diease

Acne


OVERVIEW OF Acne :

Acne occurs when the pore of the skin become clogged ,inflamed and sometimes infected.The clogged pores can result in blackheads ,whiteheads and pimples.

Acne starts in the skins sebaceous glands.These glands secrete an oily substance called sebum.The sebum  normally travels through a tiny hair follicle from the gland tot the skins surface.sometimes, the sebum becomes trapped mixing with dead skin cells and bacteria.This causes clogged pores called comedons which are blackheads that reaches the skin surfaces.whiteheads are comedones that stay beneath the surface.

The most common area for the occurrence of acne includes face, forehead, chest, shoulders and upper back.


EPIDEMIOLOGY :

It is estimated that 80%of people aged between 11-30 will have atleast a mild form of acne.It is more common among the people of puberty age.


ROUTES OF TRANSMISSION :

Using the inanimate objects such as towel, comb,kerchiefs and skin to skin contact of already acne prone patient might leads/provoke the disease.


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • Pimples
  • Large solid painful limps under the skin
  • Itchiness


DIAGNOSTIC :

  • It is based on the history and physical examination of the patient.
  • Common areas include the anatomical part which has higher concentration of sebaceous glands such as face, back,neck,chest,upper arms.
  • Visualization of the inflammation or pustules.


TREATMENT AND PROGNOSIS :

Medicines and antibiotics,Keratolytic soaps

Comedone extractor: a small pen shaped imstrument that is used to take away the blackheads and whiteheads.

Lasers -Ablative:this removes a small piece of skin for a smoother texture.

            -Non Ablative:this uses heat to stimulate collagen production and repairs the skin damage.

Chemical peels:chemical solution is used which aids in removing the old skin and replaces the new one.

Photodynamic therapy:light is applied to the skin to remove the acne

Carbon dioxide laser treatment:they are standard treatment option in acne removal.the advantage of carbon dioxide laser treatment is less tissue damage and less edema and shorter recovery time.

Microdermabrasion:Microdermabrasion is a noinvasive cosmetic procedure and involves the dermatologist removing the top layer of the skin and this procedure leads to exfoliation of the skin.

Intralesional injections of triamcinolone acetonide may be required for inflammed acne.Keloid scars responds well to intralesional injections.


PROGNOSIS :

The prognosis of most cases of the acne is excellent.The goal in all acne treament is the prevention of scarring.Non inflammatory acne heals without scarring but inflammatory acne leaves with scarring.Acne of any severity usually subsides with age group of mid 20 s.


PREVENTION :

  1. Prevention of the Wash twice a day and after sweatingPerspiration, especially when wearing a hat or helmet, can make acne worse, so wash your skin as soon as possible after sweating.

  2. Use your fingertips to apply a gentle, non-abrasive cleanserUsing a washcloth, mesh sponge, or anything else can irritate the skin.

  3. Be gentle with your skinUse gentle products, such as those that are alcohol-free. Do not use products that irritate your skin, which may include astringents, toners and exfoliants. Dry, red skin makes acne appear worse.

  4. Scrubbing your skin can make acne worseAvoid the temptation to scrub your skin.

  5. Rinse with lukewarm water

  6.  If you have oily hair, shampoo daily.

  7. Let your skin heal naturally.dont pick or squeeze your acne as it might leads to peeling of the skin and formation of the scars.

  8. Stay out from sun and tanning beds.

  9. Using tanning beds  increases the risk for melanoma the deadlist form of skin cancer by 75%.


Recovery Period :

The recovery of the acne depends upons the indivduals skin type and duration of the treatment.Minimum it takes 3-4 weeks for the pimples to subsides.Itchiness is the sign of healing.The red pustular skin needs to be replaced  with new healthy skin.


Medicines used in the Treatment :

Mild to moderate Acne:

Topical retinoids.If it doesn’t provide any relief the following can be used in the treatment:

Salicyclic acid(promotes desquamation)

Azelaic acid(antimicrobial, reduces hyperpigmentation)

Glycolic acic

Mild to moderate inflammatory acne:

Benzoyl peroxide and topical antibiotics.

Clindamycin, erythromycin, tetracyclin, metronidazole and azelaic acid.

Moderate to severe:

Oral isotretinoin:

Reduces sebaceous gland size or sebum production.monitors the cell proliferation and differentiation.

Adverse effects might occur.Teratogenicity bone marrow suppression and hepatotoxicity,Oral isotretinoin should be contraindicated in pregnancy.

Oral antibiotics used:

Tetracyclin,minocycline,doxycycline,erythromycin.

Treatment for severe acne:

Co cyprindiol:

It is an hormonal treatment that can be used for more severe acne that doensnt responds to the antibiotics and it helps to reduce the production of sebum.

Isotretinoin:

Helps to normalize the sebum and prevent the follicles from clogging.reduces the inflammatory reactions.

Tazarotene:

It is used to treat both psoriasis and acne.

Adapalene:

It has comedolytic, anti-inflammatory, and antiproliferative properties.

 


REFERENCE :

Davidson's principle and practice of Gereral medicine-22nd edition

Harison manual of general medicine

http://clevelandclinic.org.health

http://medicinenet.com

http://mayoclinic.org

www.medicalnewstoday.com

http://www.aad.org