SIGNS AND SYMPTOMS OF ACNE

• Whiteheads
• Blackheads
• Pustules
• Cysts
• Redness around the skin eruptions
• Inflammation around the skin eruptions
• Crusting of skin eruptions
• Scarring of the skin

CAUSES OF ACNE

Culprit #1: Hormones

For the majority of acne sufferers, the trouble begins at puberty, when the body begins to produce hormones called androgens. These hormones cause the sebaceous glands to enlarge, causes more sebum production, which is a natural part of the body's development. In acne sufferers, however, the sebaceous glands are overstimulated by androgens, sometimes well into adulthood.

Culprit #2: Extra sebum

When the sebaceous gland is stimulated by androgens, it produces extra sebum. In its journey up the follicle toward the surface, the sebum mixes with common skin bacteria and dead skin cells that have been shed from the lining of the follicle. While this process is normal, the presence of extra sebum in the follicle increases the chances of clogging — and can cause acne.

Culprit #3: Bacteria

The bacterium Propionibacterium acnes, (P. acnes for short) is a regular resident of all skin types; it’s part of the skin’s natural sebum maintenance system. Once a follicle is plugged, the P. acnes bacteria multiply rapidly, and thus causing inflammation.

Culprit #4: Inflammation

When your body encounters unwanted bacteria, it sends an army of white blood cells to attack the intruders. This process is called the inflammatory response. This is what causes pimples to become red, swollen and painful. The inflammatory response is different for everyone, but studies have shown that it is especially strong in adult women.

Culprit#5: Narrowing of follicle

Lately scientists and doctors have been focusing on another common causes of acne. They have focused their attention on the narrowing of the hair follicle channel as a contributing factor to acne. The abnormal shedding of the cells that line the follicle, abnormal cell binding known as hyperkeratinization within the follicle, or water retention in the skin that causes the skin to swell and press the follicles shut, thus lead to formation of acne

Other causes include:

ACNE RISK FACTORS

Risk factors for Acne are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for Acne makes the chances of getting a condition higher but does not always lead to Acne. Also, the absence of any risk factors or having a protective factor does not necessarily guard you against getting Acne.About 80 percent of all teenagers develop acne,but this disease can also begin as late as the ages 25 or 30,particularly for women.

• Hormonal changes in your body can provoke or aggravate acne. Such changes are common in:Teenagers, both in boys and girls, Women and girls, two to seven days before their periods, Pregnant women, People using certain medications, including cortisone, Menstrual cycles and puberty can cause hyperactive sebaceous glands, which can cause acne
  

• Direct skin exposure to greasy or oily substances, or to certain cosmetics

• A family history of acne — if your parents had acne, you're likely to develop it too

• Stress can play a role in acne because of the increased output of hormones from the adrenal glands, (Note that stress does not cause acne, but stress may lead to an outbreak/flare)

• High humidity causing swelling of the skin

• Certain medications:Steroids ,lithium, barbiturates, androgens or halogens such as iodides, chlorides or bromides
  

• Environment is also one of the risk factor of developing acne. The people living in the humid areas are more often get severe type of acne which clogs the pores and produces more sebum and as a result acne is caused on the surface of the skin

• Cosmetics : Sometimes acne is caused by various cosmetic products which contain some harmful ingredients which can make the acne worse.The ingredients contain oleic acid, lauryl alcohol, petroleum, vegetable oils, butyl stearate etc. These ingredients are found in foundations, moisturizers and pomades.The U.S. National Women's Health Information Center :Wearing makeup
  

• Food/Diet : Foods such as nuts, cola, milk, cheese, fried foods have been implicated as triggers of acne vulgaris; however, the connections between nutrition and acne has not definitely been proven as they are rarely supported by good analytical, epidemiological or therapeutic studies .On the other hand, recurrent acne as noted by Niemeier et al (2006) may be a cutaneous sign of an underlying eating disorder
  

• Dermatologists seem to agree that something in milk and dairy products may be linked to teen-age acne

• Pressure from wearing headbands and chinstraps
  

• Nicotine : Smoking has also been named as a risk factor for acne vulgaris; however, conflicting data exists as to the link between smoking and acne. Some population based studies have found links between smoking and acne whilst some others have not
  

• Sometimes wearing helmets and sporting equipments can be the cause of acne though they may be worn for safety reasons. As a result, oil is collected on the helmets, headbands and chinstraps and leads to acne. Therefore, these items should be thoroughly cleaned and rinsed after wearing them. The U.S. National Women's Health Information Center:Irritation to the skin caused by friction from hats, helmets or backpacks
  

• Petroleum oils : People working in fast food restaurants and those who are exposed to motor oil regularly can have more risk of having acne. This is caused because the oil or grease which are produced in the air cause skin diseases like acne and make the skin irritated.
  

ACNE TREATMENT

• No treatment will completely cure your acne
• The goals of acne therapy include controlling acne lesions, preventing scarring, and minimizing morbidity maximize effectiveness as well as help to prevent scarring
• Resolution takes time, it often takes 6 to 8 weeks for acne to improve after you start treatment. Some treatments may cause acne to get worse before it gets better
• What works for one person may not work for another,many factors affect resolution, including the causes of the acne, skin type and the kind of acne lesions present
• A dermatologist's help maybe required
• Topical cream-acne antibiotics, benzoyl peroxide
  
• If your acne still hasn't improved after several tries with other treatment, doctor may recommend that you take an oral retinoid or vitamin A, such as isotretinoin(Accutane). Doctors prescribe this medication as a last resort, because it has some rare but serious side effects and is expensive
• Acne hormone therapy, certain low-dose birth control pills may help control acne i women who tend to have flare-ups before menstruation
  

Acne Home Treatment

• Keep spot-prone areas clean
• Wash the affected area twice a day with an perfumed free cleanser
• Avoid aggressive washing with strong soaps
• Reduce intake of fatty and spicy food
• drink plenty of water

Natural Acne Treatment

• Licorice root extract-possess anti inflammatory properties and be able to clear up skin issues such as acne
• Green tea extract-produce skin clearing results without creating any further irritation to skin
• Aloe Vera extract-contain anti inflammatory agents and aid in reducing the appearance of scars related to blemish breakouts
• Tea tree oil
• olive leaf extract

ACNE RESEARCH

• Family History of acne

According to the dermatologist, sometimes pattern, severity, type and duration of acne which the person experience depend on the experiences of the parents. So, it is very difficult for the dermatologist to determine the type of acne which the person will develop. Sometimes acne is linked to the heredity but it has not been proved till now that genetic factor is the cause of acne. However, it is impossible to predict which type you will develop. While studies have been highly suggestive of a hereditary link for acne, no "acne gene" has been discovered yet.

The U.S. National Women's Health Information Center:
- A family history of acne

A genetic background is supported by a case control study by Goulden et al, as noted by Rzany et al (2006):

This stated that the risk of adult acne vulgaris in relatives of patients with acne as compared with those of patients without acne is significantly higher

• Medications

The U.S> National Women's Health information Center:

Some medications, including some used for epilepsy and depression causes acne

• Iodine

University at Buffelo dermatologist Harvey Arbesman, M.D.:says there could be something else:iodine

Myth #1 : Popping pimples is the best way to get rid of them

Fact : Popping pimples may aggravate acne by spreading the bacteria which is causing it. Popping can also lead to scarring which in severe cases can be permanent.

Myth #2 : Makeup causes acne

Fact: Some makeup can clog the pores which is bad for the health of the skin. Cosmetics labeled "non-comedogenic“ or "non-acnegenic" are safe to use and some brands may include ingredients which can treat acne.

Myth #3 : The more acne medicine the better

Fact: Some people believe that if their acne gets worse, they should use more medicine. However, excess use of acne ointments, may actually irritate the skin. Always follow the directions for the acne medications.

Myth #4: The more you wash your face, the fewer breakouts you'll have

Fact: Hygiene isn't related to the development of acne, either. Washing the face each day gets rid of dead skin cells, excess oil, and surface dirt, but too much cleansing or washing too vigorously can lead to dryness and irritation, which can actually make acne worse. Dermatologists usually recommend gently washing ; not scrubbing or rubbing and washing the face no more than twice a day with a mild cleanser and patting the skin dry.

Myth #5: Stress causes acne

Fact: Stress may have an effect on hormones and theoretically can promote acne. However, the ordinary stress of day-to-day living is not an important factor in acne. Severe stress that needs medical attention is sometimes treated with drugs that can cause acne as a side effect.

Myth #c6: Sunbathing is good for acne

Fact: Exposure to the sun has the effect of drying out excess oils, so it does in fact have a short-term effect of improving acne. However, the skin quickly becomes accustomed to sun exposure so no long-term benefit is gained. Sun exposure may also damage the skin and increase the chance of skin cancer. Sunbathing dries your skin, causing your sebaceous glands to produce more sebum (oil exuded from the pores) and thus make the acne worse.

Myth #7: If the pimples do not clear up in a day or two, the medication is not working

Fact: Be patient. Healing acne takes time. It is important to be realistic when you are trying to find a successful acne treatment. Don't be tempted by overnight promises, you want to look for the best treatment.

Simple whiteheads or blackheads can be cleared up in days or weeks. More serious lesions may take longer to heal.

Myth #8 : Acne appears only on the face

Fact: Acne can occur on many parts of the body. It is common for people to have acne on their back, chest and neck. These areas of the body have a high concentration of oil glands just as the face does. Body acne can be treated just as successfully as facial acne.

Myth #9 :Acne is a problem only for teenagers

Fact: It is true that most teenagers have acne and that many cases will clear up during a person's early 20s. Sometimes, however, acne can persist into the 30s and 40s.

Myth #10: Acne is caused by too much sex

Fact: It’s true that androgens, the hormones all of us begin producing during puberty, are one of acne’s main contributing factors. While these and other hormones may initiate sex drive, your sexual habits have no effect on acne.

Myth #11: Acne is caused by the foods you eat

Fact: This myth has been around for a long time, but contains no truth. A considerable amount of research has been performed to determine if certain foods, for example, chocolate, pizza, and French fries, may cause acne or make it worse. Research has shown there is no connection between what you eat and the development of acne. If you still think that certain foods cause you to breakout then you can simply avoid those foods. Typically, if your acne is being treated appropriately, there is no need to worry about what foods you eat.

HOW DOES ACNE AFFECT US

Acne is a common skin disorder that can impact greatly for some people; it can be either a psychology or a social impact. Many people know that things such as poor hygiene, hormones, diet and family history causes acne. But not many know how personality and emotional traits affect acne, its impact and also its treatment.

An example would be trait anger. Patients should include attention to anger and other emotional states in their acne care. Acne is the most common skin disease which affects about 85% of people at some points of their lives. Those affected by acne are usually adolescents and young adults, however some can experience acne in later adult life. Patients with acne often get depressed and suffer low self-esteem.

Biopsychosocial models in dermatology looks at multifactorial nature of skin disease by examining environmental, interpersonal, psychological and biological factors in determining the disease severity and the impact of the condition on functioning and life quality. One important variable is personality. Clinical observations are made and found out that negative emotions such as anger can disturb the regulation of immune and endocrine function and can slow wound healing.

A study was also carried out, showing that a patient with severe acne had higher trait anger score than a patient with less severe acne. A better understanding of how stable emotional factors relate to skin diseases would be helpful in finding out the underlying mechanisms as well as identifying which patients require special attention. Individuals who frequently experience anger had poorer functional outcomes than individuals who seldom experience anger. Clinicians are encouraged to pay special attention to their patient’s negative emotions in order to validate their experiences and open opportunities for joint problem solving.

Thus, a convenient acronym(I VOTE) has been developed to guide the clinicians. Firstly, Inquire about how acne affects the patient’s life. Secondly, Validate their experience by acknowledging the importance of these impacts of acne on them. Thirdly, Offer to discuss ideas to reduce the negative impacts and finding additional resources to help further. Fourthly, Tell the patients that you are committed to help them with symptom management as well as the negative impacts caused by acne on them. Lastly, Evaluate the patient’s quality of life when monitoring the other outcomes such as severity, adherence and satisfaction with treatment.

In conclusion, acne care should include other factors such as personality and emotions. It affects a person’s quality of life, satisfaction and also one’s adherence to acne care.

Acne

Article title: Diagnosis and treatment of acne

Acne vulgaris (commonly called acne) is a skin disease caused by changes in the pilosebaceous units of the skin. The bacteria that caused acne is Propionibacterium acnes, which actually provoke an immune response .

Factors that caused acne included excessive sebum production and maybe triggered or worsened by factors such as mechanical obstruction for example: shirt collar ; occupational exposures and even medications. Cosmetics and topical corticosteroids can resulted in acne too. Acne occurred in areas with the greatest concentration of sebaceous glands like the face, neck, chest, upper arms and back.

Acne can be classified by the types, and even by the level of severity. Mild acne is characterized by presence of few to several papules and pustules, with no nodules while moderate acne is characterized by the presence of nodules. Severe acne consists of both papules, pustules and nodules.

There are several ways to treat acne for example:

Tropical agents whereby it is based on the severity and types of acne. For instances, those suffering from mild acne condition, topical retinoids, benzoyl peroxide and azelaic acid can be used. Antibiotics and medication containing bacteriostatic and inflammatory properties are effective for treating mild to moderate acne condition. Retinoids and retinoid analogs : Tretinion is a comedolytic agent that normalize desquamation of the epithelial lining, and thus prevent obstruction of the pilosebaceous outlet. Like Adapalene , it has direct anti-inflammatory properties. Tazarotene caused more irritation, burns and erythema compared to other retinoids and thus are considered only when tropical tretinoin of adapalence therapy is not effective.

Tropical antibiotics is another forms of treatment. They are used together with benzoyl peroxide with any degrees of inflammatory acne. The most common tropical antibiotic used are clindamycin and erythromycin. Benzoyl peroxide has stronger effect on papules than tretinion while weaker effect on comedones.

Systemic agents

Oral antibiotics is used when acne is resistant to tropical therapies and are the initial therapy for those with moderate to severe inflammation. It must be taken for six to eight weeks and given for six months to prevent development of it.First line antibiotics used included tetracycline and erythromycin but however, erythromycin is as the second line agent as the P. acne is increasing resistance to it. Doxycycline is also frequently used to treat moderate to severe acne problem. Minocycline is used when one’s is unable to tolerate or shows no responsed to other treatment.

Oral contraceptive pills ( OCPs ) has been prescribed and used to treat acne as it decrease the circulating androgens thus decrease sebum production. OCPs when used with oral antibiotics, seems to decrease the effectiveness of it. A review of pharmakinetic data showed a reduction of contraceptive steroid hormones only with the uses of rifampin.

Goals of acne therapy include controlling, preventing scarring and minimizing morbidity. Patient education is important as it helps to minimize lack of compliance, which is the most common cause of treatment failure. Dermatologist maybe referred if one’s do not have any respond to other treatment as gram negative folliculitis maybe suspected.

In summary, acne can caused negative physical, emotion and psychological impact on a person. Thus, it is important to educate patient about acne and the treatment available and to provide emotional support for him/ her. Acne is not a one day thing, u do not see the result instantly; it takes time to clear and heal, and patience is needed. Never hesitate to see a dermatologist when one’s think he / she needs it.