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Acne vulgaris (or simply acne or pimples)





By Dr. Aejaz Wani




What is acne vulgaris?


Acne vulgaris is 8th most common human disease globally affecting 650 million people, characterized by areas of seborrhea (increased oil-sebum secretion), comedones (blackheads and whiteheads), papules (pinheads), pustules, nodules (large papules), cysts (large nodules) and possibly scarring and pigmentation.

Pigmentation and scarring are usually the result of nodular or cystic acne (the painful 'bumps' lying under the skin). Pigmentation scars nearly always fade with time taking between three months to two years to do so, although they can last indefinitely if untreated. Scars are the result of inflammation within the dermis. Aside from scarring, its main effects are psychological, such as reduced self-esteem and in very extreme cases, depression or suicide.




What are the areas affected by acne?
Acne more often affects skin with a greater numbers of oil glands; these areas include the face, the upper part of the chest, neck, shoulders and the back. The skin changes are caused by changes in pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes that require androgen stimulation.






What is the age of involvement and role of hormones in acne?
Acne occurs most commonly during adolescence, affecting an estimated 80–90% of teenagers possibly by increase in androgens such as testosterone, which occurs during puberty, regardless of sex and cause the follicular glands to grow larger and make more sebum. Use of anabolic steroids may have a similar effect. Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I). Development of acne vulgaris in later years is uncommon. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy, or disorders such as polycystic ovary syndrome, conginental adrenal hyperplasia or Cushing's syndrome. Menopause-associated acne (known as acne climacterica) occurs as production of the natural anti-acne ovarian hormones estradiol and progesterone fall, permitting the acnegenic hormone testosterone to exert its effects unopposed.

For most people, acne diminishes over time and tends to disappear – or at the very least decreases – by age 25. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will carry this condition well into their thirties, forties, and beyond. It is slightly more common in females than males. However severe acne is more common in males and lasts longer. Post-adolescent acne (acne after age 25) has an incidence of 54% in women and 40% in men. In those over 40 years old, 1% of males and 5% of females still have problems.






What are causes of acne?
Underlying pathogenic mechanisms are not well known, but understanding is slowly emerging regarding the following:
Increased androgen production
Overactivity/hyperresponsiveness of sebaceous glands in response to androgens
Hyperkeratinization within the intrafollicular ducts
Colonization of the follicles with P acnes, an anaerobic bacterium species that is widely concluded to cause acne Inflammation, including innate and induced immune responses






What are other factors responsible for acne?
The genetics of acne susceptibility is likely polygenic, as the disease does not follow classic Mendelian inheritance pattern. Twin studies suggest that acne severity may be genetically determined. Earlier onset and greater severity is noted in patients with a family history of severe acne.





What can make acne worse?
1. Premenstrual and menstrual flare possibly related to increased hydration of pilosebaceous epithelium.
2. Hot and humid climate with increased sweating possibly by increased ductal hydration.
3. Oils (acneform oil folliculitis on trunk and limbs called chloracne) and oil based makeups - moisturizing creams, lubricating lotions, and all makeup that contain oil (Comedonal acne in perioral area of mature female).
4. Greasy hair - some hair products are very greasy and might have the same effect as oil based makeup.
5. Excessive cleansing (papulopustular acne in a patient who washes many times each day)
6. Psychological stress (Severe acne related to increased stress and anxiety).
7. Squeezing the pimples acne is more likely to get worse, plus risk of scarring.
8. High glycemic load diet, consumption of dairy products and less fish. One can still have chocolate. The problem isn't the cocoa itself, it's the sugar and dairy that's added. The higher the percentage of cocoa, the lower the glycemic index.
9. Friction or pressure on your skin caused by various items, such as telephones or cellphones, helmets, caps, tight collars, hairband, backpacks, tight cloths etc.
10. Drugs like corticosteroids, anabolic steroids, antitubercular drugs, Anticonvulsants, Puva therapy, Lithium, Halogens (chloracne), Vitamin B12.




Looking after your skin if you have acne or prone to acne

1. Wash your face about twice each day. Do not wash it more often. Use a mild soap made especially for people with acne, and warm water. Do not scrub the skin.
2. Don't go to sleep with makeup on. Only use makeup that is non comedogenic or non acnegenic - you should be able to read this on the label. You should use makeup which does not have oil and does not clog up the pores. Right makeup can actually improve acne. Powder-based mineral foundations with ingredients like silica, titanium dioxide, and zinc oxide absorb oils that would otherwise be clogging the pores.
3. Hair collects sebum and skin residue. Keep your hair clean and away from your face.
4. Keep your hands and glasses clean, wash them regularly. They will collect sebum and skin residue. Do not touch face with hands.
5. Use non comedogenic sunscreens. So look for the ingredient on your sunscreen label—no more SPF excuses.
6. Too much sun can cause your skin to produce more sebum. Several acne medications make it more likely that you will be sunburned.





(The author is consulting Dermatologist at District hospital Anantnag and Hadi Skin & laser Centre K P road Anantnag and can be mailed at [email protected])



(Opinions expressed in write-ups/articles/Letters are the sole responsibility of the authors and they may not represent the scoopnews.in)


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