ACNE VULGARIS
Acne vulgaris is a common skin problem involving blockage and/or inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). Acne can present as noninflammatory lesions, inflammatory lesions, or a mixture of both, affecting mostly the face but also the back and chest.
SYMPTOMS
Acne signs and symptoms vary depending on the severity of your condition:
•Whiteheads (closed plugged pores)
•Blackheads (open plugged pores)
•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)
CAUSES
Four main factors cause acne:
•Excess oil production
•Hair follicles clogged by oil and dead skin cells
•Bacteria
•Excess activity of a type of hormone (androgens)
Factors that can trigger or aggravate acne:
•Hormones
Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
•Certain medications
Examples include drugs containing corticosteroids, testosterone or lithium.
•Diet
Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods such as bread, bagels and chips may worsen acne. Chocolate has long been suspected of making acne worse.
•Stress
Stress can make acne worse.
TREATMENT
Mild acne can be treated with over-the-counter (OTC) medications, such as gels, soaps, pads, creams, and lotions, that are applied to the skin. Creams and lotions are best for sensitive skin. Alcohol-based gels dry the skin and are better for oily skin.
OTC acne remedies may contain the following active ingredients:
•Resorcinol: helps break down blackheads and whiteheads
•Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and slows the production of sebum
•Salicylic acid: assists the breakdown of blackheads and whiteheads and helps reduce inflammation and swelling
•Sulfur: exactly how this works is unknown
Retin-A: helps unblock pores through cell turnover
•Azelaic acid: strengthens cells that line the follicles, stops sebum eruptions, and reduces bacterial growth. There is cream for acne, but other forms are used for rosacea.
Treating moderate to severe acne
A skin specialist, or dermatologist, can treat more severe cases.
They may prescribe a gel or cream similar to OTC medications but stronger, or an oral or topical antibiotic.
•Corticosteroid injection - If an acne cyst becomes severely inflamed, it may rupture. This can lead to scarring. A specialist may treat an inflamed cyst by injecting a diluted corticosteroid. This can help prevent scarring, reduce inflammation, and speed up healing. The cyst will break down within a few days.
•Oral antibiotics - May be prescribed for up to 6 months for patients with moderate to severe acne. These aim to lower the population of P. Acnes. The dosage will start high and reduce as the acne clears. P. acnes can become resistant to the antibiotic in time, and another antibiotic is needed. Acne is more likely to become resistant to topical rather than oral antibiotics. Antibiotics can combat the growth of bacteria and reduce inflammation. Erythromycin and tetracycline are commonly prescribed for acne.
•Oral contraceptives - Can help control acne in women by suppressing the overactive gland. They are commonly used as long-term acne treatments.
These may not be suitable for women who:
•have a blood-clotting disorder
•smoke
•have a history of migraines
•are over 35 years old
•It is important to check with a gynecologist first.
•Topical antimicrobials also aim to reduce P. acnes in patients with moderate to severe acne. Examples are clindamycin and sodium sulfacetamide. The dermatologist may prescribe a topical retinoid.
Topical retinoids are a derivative of vitamin A. They unclog the pores and prevent whiteheads and blackheads from developing.
Isotretinoin
This is a strong, oral retinoid, used for the treatment of severe cystic acne and severe acne that has not responded to other medications and treatments. It is a strictly controlled medication with potentially serious side effects. The patient must sign a consent form to say that they understand the risks. Adverse effects include dry skin, dry lips, nosebleeds, fetal abnormalities if used during pregnancy, and mood swings. Patients who take isotretinoin must avoid vitamin A supplements, as these could lead to vitamin A toxicity.
REFERENCES
IMAGE REFERENCES
1.https://www.empr.com/home/news/fda-approves-first-topical-minocycline-formulation-for-acne-vulgaris/
3.https://m.wikihow.com/Make-a-Salicylic-Acid-BHA-Serum?amp=1
