ACNE VULGARIS
Acne is a big problem experienced especially at the time of puberty by some adolescents.Male children when they attained puberty the matured male sex organs starts to produce the acne cause male sex hormone known as Testosterone in various amounts depending on their genetic nature.However there are so many other factors can cause acne to get at any age.
Acne vulgaris is defined as a disorder of the pilosebaceous units mainly of the neck,back, and face.The pilosebaceous glands are the hair producing glands located in the skin throught our body except the palms of the hands and the soles of the feet.There are non hair producing sebaceous glands are also exits along side and equally distributed throughout our body similar to the pilosebaceous glands.
Due to some conditions such as excess production of testosteron or blocks at the sebum secretions these pilosebaceous units produce lesions,which starts open or closed comedones and evolve into inflammatory popules.These popules either resolve into macules or develop into pyoderma.
Fortunately acne vulgaris is self limiting and need no physician to treat and can be controlled by self medications available at OTC with some pharmacy councillings.But exceptions are there if the acne becomes a tumor by some mismedications like over use of benzoyl peroxides at high concentration.
Pathology
A.The incidence of acne involves three sequences
a.Excess sebum secretions due to some reasons like over stimulation of the glands by androgens at puberty in both male and female adolescents.
b. When testosterone is converted to dihydrotesterone which stimulates the sebum secretions.
c.Development and stimulation of sebum glands by DHT.
Normally the keratinized horney cells are sloughed off from the epithelial linings of the pilosebaceous duct in the hair follicle and are carried out to the surface of the skin as sebum.
But in case of over stimulation the horney cells fails to sloughed of and block the passage which leads to the formation of bumps at the surface of the skin.
Causative Bacterium: The presence Propionibacterium acne is significant in the sebum of those who are having acne which is not present in normal people.The reason is unknown as still it is hard to conclude that acne is from purely infectious origin as mostly it is not contageous.Yet the micro organism is contributing to the formation of acne by digesting sebum triglycerides and produces various irritating fatty acids which causes comedones and inflammations.
Stages of Acne
1.Blockade of the pilosebaceous duct by the horney epithelial keratinised cells to form comedon as white head either closed or opened
2.The closed comedon develops into either a popule as black head.The black colour is attributed either by melanin or oxidized lipid.
3.The lesion may enlarge and filled with pus and is know as a pustule.
4.In bad pathological conditions the papule may develop into more painfull cysts or nodules,with unknown causes.
5.The term pimple can be refered to whiteheads,blackheads,papules and pustules.
Clinically acnes are either symptomatic or asymptomatic.Cysts and nodules are usually painfull and can form scars and to be refered to a skin specialist.
Asymptomatic acnes can be treated on OTC with pharmacist's advices
Complicating Factors There are many drugs which are comedogenic and may make the acne to get worsen.They are,
1.Topical and systemic Bromides and Iodides
2.Topical coal tar products
3.Topical and systemic Androgens and Progestins
4.Phenytoin
5.Lithium
6.Topical and systemic corticosteroids
7.Stress
8.Oily and fatty diets and chocholates are not acne producing.
9.Physical trauma and irritations,this includes agressive scrubbing of face,wearing headphones,cradling the chin with the hand,and picking the pimples can contribute to worst sequences.Gentle face wash with mild soap is better
10.Some cosmetics are comedogenic such as lanolin,petrolatum jelly,cocoa butter and avoid them.
11.Some women can experience acne at premenstural cycle.
12.High humidity and sweating can contribute to the formation of acne.
Complicating Factors There are many drugs which are comedogenic and may make the acne to get worsen.They are,
1.Topical and systemic Bromides and Iodides
2.Topical coal tar products
3.Topical and systemic Androgens and Progestins
4.Phenytoin
5.Lithium
6.Topical and systemic corticosteroids
7.Stress
8.Oily and fatty diets and chocholates are not acne producing.
9.Physical trauma and irritations,this includes agressive scrubbing of face,wearing headphones,cradling the chin with the hand,and picking the pimples can contribute to worst sequences.Gentle face wash with mild soap is better
10.Some cosmetics are comedogenic such as lanolin,petrolatum jelly,cocoa butter and avoid them.
11.Some women can experience acne at premenstural cycle.
12.High humidity and sweating can contribute to the formation of acne.
Treatments
Generally most patients can be treated successfully with either topical or systemic medications or both.Acne often improves when the patients reaches early twenties.
Acne can be Mild to Moderate to Severe
In mild cases there are a few papules and pustules without any single cysts or nodules.Daily a gentle face wash with a mild soap is beneficial.Fatty and oily diets should be avoided.High humidity and sweating also to be avoided.Keep the stress at the bay.Chocholate and nuts can be used without any harm.
In moderate cases there are many papules and pustules with a few cysts and nodules.Treatment options include salicylic acid,sulphur and resorcinol approved by FDA.There are scruffs such as Clearacil Adultcare,Clearasil Clearstick and Benzoyl peroxide 5 and 10 can be used.But while using Benzoylperoxide take an advice from a doctor and be carefull that high usage of this madicine may cause skin cancer,but not yet to be concluded. Before apply the product should be tested for allergy as follows
Wash the area with a mild soap and dry it.apply a small quantity and leave it for 20 minutes.
1.Benzoyl peroxide is available as alcoholic gel,cream and lotion.The gel preparation is more effective
There is no much difference in clinical effect between the preparations 2.5 %,5 % and 10%
This product discolour hair and cloth.Beware of that.
Benzoyl peroxide is thrown from first to third category by the FDA on safety concerns
2.Salicylic acid The first category medicines available in 0.5% to 2%.This is an irritant keratolytic agent increase epithelial cell turnover and safer than B.P.
3.Sulphur The first category medicine available in strength as 3 % to 8 %.It is keratolytic and antibacterial.But sulphur on prolonged use may be acnegenic.
4.Resorcinol This medicine comes under second category as a single agent but jump into the first category when combined with sulphur in a proper proportion as the effect and safety are increased.
In severe cases there are numerous number of papules and pustules with many cysts and nodules.These cases should avoid self treatments and to be refered to a skin specialist as there is a need for antibiotic therapies.
Wash the area with a mild soap and dry it.apply a small quantity and leave it for 20 minutes.
1.Benzoyl peroxide is available as alcoholic gel,cream and lotion.The gel preparation is more effective
There is no much difference in clinical effect between the preparations 2.5 %,5 % and 10%
This product discolour hair and cloth.Beware of that.
Benzoyl peroxide is thrown from first to third category by the FDA on safety concerns
2.Salicylic acid The first category medicines available in 0.5% to 2%.This is an irritant keratolytic agent increase epithelial cell turnover and safer than B.P.
3.Sulphur The first category medicine available in strength as 3 % to 8 %.It is keratolytic and antibacterial.But sulphur on prolonged use may be acnegenic.
4.Resorcinol This medicine comes under second category as a single agent but jump into the first category when combined with sulphur in a proper proportion as the effect and safety are increased.
In severe cases there are numerous number of papules and pustules with many cysts and nodules.These cases should avoid self treatments and to be refered to a skin specialist as there is a need for antibiotic therapies.
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