Skin disease: Acne Vulgaris
Acne is the most common skin disease for adolescents. Surprisingly, as common as it is, it still can be very distressing. I have the same problem when I was younger and it was quite embarrassing. Well, I am okay now, so, I am going to share you the secret.
Acne vulgaris is an inflammatory disorder of the pilosebaceous follicle. So, forget the myth about acne – it is not due to the lack of washing or eating sweets and chocolate. Acne is almost universal amongst teenagers. The common affecting parts are face, neck, upper chest and back.
What causes acne???
Have you heard about comedone? Well, comedone also know as blackhead. Comedone formation is due to an abnormality of keratinization or desquamation within the follicle and causes by the blockage of the secretion hence become the central abnormality in acne.
Excessive sebum production is another cause and it occurs under the control of androgens. Don’t be afraid, most individuals with acne do not have excessive androgens. On the other hand, their sebaceous gland may be more sensitive to the androgens.
Propionobacterium acnes are bacteria that are commonly found on the normal skin. It flourishes in the anaerobic conditions within the blocked follicle. The inflammatory response to this bacterial proliferation will cause the typical inflamed lesion.
Clinical features
You might have one or more of the features over the affecting area (face, neck, chest and back);
- Blackhead
- Red papules
- Pustules
- Nodules - rare
- Cysts - rare
- Scarring – rare
Sometimes, we will get confused with acne rosacea. However, in this condition, diffuse redness will be seen on the cheeks, nose, chin and forehead, BUT no comedones. Telangiectasia and flushing (especially after alcohol) might present.
Types of acne
- Mild acne – most of the time it just affect the face and only comedones are present
- Moderate acne – mainly, there is presentation of inflammatory lesions which usually seen on the face and perhaps over the chest and back as well
- Severe acne – this is severe condition of acne where nodules, cysts and scarring also present apart of other lesions
Management
Treatment are mainly depends on the severity of acne.
Mild acne
- Topical retinoid – it have anti comedone activity and is a drug of choice
- Benzoyl peroxide 2.5% - low concentration as effective as higher concentrations.
Moderate acne
· Oral antibiotics are the mainstay of treatment – oxytetracycline or erythromycin can be given for a course 4 to 6 months minimum.
· Benzoyl peroxide should also be given to avoid resistance to the antibiotics
· If topical antibiotics used, it should be the same with oral antibiotics to prevent resistance
· Isotretinoin – can be use if antibiotics fail or in the presence of scarring and severe psychological problems
Severe acne
- Synthetic retinoid isotretinoin – is the drug of choice. It usually given for 16 weeks. Highly significant improvement can be seen at majority of patients and 60-70% has no recurrence. However, it shouldn’t be taken by pregnant woman or if you are trying to conceive because it have serious teratogenic effects and cause severe abnormality to the fetus. Sexually active women should use contraceptive during and 1 month after treatment. Other side effects of this drug include dryness of skin, lips, mucosa, myalgia (mscle pain), headache, hepatitis and increase lipids.
Conclusion
Having acne can be very distressing but it is not the end of the world. You can have sweets and chocolate but not too much because you will end up being fat although you might not have acne. Of course, washing your face twice daily will help a lot in preventing the acne and oily face. So, if you have tried variety of facial cleanser and some medications given by your pharmacist but there is still no improvement, maybe it’s time for you to visit your doctor and ask their advice. Thank you.
Reference:
1. Oxford handbook of clinical specialties. 5th edition. 2001.
Recommended products:
Acne Free In 3 Days. All Natural Cure For Stopping Acne In 3 Days!
Tags: acne, benzoyl peroxide, blackhead, health, skin problems, teenagers, vulgaris
