Tuesday, June 10, 2008

Acne formation


Hair Follicle

Comedones (blackheads & whiteheads)

Zits

Nodules

images courtesy of EMedicine Health

How acne appears:

Your skin sheds dead cells and produces oil from the moment you are born. Your hormone balance affects the rate at which you produce oil and at which your skin sheds dead skin cells, and it changes throughout your life. Acne happens when these natural processes are thrown off-balance.

1) A blemish begins approximately 2-3 weeks before it appears on your skin's surface. Deep within each pore (or hair follicle), your sebaceous glands are working to produce sebum, the oil that keeps your skin moist and pliable.

2) The pores clog: As your skin renews itself, the old cells die and slough off. When cells are shed unevenly, they clump together with natural skin oil to form a plug – much like a cork in a bottle.
3) The blemish appears: This plug, or comedo, traps oil and bacteria inside your pore. As your skin continues to produce oil, the pore swells because of the plug, and bacteria flourish. Your pore becomes infected and possibly inflamed.

Acne is a red, irritating skin rash primarily affecting teenagers and young adults. It can, however, occur at all ages. Typical acne appears in the oil-producing areas of the body—namely, the face, chest, and back. Acne can also occur on the neck and upper arms.


Acne can have a short-term, potentially lasting psychological effect. Decreased self-esteem and self-confidence can lead to social withdrawal and even
depression. Left untreated, severe acne can lead to disfiguring scarring, which can itself be difficult to treat.

When to Seek Medical Care:

Acne that does not improve with over-the-counter medicines should be evaluated by a doctor.
People with acne that is severe and tender or already scarring should also be seen by a doctor.
Women with acne who develop facial hair or have irregular periods require evaluation by a doctor.
Anyone with a sudden severe worsening of their acne or acne with fever and severe swelling should see a doctor immediately. These could be signs of a serious skin infection.


At home Treatment:

Wash once or twice daily with a soap and water to remove excess oil from the skin. An acne cleanser purchased over-the-counter in any drug store can also be helpful. Avoid scrubbing too abrasively because this can actually irritate the skin and cause acne to worsen.

Over-the-counter acne medications can be used either at bedtime or during the day. Always follow the directions on any acne product.

Many cover-up products are available without a prescription to improve the appearance of blemishes while they have a chance to heal. Most work well and should not worsen acne.

Some cosmetics and other skin care products, however, can cause acne to worsen. Look for make-up, cosmetics, and skin care products labeled with the word noncomedogenic. This means that it does not cause or worsen acne.

Medical Treatment:
Many treatment options are available to treat all forms of acne. Medications are the main treatment for acne and usually work well. Several preparations are available over-the-counter, while others require a prescription from a doctor.


Over-the-counter medications: Nonprescription or over-the-counter medications for acne are plentiful and can be effective for milder forms of acne. They come in the form of soaps, washes, and cleansers.

Many contain benzoyl peroxide, which does two things. First, benzoyl peroxide kills the acne-causing bacteria, which are thought to play a role in acne. Second, benzoyl peroxide can cause drying and flaking off of skin, which can help prevent the pores from becoming plugged. Plugged pores can develop into acne blemishes.

Scrubbing excessively with any over-the-counter preparation can actually cause acne to worsen by additionally irritating the hair follicles.

Prescription medications: Doctors can prescribe medications when acne becomes moderate to severe or is not controlled by over-the-counter medications. Prescription drugs can be used effectively alone or in combination with other prescription and nonprescription medications.

Antibiotics: Antibiotics can be effective in treating most inflammatory acne (papules and pustules). They work by killing the bacteria and also by decreasing the redness and swelling seen in the inflammatory forms of acne.

Antibiotics may be applied to the skin in the form of gels and lotions, or by way of pills. We now know that using a combination of 2 medications together may be very effective in treating acne. Using a topical antibiotic with topical benzoyl peroxide, for example, may prevent bacterial resistance to the antibiotic. Giving an antibiotic by mouth is often needed for acne that is more extensive, red, and tender.

Antibiotics taken by mouth can be associated with more side effects than if applied to the skin and may interact with other medicines such as birth control pills. Sensitivity to the sun can result in a "bad
sunburn" in some people who take the antibiotic tetracycline by mouth.

Retinoids: Medicines made from vitamin A (retinoids) are useful in treating several types of acne lesions. Topical retinoids are effective in treating the noninflammatory types of acne (blackheads and whiteheads).

Topical retinoids (applied directly to the skin) help to open clogged pores by creating a mild peeling effect. Drying of the skin can be a frequent side effect. Oral retinoids are reserved for treating the more extensive nodular type of acne or severe inflammatory acne, which has not responded to other treatments. Oral retinoids not only have a peeling effect but also decrease the production of oil.

They can also be associated with a number of serious side effects including birth defects in babies of women who become pregnant while taking the medicine. They can also cause elevated blood fats (triglycerides) and damage to the liver. Your doctor may recommend certain blood tests to check for these problems (and to make sure you are not pregnant) if you are given oral retinoids. Depression and
suicidal thoughts have been reported while taking oral retinoids.

Other medications: A doctor may recommend other types of drugs or therapy to improve acne. For women, medications such as birth control pills or certain "water pills" may be helpful. These drugs counteract the acne-causing effect of male hormones. Newer treatments for acne include the use of light or zinc. Your doctor can advise you whether these types of acne therapy might be good for you.



Author: Brian W Russ, MD, Consulting Staff, Department of Dermatology. For more information check out
American Academy of Dermatology

Au revoir



No comments: