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Dictionary The Dermal System


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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 >

             Diagnosis is essentially clinical.

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 :-
Arctium lappa (Burdock)
Eleutherococcus senticosus (Siberian ginseng)
Glycyrrhiza glabra (Licorice)
Lavendula officinalis (Lavender)
Ocimum basilicum (Basil)

(source : -)

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