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Acne
Acne
Acne is a very common problem faced by the adolescents. It is medically referred to as Acne Vulgaris. Acne is chronic inflammation of the pilosebaceous units. The condition is extremely common; Ā it generally starts Read more...
Acne
Acne is a very common problem faced by the adolescents. It is medically referred to as Acne Vulgaris. Acne is chronic inflammation of the pilosebaceous units. The condition is extremely common; Ā it generally starts after puberty and there are reports Ā of Ā it Ā affecting Ā over 90% Ā of Ā adolescents. Ā It Ā is Ā usually Ā most Ā severe Ā in Ā the Ā late teenage Ā years Ā but Ā can Ā persist Ā into Ā the thirties Ā and Ā forties, particularly Ā in females. Ā Acne vulgaris is most common between the ages of 12 and 20. It often begins around 10ā13 years of Ā age, lasts for 5ā10 years and usually resolves by age 20ā25.
Causes of Acne:
Infection of the pilosebaceous glands by propionibacterium acnes. Severity Ā of Ā acne Ā is Ā associated Ā with Ā sebum excretion Ā rate, Ā which Ā increases Ā at Ā puberty. Ā Both Ā androgens Ā and progestogens Ā increase sebum Ā excretion Ā and oestrogens Ā reduce Ā it, Ā although Ā the Ā hormonal Ā effects Ā may also Ā reflect Ā end-organ Ā sensitivity, Ā as Ā most Ā patients Ā have normal Ā hormone profiles. There Ā may Ā be Ā a Ā positive Ā family history; there is high concordance in monozygotic twins and Ā it Ā is Ā likely Ā that Ā genetic Ā factors Ā are Ā important Ā in Ā some families, Ā but Ā candidate Ā genes have Ā not Ā been Ā confirmed.
Symptoms :
Emotional Effects:
At allagens can have negative effects on self-esteem, but it is especially important to assess how it affects anadolescents. The consequences (whether acne is objectively severe or not)can be devastating, leading to embarrassment, school avoidance, life-long effects on ability to form friendships, attract partners, and acquire and keep employment.
Acne Ā usually Ā affects Ā the Ā face Ā and Ā often Ā the Ā trunk. Ā Greasiness Ā of Ā the Ā skin Ā may Ā be Ā obvious Ā (seborrhoea). Ā The Ā hallmark Ā is Ā the Ā comedone: Ā open Ā comedones Ā (blackheads) are Ā dilated keratin-filled follicles, Ā which Ā appear Ā as Ā black papules Ā due Ā to Ā the Ā keratin Ā debris; Ā closed Ā comedones (whiteheads) Ā usually Ā have Ā no Ā visible Ā follicular Ā opening and Ā are Ā caused Ā by accumulation Ā of Ā sebum Ā and Ā keratin deeper Ā in Ā the Ā pilosebaceous Ā ducts. Ā Inflammatory papules, Ā nodules Ā and Ā cysts Ā occur Ā and Ā may Ā arise Ā from comedones. Scarring Ā may Ā follow Ā deep-seated or Ā superficial Ā acne Ā and Ā may Ā be Ā keloidal.
There Ā are Ā distinct Ā clinical Ā variants:
- Acne Conglobata:Ā Characterised Ā by Ā comedones, nodules, Ā abscesses, Ā sinuses Ā and Ā cysts, Ā usually Ā withmarked Ā scarring. Ā It Ā is Ā rare, Ā usually Ā affecting Ā Ā adult Ā males, Ā and Ā most Ā commonly Ā occurs Ā on Ā Ā trunk Ā and Ā upper Ā limbs. Ā It Ā may Ā be Ā associated Ā with hidradenitis Ā suppurativa Ā (a Ā chronic, Ā inflammatory disorder Ā of Ā apocrine Ā glands, Ā predominantly affecting Ā axillae Ā and Ā groins), Ā scalp Ā folliculitis Ā and pilonidal Ā sinus.
- Acne Fulminans: Ā A Ā rare Ā but Ā severe Ā presentation of Ā acne, Ā associated Ā with Ā fever, Ā arthralgias Ā and systemic Ā inflammation, Ā with Ā raised Ā neutrophil Ā Ā count Ā and Ā plasma Ā viscosity. Ā It Ā is Ā usually Ā found Ā Ā on Ā the Ā trunk Ā in Ā adolescent Ā males. Ā Costochondritis can Ā occur.
- Acne ExcoriĆ©e:Ā Describes Ā self-inflicted Ā excoriations due Ā to Ā compulsive Ā picking Ā of Ā pre-existing Ā or imagined Ā acne Ā lesions. Ā It Ā usually Ā affects Ā teenage girls Ā and Ā underlying Ā psychological Ā problems Ā are common.
- Secondary Acne:Ā Comedonald acne Ā can Ā be Ā caused Ā by greasy Ā cosmetics Ā or Ā occupational Ā exposure Ā to Ā oils, tars Ā or Ā chlorinated Ā aromatic Ā hydrocarbons. Predominantly Ā pustular Ā acne Ā can Ā occur Ā in Ā patients using Ā systemic Ā or Ā topical Ā corticosteroids, Ā oral contraceptives, Ā anticonvulsants, Ā lithium Ā or antineoplastic Ā drugs, Ā such Ā as Ā the Ā epidermal Ā growth factor Ā receptor Ā (EGFR) Ā inhibitor, Ā cetuximab. Ā Most patients Ā with Ā acne Ā do Ā not Ā have Ā an Ā underlying endocrine Ā disorder. Ā However, Ā acne Ā is Ā a Ā common feature Ā of Ā polycystic Ā ovary Ā syndrome, which Ā should Ā be Ā suspected Ā if Ā acne Ā is Ā moderate Ā to severe Ā and Ā associated Ā with Ā hirsutism Ā and Ā menstrual irregularities. Ā Virilisation Ā should Ā also Ā raise Ā suspicion of Ā an Ā androgen-secreting Ā tumour.
Diagnosis:
Acne is a clinical diagnosis. But certain associated features can be investigated. Investigations Ā are Ā not Ā required Ā in Ā typical Ā acne Ā vulgaris. Secondary Ā causes Ā and Ā suspected Ā underlying endocrine disease or virilisation Ā should Ā be Ā investigated:
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Estrogen levels
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Testosterone levels
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Sex hormone binding globulins
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Total Iron binding capacity
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FSH/LH levels
Mild Ā disease Ā is Ā usually Ā managed Ā with Ā topical Ā therapy. Ā If Ā comedones Ā predominate, Ā then Ā topical benzoyl Ā peroxide Ā or Ā retinoids Ā should Ā be Ā used. Ā Treatment should Ā initially Ā be Ā applied Ā at low concentrations Ā for short Ā duration Ā and Ā increased Ā as Ā tolerated. Ā Azelaic Ā acid may Ā also Ā be Ā useful Ā for Ā mild Ā acne. Ā Patients Ā with Ā mild inflammatory Ā acne Ā should Ā respond Ā to Ā topical antibiotics, such Ā as erythromycin Ā or Ā clindamycin, Ā which Ā can Ā be Ā used in Ā combination Ā with Ā other Ā treatments. For Ā moderate Ā inflammatory Ā acne, Ā a Ā systemic Ā tetracycline, Ā such Ā as oxytetracycline Ā or Ā lymecycline, Ā should be used Ā at Ā adequate Ā dose Ā for Ā 3ā6 Ā months Ā in Ā the Ā first instance. Ā If Ā the Ā case Ā fails Ā to Ā respond, then Ā alternatives Ā include Ā erythromycin Ā or trimethoprim. Oestrogen-containing Ā oral Ā contraceptives Ā or Ā a combined Ā oestrogen/anti-androgen Ā (such Ā as Ā cyproterone acetate) Ā contraceptive Ā may Ā provide Ā additional Ā benefit Ā in women. Patients Ā should Ā be Ā referred Ā for Ā consideration Ā of isotretinoin Ā (13 Ā cis-retinoic acid) Ā if Ā there Ā is Ā a Ā failure Ā to respond Ā adequately Ā to Ā 6 Ā months Ā of Ā therapy Ā with Ā these combined Ā systemic and topical Ā approaches.
Isotretinoin Ā has Ā revolutionised Ā the Ā treatment Ā of Ā moderate Ā to Ā severe Ā acne Ā that Ā has Ā not Ā responded Ā adequately Ā to other Ā therapies. Ā It Ā has Ā a Ā multifactorial Ā mechanism Ā of action, Ā with reduction Ā in sebum excretion Ā by Ā over Ā 90%, follicular hypercornification Ā and Ā P. acnes Ā colonisation. A typical Ā course Ā lasts Ā for Ā 4 Ā months. Ā Sebum Ā excretion usually Ā returns Ā to Ā baseline Ā over the Ā space Ā of Ā a Ā year Ā after treatment Ā is Ā stopped, Ā although Ā clinical Ā benefit Ā is usually Ā longer-lasting. Ā Many Ā patients Ā will Ā not Ā require further Ā treatment, Ā although Ā a Ā second Ā or Ā third Ā course of isotretinoin Ā may Ā be Ā required. Ā A Ā low-dose Ā continuous Ā or intermittent-dose Ā regimen Ā may Ā be Ā considered Ā for Ā a longer Ā duration, Ā in Ā patients Ā who Ā relapse Ā after Ā a Ā higher dose Ā regimen. Combination Ā with Ā systemic Ā steroid Ā may be Ā required Ā in the Ā short Ā term Ā for Ā severe Ā acne, Ā in Ā order Ā to minimise Ā the Ā risk Ā of Ā disease Ā flare Ā early Ā in Ā the Ā treatment course. Thorough screening and monitoring are required, given Ā the Ā side-effect Ā profile Ā of isotretinoin.
Intralesional Ā injections Ā of Ā triamcinolone Ā acetonide Ā may be Ā required Ā for Ā inflamed Ā acne Ā nodules Ā or Ā cysts, Ā which can Ā also Ā be Ā incised Ā and Ā drained, Ā or Ā excised Ā under Ā local anaesthetic. Scarring Ā may Ā be prevented Ā by Ā adequate treatment Ā of Ā active Ā acne. Ā Keloid Ā scars Ā may Ā respond Ā to intralesional Ā steroid Ā and/or Ā silicone Ā dressings. Ā Carbon dioxide Ā laser, microdermabrasion, Ā chemical Ā peeling Ā or localised excision Ā can Ā also Ā be Ā considered Ā for Ā scarring. UVB Ā phototherapy Ā or Ā PDT Ā can Ā occasionally Ā be Ā used Ā in patients Ā with Ā inflammatory acne Ā who Ā are Ā unable Ā to Ā use conventional Ā therapy, Ā such Ā as isotretinoin. Ā There Ā is Ā no convincing Ā evidence Ā to Ā support Ā a Ā causal Ā association between Ā diet Ā and Ā acne. Ā
Myths/Facts:
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Myth: Acne is not a disease to be worried, it comes and goes.
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Fact: Acne is a disease which can be treated depending upon the severity.
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Myth: Once you get acne, youāll have scars forever.
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Fact: Acne scars fade over time.