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The Dermal SystemAcne Synonyms : Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs, This
disorder of the pilosebaceous apparatus affects teenagers of both sexes. 85%
will develop some form of acne, but acne clears by the age of 23-25 years in
90% of patients. Many
factors, rather than a single one, combine to cause chronic inflammation of
blocked pilo-sebaceous follicles. 1.
Sebum
excretion
is increased and sebum of patients with acne contains an excess of free fatty
acids. 2.
Hormones
are another factor and androgens from the testes and adrenals are the main
hormones which stimulate sebum excretion as well as follicular cell
proliferation, especially in puberty. In acne the sebaceous glands appear to
be hypersensitive to normal levels of these hormones. Increased and abnormal keratinisation at the exit of the pilosebaceous follicle obstructs
the flow of sebum. 3.
Fluid
retention
swells keratin and accounts for premenstrual flares. Similar mechanism is
responsible for exacerbations caused by excessive sweating. 4.
Bacteria
play a pathogenic role. Propionibacterium
acnes is present on normal skin, but it may colonise the pilosebaceous
duct; it is capable of secreting a lipase that hydrolyses sebum
triglycerides into free fatty acids which irritate the follicular wall and
predispose to the inflammatory process. 5.
Exogenous acne may be caused by certain chemicals
or oil-based cosmetic preparations. 6. Acne is often familial, and the inheritance is probably polygenic. Clinical features: < BACK TO TOP >
Acne is
often worse in winter and improve in summer, probably because of the benefits
of sunlight; acne may also cycle with the period.
Lesions
are limited to the face, shoulders, upper chest and back.
Seborrhoea (greasy skin) is often present.
Open
comedones (blackheads) due to
plugging of the pilosebaceous orifice by keratin and sebum, or closed
comedones (whiteheads) due to
accumulation of sebum and keratin deeper in the pilosebaceous ducts, are
always evident. In other words blackheads are located in the epidermis whereas
whiteheads develop in the dermis.
The
black colour of the blackheads is caused not by dirt but by oxidised melanin
within the stratum corneum of the cellular plug.
Open
comedones relatively rarely progress to inflammatory lesions; but it appears
that closed comedones are precursors of inflammatory acne.
If open
or closed comedones are the prominent lesions on the skin, the condition is
called comedonal acne.
Inflammatory
papules, pustules and cysts commonly occur, sometimes permanent scarring may
follow.
In
typical adolescent acne several different types of lesions are present
simultaneously: open and closed comedones and various inflammatory lesions. Less common form of acne fulminans is accompanied by fever, joint pains and high ESR. Diagnosis: < BACK TO TOP >
Management < BACK TO TOP >
Reassurance
and explanation are always important and patients should be told that:
The
lesions can be expected to clear in time in great majority of individuals.
This
condition is not infectious nor is due to poor hygiene.
The
less sufferers worry about their appearance the less other people will take
any notice.
Local
measures such as regular washing with antibacterial skin soaps and lotions
[e.g., Acnederm, Sapoderm, Hexol, Phisohex] can help; there is no evidence
that dietary management is of any benefit.
The
mainstay of acne therapy is the use of potent keratolytic agents applied to
the lesions to relieve follicular obstruction (e.g., tretinoin-retinoic acid
[Retin A, Stieva A], isotretinoin [Isotrex], benzoyl peroxide gel [Panaxyl
Acne, Benzac, Brevoxyl], azelaic acid [Skinoren]).
Topical
antibiotics are used to avoid the side-effects caused by systemic
antibiotics; clindamycin in solution or cream [Dalacin V, Clindatech] and
erythromycin in gel [Eryacne] can be applied.
Systemic
antibiotics such as tetracycline [Mysteclin], minocycline [Akamin, Minomycin],
doxycycline [Doxy, Doxsig. Doxyhexal, Doxylin, Doryx] or erythromycin [Eryc,
Emu-V, E-Mycin, EES, Eryhtrocin, Eryhexal] can be used initially, but not for
less than 3 months and may even be necessary for 1 year. The most common
adverse effect of prolonged antibiotic use in women is candidal vaginitis
(thrush).
Oral
isotretinoin [Roaccutane, Accure, Oratane] is a derivative of retinoic acid
that can reduce sebum excretion and follicular obstruction in patients in
whom antibiotics are unsuccessful or in patients with very severe cystic
acne. However it is highly teratogenic and female patients must practice
strict contraception. When other measures fail and acne seems related to the period, an oral contraceptive composed of oestrogen ethinyloestradiol and anti-androgen cyproterone [Diane-35] may be tried. Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP > Nutrition that alleviate or prevent Acne :- Herbs < BACK TO TOP > Herbs that alleviate or prevent Acne :- (source : -) |
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