Acne vulgaris is a multifactorial common condition of adolescence and early childhood affecting pilosebaceous unit of skin with formation of comedones ,papules ,pustules ,cystic and nodular lesion. it leads to post acne pigmentation and various types of scar in many. this leads to social embarrassment and psychological problems in few.Thus acne patients with cosmetic awareness may need medical and surgical treatment with counselling for same.
Acne vulgaris typically affects the areas of skin with the densest population of sebaceous follicles (eg, face, upper chest, back). Local symptoms of acne vulgaris may include pain, tenderness, or erythema.
Main factors which cause ACNE:
- Excess oil production
- Hair follicles clogged by oil and dead skin cells
- Bacteria
- Excess activity of a type of hormone (androgens) Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum.
Factors that may worsen acne-
- Certain medications. Examples include drugs containing corticosteroids, testosterone or lithium.
- Diet. Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne. Chocolate has long been suspected of making acne worse. A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.
- Stress. Stress can make acne worse.
People who are more prone to develop ACNE:
Age. People of all ages can get acne, but it’s most common in teenagers.
Hormonal changes. Such changes are common in teenagers, women and girls, and people using certain medications, including those containing corticosteroids, androgens or lithium
.Family history. Genetics plays a role in acne. If both parents had acne, you’re likely to develop it, too.
Greasy or oily substances. You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats
.Friction or pressure on your skin. This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
TYPES OF ACNE
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Comedonal acne: Presence of open and closed comedones but usually no inflammatory papules or nodules
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Mild acne: Presence of comedones and a few papulopustules
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Moderate acne: Presence of comedones, inflammatory papules, and pustules; a greater number of lesions are present than in milder inflammatory acne
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Nodulocystic acne: Presence of comedones, inflammatory lesions, and large nodules greater than 5 mm in diameter; scarring is often evident
INVESTIGATION.
Acne vulgaris is a clinical diagnosis. However, laboratory testing may be indicated in the following situations:-
Polycystic ovarian syndrome (PCOS): Consider PCOS in female patients with oligomenorrhea, hirsutism and/or acanthosis nigricans in addition to acne. These patients should be evaluated with total and free testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, luteinizing hormone, and follicle-stimulating hormone values, as well as a lipid panel, glucose value, and insulin level.
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Cases refractory to long-term antibiotic treatment or when improvement with antibiotics is not maintained: Culture skin lesions to rule out gram-negative folliculitis.
Treatment of acne vulgaris should be directed toward the known pathogenic factors, including follicular hyperproliferation, excess sebum, C acnes (formerly P acnes), and inflammation. The most appropriate treatment is based on the grade and severity of the acne.
Pharmacotherapy
The following medications are used in the treatment of Cutibacterium (formerly Propionibacterium) acne vulgaris:
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Acne products (eg, erythromycin and benzoyl peroxide, clindamycin and tretinoin, clindamycin and benzoyl peroxide, azelaic acid, benzoyl peroxide, topical dapsone)
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Retinoidlike agents (eg, topical tretinoin, adapalene, tazarotene, isotretinoin)
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Antibiotics (eg, tetracycline, minocycline, doxycycline, trimethoprim/sulfamethoxazole, clindamycin, topical clindamycin, topical erythromycin, daptomycin)
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Selective aldosterone antagonists (eg, spironolactone)
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Estrogen/progestin combination oral contraceptive pills (eg, ethinyl estradiol, drospirenone, and levomefolate; ethinyl estradiol and norethindrone; ethinyl estradiol and norgestimate; ethinyl estradiol and drospirenone)
When a topical or systemic antibiotic is used, it should be used in conjunction with benzoyl peroxide to reduce the emergence of resistance.
Nonpharmacotherapy
Diet therapy, such as a low-glycemic diet and avoidance of “junk foods,” has been suggested as a nonpharmacologic measure to manage acne vulgaris. Skim milk has been found to have a positive association with acne.
Procedures — for acne vulgaris include the following:
(1) Manual extraction of comedones -
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(2) Intralesional steroid injections
(3)Superficial peels that use glycolic or salicylic acid
(4)Light and laser therapy
(5) microdermabrasion –
(6) led light for acne
They may experience lowered self-esteem and depression as a result of living with acne scars. Acne scars can become worse with age as your skin loses collagen and its natural volume. For many years the only treatment available for acne scars were invasive and minimally effective. There was now much hope for people who suffered from acne scars.
Lasers, Radiofrequency Microneedling, subcision (acne scar surgery), and other light-based technologies like IPL all treat different types of acne scar symptoms, including pigmentation, texture, and tone concerns. Most patients experience a variety of these symptoms, and their best results come from combining a few different therapies.