Acne is a disorder resulting from the action of hormones and other substances on the skin's oil glands (sebaceous glands) and hair follicles. These factors lead to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest and shoulders. Although acne is usually not a serious health threat, it can be a source of significant emotional distress. Severe acne can lead to permanent scarring.
How does acne develop?
Doctors describe acne is a disease of pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, which contains a fine hair (see diagram "normal pilosebaceous unit"). These units are most numerous on the face, upper back and chest. The sebaceous glands are an oily substance called sebum which normally empty on the surface of the skin through the follicle opening, commonly called a pore. Cells called keratinocytes line the follicle.
How does acne develop?
Doctors describe acne is a disease of pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, which contains a fine hair (see diagram "normal pilosebaceous unit"). These units are most numerous on the face, upper back and chest. The sebaceous glands are an oily substance called sebum which normally empty on the surface of the skin through the follicle opening, commonly called a pore. Cells called keratinocytes line the follicle.
The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The stopper prevents the sebum reach the skin surface through a pore. The mixture of oil and cells allows Propionibacterium acnes (P. acnes) bacteria that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs. Swelling, redness, heat and pain) When the wall of the plugged follicle
breaks down, it spills everything into the skin, sebum Nearby, a shed skin cells and bacteria resulting in lesions or pimples.
Acne sufferers often have a variety of lesions, some of which are presented in the diagrams below. The basic acne lesion, called the comedo (KOM-e-do), is simply an enlarged and plugged hair follicle Europe. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that
Acne sufferers often have a variety of lesions, some of which are presented in the diagrams below. The basic acne lesion, called the comedo (KOM-e-do), is simply an enlarged and plugged hair follicle Europe. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that
reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the surface of the skin. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.
Other troublesome acne lesions can develop, including the following:
- Papules. Inflammatory lesions that usually appear as small pink bumps on the skin and can be sensitive to touch
- Pustules (pimples). Papules topped by pus-filled white or yellow lesions that may be red at the base
- Nodules. Large and painful, solid lesions that are lodged deep within the skin
- Cysts. Deep lesions, painful, pus-filled, which can cause scarring.
What Causes Acne?
The exact cause of acne is unknown, but doctors believe it results from several related factors. An important factor is the increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.
Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from their parents. For example, studies have shown that many school-age boys with acne have a family history of the disease. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.
The exact cause of acne is unknown, but doctors believe it results from several related factors. An important factor is the increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.
Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from their parents. For example, studies have shown that many school-age boys with acne have a family history of the disease. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.
The factors that can aggravate acne
The factors that can cause an acne breakout include:
The factors that can cause an acne breakout include:
- Changing hormone levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts
- Oil from skin products (lubricants or cosmetics) or grease encountered in the work environment (eg, a kitchen with tanks FRY)
- Pressure from sports helmets or equipment, backpacks, tight collars, or tight sports uniforms
- Environmental irritants, such as pollution and high humidity
- Squeezing or picking at blemishes
- Washing the skin disk
- Stress.
Myths about the causes of acne
There are many myths about the causes of acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on the development and evolution of acne in most people. Another common myth is that dirty skin causes acne, but blackheads and other acne lesions are not caused by dirt. Stress does not cause acne, but research suggests that for people who have acne, stress can worsen the situation.
There are many myths about the causes of acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on the development and evolution of acne in most people. Another common myth is that dirty skin causes acne, but blackheads and other acne lesions are not caused by dirt. Stress does not cause acne, but research suggests that for people who have acne, stress can worsen the situation.
Who gets acne?
People of all races and ages get acne. It is more common in adolescents and young adults. An estimated 80 percent of people between the ages of 11 and 30 have acne outbreaks at some point. For most people, acne tends to disappear when they reach their thirties, but some people in their forties and fifties continue to have this skin problem.
People of all races and ages get acne. It is more common in adolescents and young adults. An estimated 80 percent of people between the ages of 11 and 30 have acne outbreaks at some point. For most people, acne tends to disappear when they reach their thirties, but some people in their forties and fifties continue to have this skin problem.
How is acne treated?
Acne is often treated by dermatologists (specializing in skin problems doctors). These doctors treat all kinds of acne, particularly severe cases. The doctors who are practitioners, pediatricians or general internists or family can treat patients with mild cases of acne.
The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. treatment1 drugs aimed at reducing several problems that play a role in causing acne:
Acne is often treated by dermatologists (specializing in skin problems doctors). These doctors treat all kinds of acne, particularly severe cases. The doctors who are practitioners, pediatricians or general internists or family can treat patients with mild cases of acne.
The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. treatment1 drugs aimed at reducing several problems that play a role in causing acne:
- agglutination of abnormal cells in the follicles
- increase the production of oil
- bacteria
- inflammation.
1 All medicines can have side effects. Some medicines and side effects are mentioned in this brochure. Some side effects may be more severe than others. You must refer to the manual that accompanies the medication and ask your health care provider or pharmacist if you have questions about possible side effects.
Depending on the extent of the problem, the doctor may recommend one of several over-the-counter medications and / or drugs (OTC). Some of these medicines may be topical (applied to the skin), and others may be oral (by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medications.
Treatment of blackheads, whiteheads and mild inflammatory acne
Doctors usually recommend an OTC or prescription topical medicine for people with mild signs of acne. Topical medication is applied directly to the acne lesions or to the entire area of affected skin.
There are several OTC topical medicines used for mild acne. Each works a little differently. Following are the most common:
Depending on the extent of the problem, the doctor may recommend one of several over-the-counter medications and / or drugs (OTC). Some of these medicines may be topical (applied to the skin), and others may be oral (by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medications.
Treatment of blackheads, whiteheads and mild inflammatory acne
Doctors usually recommend an OTC or prescription topical medicine for people with mild signs of acne. Topical medication is applied directly to the acne lesions or to the entire area of affected skin.
There are several OTC topical medicines used for mild acne. Each works a little differently. Following are the most common:
- Benzoyl peroxide-destroying P. acnes, and may also reduce oil production
- Resorcinol-can help break the black and white points
- Salicylic acid helps break down blackheads and whiteheads. Also reduces the shedding of cells lining the hair follicles
- Sulfur helps to break down blackheads and whiteheads.
Topical OTC medicines are available in many forms, such as gels, lotions, creams, soaps, or pads. In some people, OTC acne medicines may cause side effects such as skin irritation, burning, redness, or often get better or go away with continued use of the drug. If you experience severe or prolonged side effects, you should tell your doctor.
OTC topical medicines are somewhat effective in treating acne when used regularly, but it can take up to 8 weeks before you see a noticeable improvement.
OTC topical medicines are somewhat effective in treating acne when used regularly, but it can take up to 8 weeks before you see a noticeable improvement.
The treatment of moderate to severe inflammatory acne
People with moderate to severe inflammatory acne can be treated with topical or oral prescription drugs, alone or in combination.
People with moderate to severe inflammatory acne can be treated with topical or oral prescription drugs, alone or in combination.
Prescription Topical Medicines
Several types of prescription topical medicines are used to treat acne. They include:
- Antibiotics help stop or slow the growth of bacteria and reduce inflammation
- Vitamin A derivatives (retinoids), unplug existing comedones (plural of comedo), allowing other topical medications, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A. Some examples are tretinoin, adapalene and tazarotene
- Others may destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength Benzoyl peroxide, sodium sulfacetamide / sulfur products or azelaic acid.
As topical prescription drugs, topical prescription drugs come as creams, lotions, solutions, gels or pads. Your doctor will examine your skin type when prescribing a product. Creams and lotions provide moisture and tend to be good choices for people with sensitive skin. If you have very oily skin or live in a hot and humid climate, you may prefer a gel or a solution containing alcohol, which tends to dry the skin. Your doctor will tell you how to apply the medicine and how often to use.
For some people, prescription topical medicines cause adverse side effects, including tingling, burning, redness, peeling, scaling, or discoloration of the skin. With some medicines, such as tretinoin, these side effects diminish or disappear after the medication is used for a period of time generally. If side effects are severe or do not go away, tell your doctor.
As for prescription drugs, the benefits of topical prescription drugs are not immediate. Your skin may look worse before it gets better. It may take 4 to 8 weeks to see an improvement.
For some people, prescription topical medicines cause adverse side effects, including tingling, burning, redness, peeling, scaling, or discoloration of the skin. With some medicines, such as tretinoin, these side effects diminish or disappear after the medication is used for a period of time generally. If side effects are severe or do not go away, tell your doctor.
As for prescription drugs, the benefits of topical prescription drugs are not immediate. Your skin may look worse before it gets better. It may take 4 to 8 weeks to see an improvement.
Prescription Oral Medicines
For patients with moderate to severe acne, doctors often prescribe oral antibiotics. Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reduce inflammation. Oral and topical prescription drugs can be combined. Antibiotics commonly used to treat acne are tetracycline, minocycline and doxycycline.
Other oral medicines less commonly used are clindamycin, erythromycin, or sulfonamides. Some people taking these antibiotics have side effects such as upset stomach, dizziness or lightheadedness, changes in skin color, and increased tendency to sunburn pain. Because tetracyclines may affect tooth and bone formation in fetuses and young children, these drugs are not given to pregnant women or children under 14 years. There is some concern, but it has not been proven, that tetracycline and minocycline may decrease the effectiveness of birth control pills. Therefore, a backup or another form of birth control may be needed. Prolonged treatment with oral antibiotics may be needed to achieve the desired results.
Other oral medicines less commonly used are clindamycin, erythromycin, or sulfonamides. Some people taking these antibiotics have side effects such as upset stomach, dizziness or lightheadedness, changes in skin color, and increased tendency to sunburn pain. Because tetracyclines may affect tooth and bone formation in fetuses and young children, these drugs are not given to pregnant women or children under 14 years. There is some concern, but it has not been proven, that tetracycline and minocycline may decrease the effectiveness of birth control pills. Therefore, a backup or another form of birth control may be needed. Prolonged treatment with oral antibiotics may be needed to achieve the desired results.
The treatment of severe cystic or nodular acne
People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin, a retinoid (vitamin A derivative). Isotretinoin is one that is usually taken once or twice daily with food for 15 to 20 weeks oral medication. It dramatically reduces the size of the sebaceous glands so that much less oil is produced. As a result, the growth of bacteria is reduced.
People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin, a retinoid (vitamin A derivative). Isotretinoin is one that is usually taken once or twice daily with food for 15 to 20 weeks oral medication. It dramatically reduces the size of the sebaceous glands so that much less oil is produced. As a result, the growth of bacteria is reduced.
Advantages of isotretinoin
Isotretinoin is a very effective drug that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely disappears in most patients. In patients with acne recurs after a course of isotretinoin, the doctor may take another course of the same treatment or prescribe other medicines.
Isotretinoin is a very effective drug that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely disappears in most patients. In patients with acne recurs after a course of isotretinoin, the doctor may take another course of the same treatment or prescribe other medicines.
Disadvantages of isotretinoin
Isotretinoin can cause birth defects in the fetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while you are taking this medicine. Women must use two separate effective forms of birth control together for 1 month before starting treatment, throughout the duration of treatment and for 1 full month after stopping the drug. You should ask your doctor when it is safe to get pregnant after you stop taking isotretinoin.
Some people with acne become depressed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medicines like isotretinoin. There have been a number of suicides and suicide attempts in people taking isotretinoin, but the link between isotretinoin and suicide or depression is not known. However, if you or someone you know is feeling particularly sad or has other symptoms of depression, such as loss of appetite, loss of interest in activities once enjoyed, or difficulty concentrating, it is important to consult your doctor.
Other possible side effects of isotretinoin include:
Isotretinoin can cause birth defects in the fetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while you are taking this medicine. Women must use two separate effective forms of birth control together for 1 month before starting treatment, throughout the duration of treatment and for 1 full month after stopping the drug. You should ask your doctor when it is safe to get pregnant after you stop taking isotretinoin.
Some people with acne become depressed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medicines like isotretinoin. There have been a number of suicides and suicide attempts in people taking isotretinoin, but the link between isotretinoin and suicide or depression is not known. However, if you or someone you know is feeling particularly sad or has other symptoms of depression, such as loss of appetite, loss of interest in activities once enjoyed, or difficulty concentrating, it is important to consult your doctor.
Other possible side effects of isotretinoin include:
- dry eyes, mouth, lips, nose or skin (very common)
- itching
- nosebleeds
- muscle aches
- sensitivity to the sun
- poor night vision
- changes in the blood, such as increased blood fats (triglycerides and cholesterol)
- change the function of the liver.
To be able to determine if isotretinoin should be discontinued if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. The side effects usually disappear after cessation of treatment.
Treatment for hormonal acne in women Influenced
In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be particularly true hirsutism (excessive hair growth on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens.
The doctor may prescribe one of several drugs to treat women with this type of acne:
In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be particularly true hirsutism (excessive hair growth on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens.
The doctor may prescribe one of several drugs to treat women with this type of acne:
- Pills birth control help suppress the androgen produced by the ovaries
- Low-dose corticosteroids, such as prednisone or dexamethasone to help suppress the androgen produced by the adrenal glands
- Anti-androgens such as spironolactone to reduce excessive oil production.
The side effects of anti-androgen drugs may include irregular menstruation, breast tenderness, headache and fatigue.
Other treatments for acne
Doctors may use other types of procedures in addition to drug therapy to treat patients with acne. For example, the doctor may remove the patient's comedones during office visits. Sometimes the doctor will inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules.
Early treatment is the best way to prevent acne scars. Once healing has occurred, the doctor may suggest a medical or surgical procedure to help reduce scarring. A surface laser can be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of "sanding" scars, is sometimes used. Another treatment option for deep scars caused by cystic acne is the transfer of fat from another part of the body to the scar. A doctor may also inject a synthetic filling material under the scar to improve its appearance.
Doctors may use other types of procedures in addition to drug therapy to treat patients with acne. For example, the doctor may remove the patient's comedones during office visits. Sometimes the doctor will inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules.
Early treatment is the best way to prevent acne scars. Once healing has occurred, the doctor may suggest a medical or surgical procedure to help reduce scarring. A surface laser can be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of "sanding" scars, is sometimes used. Another treatment option for deep scars caused by cystic acne is the transfer of fat from another part of the body to the scar. A doctor may also inject a synthetic filling material under the scar to improve its appearance.
How should people with acne care for the skin?
Gently clean the skin
If you have acne, you should wash your face gently with a mild cleanser, once in the morning and once in the evening, and after intense exercise. Wash your face in the jaw to the hairline and be sure to rinse your skin.
Ask your doctor or another health professional for advice on the best type of cleanser to use.
To use strong soaps or rough scrub pads is not helpful and may even exacerbate the problem. Astringents are not recommended unless the skin is very oily, and then they must be used only on oily spots.
It is also important to shampoo your hair regularly. If you have oily hair, you can wash it every day.
If you have acne, you should wash your face gently with a mild cleanser, once in the morning and once in the evening, and after intense exercise. Wash your face in the jaw to the hairline and be sure to rinse your skin.
Ask your doctor or another health professional for advice on the best type of cleanser to use.
To use strong soaps or rough scrub pads is not helpful and may even exacerbate the problem. Astringents are not recommended unless the skin is very oily, and then they must be used only on oily spots.
It is also important to shampoo your hair regularly. If you have oily hair, you can wash it every day.
Avoid frequent handling of the skin
Avoid rubbing and touching skin lesions. Squeezing, pinching or picking blemishes can lead to the development of scars or dark spots.
Shave carefully
Men who shave and who have acne should test both electrical and safety razors to see which is more comfortable. When using a safety razor, make sure the blade is sharp and soften your beard thoroughly with soap and water before applying shaving cream. Shave gently and only when necessary to reduce the risk of nicking blemishes.
Avoid rubbing and touching skin lesions. Squeezing, pinching or picking blemishes can lead to the development of scars or dark spots.
Shave carefully
Men who shave and who have acne should test both electrical and safety razors to see which is more comfortable. When using a safety razor, make sure the blade is sharp and soften your beard thoroughly with soap and water before applying shaving cream. Shave gently and only when necessary to reduce the risk of nicking blemishes.
Avoid sunburn to tan
Most drugs used to treat acne can make you more prone to sunburn. A sunburn that reddens the skin to tan, which darkens the skin may make blemishes less visible and make the skin feel dry. However, these benefits are only temporary, and there are known to excessive sun exposure risks, such as the aging of the skin faster and risk of developing skin cancer.
Most drugs used to treat acne can make you more prone to sunburn. A sunburn that reddens the skin to tan, which darkens the skin may make blemishes less visible and make the skin feel dry. However, these benefits are only temporary, and there are known to excessive sun exposure risks, such as the aging of the skin faster and risk of developing skin cancer.
Choose carefully Cosmetics
While undergoing acne treatment, you may need to change some of the cosmetics you use. All cosmetics such as foundation, blush, eye shadow, lubricants and hair care products should be oil free. Choose products labeled noncomedogenic (meaning they do not promote the formation of closed pores). In some people, however, even these products may make acne worse.
During the first weeks of treatment, applying foundation evenly may be difficult because the skin may be red or scaly, particularly with the use of topical tretinoin or benzoyl peroxide.
While undergoing acne treatment, you may need to change some of the cosmetics you use. All cosmetics such as foundation, blush, eye shadow, lubricants and hair care products should be oil free. Choose products labeled noncomedogenic (meaning they do not promote the formation of closed pores). In some people, however, even these products may make acne worse.
During the first weeks of treatment, applying foundation evenly may be difficult because the skin may be red or scaly, particularly with the use of topical tretinoin or benzoyl peroxide.
Highlights of the research
Medical researchers are working on new drugs to treat acne antibiotics, particularly relevant to replace some of those in current use. Like many other types of bacterial infections, doctors are finding that, over time, the bacteria associated with acne are becoming resistant to treatment with certain antibiotics, but it is not clear how an important problem this resistance is.
Scientists are also trying to better understand the mechanisms involved in acne so that they can develop new treatments that work on those mechanisms. For example, a group of NIAMS supported researchers is studying the mechanisms that regulate the development of sebaceous glands. Another group trying to understand how P. acnes activates the immune system to identify possible immunologic interventions. Other areas of research include examining the effects of isotretinoin (a potent drug against acne) on the sebaceous glands. In addition, a new drug called isoprenylcysteine is currently being evaluated for the treatment of P. acnes-induced inflammation and the overproduction of sebum.
Medical researchers are working on new drugs to treat acne antibiotics, particularly relevant to replace some of those in current use. Like many other types of bacterial infections, doctors are finding that, over time, the bacteria associated with acne are becoming resistant to treatment with certain antibiotics, but it is not clear how an important problem this resistance is.
Scientists are also trying to better understand the mechanisms involved in acne so that they can develop new treatments that work on those mechanisms. For example, a group of NIAMS supported researchers is studying the mechanisms that regulate the development of sebaceous glands. Another group trying to understand how P. acnes activates the immune system to identify possible immunologic interventions. Other areas of research include examining the effects of isotretinoin (a potent drug against acne) on the sebaceous glands. In addition, a new drug called isoprenylcysteine is currently being evaluated for the treatment of P. acnes-induced inflammation and the overproduction of sebum.
Source Article: http://www.niams.nih.gov/Health_Info/Acne/
No comments:
Post a Comment