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Acne - Health Information By Michael Semchism, BSc Pharm.
  Acne is a condition that affects areas of the skin that contain a large number of oil glands. This would include the nose, the forehead, cheeks, chin, back, and trunk. It is very common in adolescents and generally disappears by age 30. Males are more likely to get acne and tend to have more severe cases. In females acne seems to last longer. Acne is caused by a disorder of the oil glands that result in clogged pores and outbreaks of lesions known as pimples. Although it is not a serious health threat, severe acne can be painful and may cause permanent scarring. It can also make people miserable and cause social and psychological problems.
   
  Signs and Symptoms
 

There are various types of acne lesions:

Comedone – general term for an enlarged hair follicle plugged with oil and bacteria. This is the smallest type of lesion.

Open comedone (blackhead) – a plugged follicle that reaches the surface of the skin. Although dark in appearance, blackheads do not indicate the present of dirt.

Closed comedones (whitehead) – are clogged follicles that stay beneath the skin. Whiteheads usually appear on the skin as round, white bumps roughly 1 to 2 mm in diameter.

Papule - inflamed lesions that appear as small, pink bumps on the skin

Pustules (pimples) – inflamed pus-filled lesions that are red at the base

Cysts and nodules – large, inflamed, pus-filled lesions that are lodged deep and can drain, causing pain and scarring

In some cases acne can lead to scarring. Picking at or squeezing the pimples can often leave a pitted appearance that may or may not be permanent.

   
  Causes
  Acne is a disorder of the skin’s oil glands. It develops because the sebaceous glands are overactive. Oil glands make a substance called sebum that normally rises up through a hair-containing canal called a follicle and empties onto the skin surface. During adolescence , rising hormone levels are thought to increase the number of oil glands and the amount of sebum produced. This overproduction of sebum causes blockage of the hair follicle, leading to the formation of small bacteria filled cysts called comedones. If the comedones remain intact and don’t rupture, they progress to open comedones (whiteheads) or closed comedones (blackheads). When comedones rupture, and inflammatory reaction occurs and spreads into the surrounding tissues, the inflammatory lesions are papules, pustules, cysts, and nodules.
   
  Risk factors
 
  • Family history of acne
  • Greasy /oily cosmetics, or workplace environment
  • Hormonal changes associated with adolescence, pregnancy or menstruation (acne tends to flare up 2-7 days before menstruation begins)
  • High levels of humidity
  • Sweating and friction from items such as headbands , back packs, bicycle helmets

Note – There is no evidence that fatty foods, candies or chocolate either cause or aggravate acne.

   
 

Making the Diagnosis

  Acne has a characteristic appearance and is not difficult to diagnose. A Family physician can treat most patients with mild and moderate acne. People with severe cases of acne are referred to a dermatologist. Your doctor will take a complete medical history including questions about cosmetic use, any medications you may be on, or factors that trigger flare-ups, and your work environment. This is done to rule out the other possible skin conditions.
   
  Treatment Approach
  The main goals of acne treatment are to prevent scarring, reduce the number of lesions and prevent recurrence. Wash your face twice a day using a gentle, unscented soap, and pat dry. Creams and lotions containing benzoyl peroxide are widely available without a prescription. They are designed to wear away the top layer of skin (exfoliate) as well as to unplug the clogged pores. The skin improves over two weeks and the cream or lotion is used afterwards to maintain its effectiveness. Sunlight is helpful for many people. For some women, taking birth control pills can help regulate the hormones that cause acne flare-ups. For more severe acne, an antibiotic lotion or retinoic acid (a derivative of vitamin A) usually works. For inflamed acne, antibiotic pills may be given. If there is a risk of scarring, an oral retinol may be used - but they should be used with caution by women. It’s important to discuss benefits and risks of these drugs with your doctor. For deep acne scarring, collagen injections and laser resurfacing may be used.
   
  Controlling Acne
 
  • Don’t pick at pimples because this may worsen the condition and result in scarring.
  • Wash your face twice a day using a gentle soap.
  • Use a fresh washcloth every day.
  • Use an astringent such as alcohol after washing your face.
  • Use “noncomedogenic” cosmetics, which won’t cause acne.
  • Wash off sweat and oil as soon as possible.
  • Blackheads should be removed by your doctor.
  • Shampoo your hair at least twice a week.


 

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