Acne

Acne is an inflammatory skin disease, which affects the tiny pores, which cover the face, arms, back, and chest and the oil glands attached to them. It is an abnormal response in the skin to normal levels of the male hormone, testosterone, in the blood. Both men and women have testosterone circulating in the blood, but in the acne sufferer, this hormone has a profound effect on the skin. This abnormal response is self limiting and eventually acne does get better without treatment, but there is no way of predicting how long this can take, and it may take years or even decades! Acne can also leave scars, which are permanent and are easier to prevent than to treat.

In the skin, the disease attacks two structures:

1. The pore through which the hairs emerge from the skin - here dead skin cells become more "sticky" and partially block the pore.
2. The oil or sebaceous gland - more oil is produced, which gives rise to a generally oily complexion.

The partial blockage in the pore restricts the flow of oil onto the skin surface. This result in solidification of the oil, which fills the hair, channels forming a blackhead. The black of the blackhead is not due to dirt, but a change in pigment in the blockage in the pore. If the partial blockage becomes complete, the oil builds up around the hair and hair root and becomes infected with bacteria normally present on the skin.

The bacteria break down the oil to very inflammatory chemicals, which cause redness, pus formation and pain - the "zit". If the inflammation is deep and severe, or if the spot is manipulated or squeezed, the pus can burst deep into the skin rather than onto the surface. This deep-rooted inflammation and infection results in scarring and cyst formation.

Causes and Risk Factors

Acne occurs as a result of four key contributing factors:

• HORMONES:
  With puberty, there is an increase in the hormones that causes the sebaceous glands to grow and produce more sebum. Androgens - the hormones that cause maturation in males, have the greatest effect on sebaceous glands. Androgens are found in both males and females, but are at much higher levels in males. This is the main reason severe acne affects more boys than girls.
• INCREASED SEBUM PRODUCTION:
  The hair follicle may not be large enough to permit a free flow of large amounts of sebum produced during puberty. Sebum can back up in the hair follicle.
• CHANGES INSIDE THE HAIR FOLLICLE:
  The lining in each hair follicle changes as androgen production increases and sebaceous glands enlarge. Normally dead cells from the lining of the follicle shed gradually and flow out of the surface with sebum. During puberty these cells shed more rapidly and tend to stick together and when mixed with sebum they can clog and result in a pimple.
• BACTERIA:
  Clogged follicles and the sebum they contain are a breeding ground for acne-causing bacteria. One type of bacteria especially important to acne is P. acnes. A normal resident on the skin, P. acnes usually cause no problems, however, a clogged sebaceous gland offers it an opportunity to grow and reproduce.

Diagnosis and Screening

Acne is commonest in adolescents with a peak in the late teens. Acne may however, appear for the first time in the mid-twenties or even later and persists in a significant number of people into their 40s or even their 50s.

Acne is a very treatable disease, but in many patients treatment needs to be started early and be aggressive to prevent the scarring.

If your acne fails to respond quickly to products bought at the chemist, consult your doctor. He or she can advise you about the different treatment options and can prescribe most of these. In severe or difficult cases, your doctor can refer you to a Dermatologist for further specialist treatment.

Management

Please note the availability of treatments will vary in different countries.

• Benzoyl peroxide:
  This is available over the counter and can be effective in mild acne; however it can irritate the skin and may dry it.
• Antibiotic lotions:
  These are available on prescription only. They are very effective in mild-to-moderate acne and dry up pustules quickly. Clindamycin lotion has been shown to be as effective as taking antibiotics by mouth in acne.
• Topical vitamin A derivatives:
  These are supplied as creams, gels or lotions. They are very good for blackheads but often dry and irritate the skin. They should be used with lots of moisturisers.
• Antibiotic tablets:
  These are the usual treatment for moderate-to-severe acne. Many different antibiotics can be used, but the tetracyclines are the most popular. Treatment should last for at least 6 months and, depending on the response, may last for 2 to 3 years. Never stop antibiotics suddenly as the acne may flare up badly if this is done. The tablets should always be slowly reduced.
• Hormone treatments:
  High oestrogen pills do help acne, but are not without their side-effects. A form of the pill is made with low-dose oestrogens and an anti-testosterone drug, which may be useful in bad acne.
• Oral vitamin A derivatives:
  These drugs are only available from prescriptions. They are very powerful anti-acne drugs and with them we can control and even cure the most severe forms of acne. They do have side effects and we recommend you to talk to your dermatologist.

You can read more information about acne on Wajhi.com, and on dermnet-arabia.ne