolescent girls.

Ø Anti-androgen agent - spironolactone (Aldactone), cyproterone acetate may be considered for women and adolescent girls if oral antibiotics aren't helping.

Ø Isotretinoin - reserved for people with the most severe acne. Serious potential side effects include ulcerative colitis, risk of depression and suicide, and severe birth defects.

Other Therapies include

• Phototherapy (Light therapy).
• Chemical peel - This procedure uses repeated applications of a chemical solution, such as salicylic acid. .
• Extraction of whiteheads and blackheads - Dermatologist uses special tools to gently remove whiteheads and blackheads that haven't cleared up with topical medications. This can lead to scarring.
• Steroid injection. Nodular and cystic lesions can be treated by injecting a steroid drug directly into them.

TREATING ACNE SCARS

Procedures used to diminish scars left by acne include :

·       Soft tissue fillers.

·       Chemical peels.

·       Dermabrasion.

·       Laser resurfacing.

·       Light therapy.

·       Skin surgery - grafting

LIFESTYLE AND HOME REMEDIES

·         Wash problem areas with a gentle cleanser - Twice a day, use your hands to wash your face with a mild soap and warm water

• Use an oil-free moisturizer with sunscreen. For some people, the sun worsens acne.
• Avoid irritants - oily or greasy cosmetics, hairstyling products or acne concealers.
• Don't pick or squeeze blemishes.

·         Try products to dry excess oil and promote peeling – products containing benzoyl peroxide, sulfur, resorcinol or salicylic acid.

·          Keep your hair clean and off your face.

·         Also avoid resting your hands or objects, such as telephone receivers, on your face.

·         Tight clothing or hats also can pose a problem, especially if you're sweating. Sweat and oils can contribute to acne.

ALTERNATIVE MEDICINE

Some studies suggest that using the following supplements may help treat acne.

• Tea tree oil.
• Alpha hydroxyl acid.
• Azelaic acid.
• Bovine cartilage.
• Zinc. Zinc in lotions and creams may reduce acne breakouts.
• Green tea extract.
• Aloe vera gel.
• Brewer's yeast.

PREVENTION

• Wash acne-prone areas only twice a day. But too much washing can irritate the skin. Wash affected areas with a gentle cleanser and use oil-free, water-based skin care products.
• Use cream or gel to help dry excess oil - products containing benzoyl peroxide or salicylic acid.
• Avoid touching or picking at the problem areas. Doing so can trigger more acne.
• Shower after strenuous activities.
• Use non-oily makeup.
• Remove makeup before going to bed. Going to sleep with cosmetics on your skin can clog your pores.
• Wear loose fitting clothing.

-DR EMORINKEN KELVIN