Acne,Acne vulgaris,Cystic acne,Zits,Pimples management

Acne, commonly known as pimples, and also known as Acne vulgaris,Cystic acne,Zits.Here a discussion about Pimples management.It is more common and more server, in males than females in their teens. Contrary to belief pimples do not clear spontaneously when maturity is reaches. 6% patients may have the disease continuing up to 25 to 40 years of age. There is genetical predisposition and similar involvement may occur in identical twins. Androgens play a positive role and hence eunchs are spared. Oily and glossy skin is more predisposed.

There is blockage of sebaceous ducts at the surface of sebaceous the skin with keratinazation and melanin deposits from hair follicle giving rise to the characteristic black head spots (comedon) or early acne. The lesions are likely to occur in areas like face, shoulder and upper chest where sebaceous glands are in plenty. Retained sebum inside the gland and growth of propinibacterium acne, an anaerobic dipththrtrois normally present within pilo-sebaseous duct sets in complement mediated inflammation so that the blackhead turns to a vesicle and pustule. The pustules are sterile on routine culture. When the pustule bursts the chemoirritant fatty acid content of sebum causes inflammation on surrounding skin. Following rupture and healing, deep pitted scars may from which progress to keloid.

Excess of androgen secretion due to tumor of adrenal, ovary or tests be excluded. Polytcystic overary need exclusion by pelvic ultrasound. 21 hydroxylase deficiency causing adrenal hyperplasia has excess of antrogen secretion too.

Besides mild in itching, soreness of pain, there is more of self consciousness, embarrassment and psychic trauma. The morbid fear of scarring and pitting always haunts the patient, especially the girls.

Initial lesion

Comedones-Conical raised lesion with broad base and plugged apex. Plug may be black (black head) or white (white head) 25% white heads resolve, 75% develop into inflamed lesion.

Symptoms of Acne

 

Acne commonly appears on the face and shoulders. It may also occur on the trunk, arms, legs, and buttocks

Blackheads

Crusting of skin bumps

Cysts

Papules (small red bumps)

Pustules

Redness around the skin eruptions

Scarring of the skin

Whiteheads

Inflammatory lesion

 Severity grades

Gr. 1 (Mild)           :     Open and closed comedones

Gr. 2 (Moderate)   :     Comedones, papulules, few pustules

Gr. 3 (Severe )      :      Predominant pustules, nodules, abscesses

Gr. 4                     :     Mainly cysts and abscesses. Widesperead scarring as Inflammatory lesions resolve.

Treatment for Acne or Pimples management

     SELF-CARE

       Persons should be discouraged to apply oils and greases on the affected area.

Clean your skin gently with a mild, nondrying soap (such as Dove, Neutrogena, Cetaphil, CeraVe, or Basics). Remove all dirt or makeup. Wash once or twice a day, including after exercising. However, avoid scrubbing or repeated skin washing.

          Shampoo your hair daily, especially if it is oily. Comb or pull your hair back to keep the hair out of your face.

          Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to skin infections and scarring.

         Avoid wearing tight headbands, baseball caps, and other hats

         Avoid touching your face with your hands or fingers.

        Avoid greasy cosmetics or creams. Take off make-up at night. Look for water-based or “noncomedogenic” formulas. Noncomedogenic products have been tested and proven not to clog pores and cause acne.

        If these steps do not clear up the blemishes, try over-the-counter acne medications. You apply these products directly to your skin.

       They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid.

       They work by killing bacteria, drying up skin oils, or causing the top layer of your skin to peel.

       They may cause redness or peeling of the skin.

     A small amount of sun exposure may improve acne a little, but mostly it just hides the acne. However, too much exposure to sunlight or ultraviolet rays is not recommended because it increases the risk for skin cancer.

Topical theraphy  :  Retinoids

Antibiotics           :  Erythromycin, tetracycline, Benzyl peroxide

Combination therapies for pimples

Benzoyl peroxide / erythromycin

Isotrionin / erythromycin

Local use of clindamycin phosphate or erythromycin in hydroalcoholic base is beneficial.

Low dose long term tetracycline 500 mg, bid, doxyclycline 100 mg bid and minicycline 100 mg bid orally may prevent complications but tooth discoloration remains a problem.

Isotertionoin, a Vit A analog is helpful in treatment of comedonal acne in the dose of 0.5-1 mg/kg/day for 4-5 months. This agent is absolutely contraindicated during pregnancy.

Long term use may couse hypertriglyceridemia and hypercholesterolemia. Dry eyes and lips and nose bleed may occur. Pseudotumor cerebri syndrome, bony hyperostosis and hair loss may occur but the agent is certainly not stored in liver.

Keratolytic and keratoplastic acne lotions containing Zince-sulphur, tretinoin, 0.025 and 0.05% benzoyal peroxide (2.5% and 10%) are available for use in mild to moderate acne.

Cosmetic improvement may be achieved by abrasion of inactive acne lesion, particularly flat superficial scars. Superficial ultraviolet irradiation, 2% erythromycin cream 2% clindamycin cream and 15% azelaic acid cream may be beneficial in comedonal lesions.