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Sunday, December 08, 2019

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Common acne

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What is it?
Acne is a condition of the skin that shows up as different types of bumps.

Every strand of hair grows from a follicle under the skin. In the skin, there are also oil glands –the sebaceous glands that secrete a greasy substance called sebum.

Acne is an inflammation of the pilosebaceous unit (hair follicle + sebaceous gland) of certain body areas.

Acne happens when the inside of a hair follicle becomes sticky and forms a plug.

It is thought to be caused by the interplay of four factors:

1-excessive sebum production by the sebaceous glands.

2-obstruction of the hair follicle by dead cells.

3-accumulation of lipids and cellular debris within the blocked follicle.

4-colonization of this microenvironment by a bacterium called “Propionibacterium Acne”, which provokes an immune response and increases the inflammation.

Types of Acne
Acne can be mild, moderate or severe.

1- It is mild when there are only whiteheads (white bumps) and blackheads (dark specks), called also closed and open comedons respectively, on the skin.

2- It is moderate when there are swelling, red bumps, pustules (red bumps with a white head) along with the whiteheads and blackheads in the skin.

3- It is severe when deep, painful bumps are present under the skin in addition to the whiteheads and blackheads.

Scars may follow all types but they occur especially with severe acne.

Characteristics of Acne
A- Location : lesions most commonly develop in areas with the greatest concentration of the sebaceous glands, and that include the face, neck, chest, upper arms, back and buttocks to a lesser extent.

B- Age of onset : puberty (10-17 years old in females, 14-19 years old in males) when, under the influence of hormones, the sebaceous glands become more active and secrete more sebum.

It may however appear first at age 25 or older.

C- Sex Distribution : it affects both males and females but it is more severe in males.


Cause of Acne:
Acne is not caused by chocolate, fatty foods (like fries, peanuts, etc…), soda.

In fact, it is not caused by any type of food .

Genetics play a role. Severe acne can run in families

It can be induced by certain drugs (anti-epileptics, steroids, androgens…) or by certain organic conditions.

Most of the times, no direct cause is found. However, acne can be exacerbated by many factors:

1- Emotional stress

2- Menstruation in girls

3- Oil-based make-up, hair gels, sprays, suntans

4- Squeezing or picking at blemishes

5- Hard scrubbing of skin

6- Occlusion and pressure on the skin by leaning face on hands or on a telephone (“acne mechanica”).

7- Too much exposure to sun (“acne aestivalis”)

8- Certain occupations with much exposure to mineral oils


Course
Acne clears often spontaneously by early twenties but sometimes it can persist to age 40 or older.


Treatment
Early treatment is important to avoid scarring, which is the only physical sequel.

It depends on the psychological impact of acne on the individual (perceived cosmetic disfigurement).

There are multiple modalities of treatment. Your doctor will choose the treatment that suits most your skin and your type of acne:

1- Topical products, available in many forms (gels, lotions, creams, soaps) such as benzoic peroxide , salicylic acid, etc... are especially used in mild acne.

2- Certain Antibiotics are also sometimes effective in treating moderate acne.

3- Retinoids (“Retin-A”) are other medicines used to treat acne .A strong sunscreen is recommended when using retinoids , and pregnancy should be avoided ( risk of birth defects) .

4- Isotretinoin ( brand name : “Ro-Accutane”) which is a very effective drug that is used for severe acne , that did not respond to other treatments. However, it has multiple side effects, and people taking it should be monitored closely by their doctor.


Scars
Acne, especially severe acne, can cause scars and disfigurement in some people.

The risk of scars is reduced by avoiding to squeeze at blemishes or to scrub hard the skin, and by starting appropriate treatment early.

However, in case scars do occur, there are some treatments available:

•  Laser resurfacing: the laser removes the damaged top layer of the skin and tightens the middle layer, leaving it smoother.

•  Dermabrasion: a diamond instrument or a rotating brush is used to wear down the surface of the skin. Later, a new smoother layer replaces the abraded skin.

•  Chemical peel if the scars are mild.

•  Surgery is reserved for deep, severe scars.