Acne
Acne, a skin disease caused by changes in the sebaceous gland, is most common during adolescence, and sometimes continues into adulthood. Acne lesions are commonly referred to as pimples, spots, zits, or acne. The face and upper neck are the most commonly affected areas, but the chest, back and shoulders may have acne as well. For most people, acne diminishes over time and tends to disappear, or decrease significantly after reaching their early twenties. There is, however, no way to predict how long it will take to disappear entirely; some individuals continue to suffer well into their thirties, forties and beyond.
As the sebaceous glands enlarge and sebum production increases, skin pores become clogged, blockages in follicles develop and acne appears. Aside from scarring, main effects of acne are psychological, such as reduced self-esteem. Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall impact to individuals.
Possible Cause
The root cause of acne is not fully known. Several factors are known to be linked to acne:
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Family/Genetic history
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Hormonal activity
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Inflammation, skin irritation or scratching will activate inflammation
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Stress
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Hyperactive sebaceous glands
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Accumulation of dead skin cells
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Bacteria in the pores
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Use of anabolic steroids
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Use of medication containing lithium, barbiturates or androgens.
Diet
Although no scientific statistics indicates one way or another, many hold the belief that acne is influenced by dietary factors; so, it may benefit to pay attention to ones daily diet, and refrain from consuming such fare if particular foods are found to affect the severity of the acne. As consumption of high-glycemic foods should in any case be kept to a minimum for general health reasons, it is believed that a low glycemic diet can not only reduce weight but also improve acne. So, avoidance of "junk food" with its high fat and sugar content is also recommended.
Studies have shown that newly diagnosed acne patients tend to have lower levels of vitamin A circulating in their bloodstream than those who are acne free. In addition, people with severe acne also tend to have lower blood levels of vitamin E.
Hygiene
Acne is not caused by dirt, but a built-up of the skin’s oil blocking the passages of the pores. The blockage can cause inflammation and therefore leading to acne; so standard washing of the face could wash off old oil and help unblock the pores.
Available treatments
There are many products available for the treatment of acne. Generally speaking, a successful treatment program can take a period of approximately three months to improve and flatten out the acne. However, short bursts of cortisone can give very quick results, and other treatments can rapidly improve some active spots, but usually not all active spots.
Modes of improvement work in at least 4 different ways (with many of the best treatments providing multiple simultaneous effects):
A combination of treatments can greatly reduce the amount and severity of acne in many cases. Those treatments that are most effective tend to have greater potential for side effects and need a greater degree of monitoring, so a step-wise approach is often taken. Consult with a physician when deciding which treatments to use, especially when considering using any treatments in combination. There are a number of treatments that have been proven effective:
Topical bactericidals
Over the counter bactericidal products containing benzoyl peroxide may be used in mild to moderate acne. Many experienced a reduction in acne lesions after 6 weeks of continuous use. Benzoyl peroxide routinely causes dryness, local irritation and redness. A sensible regimen may include the daily use of low-concentration (2.5%) benzoyl peroxide preparations, combined with suitable non-comedogenic moisturisers to help avoid overdrying the skin.
Other antibacterials that have been used include triclosan, or chlorhexidine gluconate but these are often less effective, but also have fewer side-effects.
Topical antibiotics
Externally applied antibiotics such as erythromycin, clindamycin, stievamycin, or tetracycline kill the bacteria that are harbored in the blocked follicles. While topical use of antibiotics is equally as effective as oral use, this method avoids possible side effects including upset stomach and drug interactions (e.g. it will not affect use of the oral contraceptive pill), but may prove awkward to apply over larger areas than just the face alone.
Oral antibiotics
Oral antibiotics used to treat acne include erythromycin or one of the tetracycline antibiotics (tetracycline, the better absorbed oxytetracycline, or one of the once daily doxycycline, minocycline, or lymecycline). However, reducing the P.acnes bacteria will not, in itself, do anything to reduce the oil secretion and abnormal cell behavior that is the initial cause of the blocked follicles.
Topical retinoids
Topical retinoids are a group of medications for normalizing the follicle cell lifecycle. They are tretinoin (brand name Retin-A), adapalene, and tazarotene. They are administered as topicals, appear to influence the cell creation and death lifecycle of cells in the follicle lining which helps prevent the hyperkeratinization of these cells that can create a blockage. But the process may cause irritation of the skin. Retinol, a form of vitamin A, has similar but milder effects and is used in many over-the-counter moisturizers and other topical products. Effective topical retinoids have been in use over 30 years but are available only on prescription so are not as widely used as the other topical treatments. Topical retinoids often cause an initial flare up of acne and facial flushing.
Oral retinoids
A daily oral intake of vitamin A derivative isotretinoin (marketed as Accutane, Amnesteem, Sotret, Claravis, Clarus) over a period of 4-6 months can cause long-term resolution or reduction of acne. Isotretinoin has been shown to be very effective in treating severe acne and can either improve or clear well over 80% of patients. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects (many of which can be severe). The most common side effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa).
Phototherapy
'Blue' and red light
Visible light has been successfully employed to treat acne (phototherapy) - in particular intense violet light (405-420nm) generated by purpose-built fluorescent lighting, or lasers. Used twice weekly, this has been shown to reduce the number of acne lesions by about 64%; and is even more effective when applied daily.
Photodynamic therapy
Intense blue/violet light (405-425 nanometer) can decrease the number of inflammatory acne lesion by 60-70% in 4 weeks of therapy, particularly when the P. acnes is pretreated with delta-aminolevulinic acid (ALA), which increases the production of porphyrins.
Laser treatment
Laser surgery has been in use for some time to reduce the scars left behind by acne, but research has been done on lasers for prevention of acne formation itself. The laser is used to produce one of the following effects:
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to burn away the follicle sac from which the hair grows
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to burn away the sebaceous gland which produces the oil
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to induce formation of oxygen in the bacteria, killing them
In the , the FDA has approved a selected number of cosmetic lasers for the treatment of acne.
Less widely used treatments
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Azelaic acid (brand names Azelex, Finevin and Skinoren) is suitable for mild, comedonal acne.
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Heat: local heating may be used to kill the bacteria in a developing pimple and so speed healing.
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Naproxen or ibuprofen are used for some moderate acne for their anti-inflammatory effect.
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Nicotinamide, (Vitamin B3) used topically in the form of a gel, its anti-inflammatory nature benefit in treating acne. It is also purported to result in increased synthesis of collagen.
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Tea tree oil (melaleuca oil) dissolved in a carrier (5% strength) kills P. acnes, and has been shown to be an effective anti-inflammatory in skin infections.
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Rofecoxib was shown to improve premenstrual acne.
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Zinc: Orally administered zinc gluconate has been shown to be effective in the treatment of inflammatory acne.
