Acne No More Summary
Acne is a common skin disease that causes pimples. Pimples form when hair follicles under your skin clog up. Most pimples form on the face, neck, back, chest, and shoulders. Anyone can get acne, but it is common in teenagers and young adults. It is not serious, but it can cause scars.No one knows exactly what causes acne. Hormone changes, such as those during the teenage years and pregnancy, probably play a role. There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and pimples are not caused by dirt. Stress doesn't cause acne, but stress can make it worse.If you have acne Clean your skin gently Try not to touch your skin Avoid the sun Treatments for acne include medicines and creams.NIH: National Institute of Arthritis and Musculoskeletal and Skin DiseasesAcne vulgaris (or simply acne) is a long-term skin condition characterized by areas of blackheads , whiteheads , pimples , greasy skin , and possibly scarring . Acne mostly affects skin with a greater number of oil glands including the face, upper part of the chest, and back. Many treatment options are available to improve the appearance of acne including lifestyle changes, procedures, and medications. Eating fewer simple carbohydrates like sugar may help. Though it becomes less common in adulthood than in adolescence, nearly half of people in their twenties and thirties continue to have acne. Acne is commonly classified by severity as mild, moderate, or severe. This type of categorization can be an important factor in determining the appropriate treatment regimen. Acne may be considered to be of moderate severity when a higher number of inflammatory papules and pustules occur on the face compared to mild cases of acne and acne lesions also occur on the trunk of the body. Lastly, severe acne is said to occur when nodules and cysts are the characteristic facial lesions and involvement of the trunk is extensive. Some of the large nodules were previously called cysts and the term nodulocystic has been used to describe severe cases of inflammatory acne. Acne scars are the result of inflammation within the dermal layer of skin brought on by acne and are estimated to affect 95% of people with acne vulgaris. Acne scars are classified based on whether the abnormal healing response following dermal inflammation leads to excess collagen deposition or collagen loss at the site of the acne lesion. Hypertrophic scars remain within the original margins of the wound whereas keloid scars can form scar tissue outside of these borders. Postinflammatory hyper pigmentation (PIH) is usually the result of nodular or cystic acne (the painful 'bumps' lying under the skin). They often leave behind an inflamed red mark after the original acne lesion has resolved. PIH occurs more often in people with darker skin color . Pigmented scar is a common but misleading term, as it suggests the color change is permanent. Often, PIH can be avoided by avoiding aggravation of the nodule or cyst. These scars can fade with time. However, untreated scars can last for months, years, or even be permanent if deeper layers of skin are affected. The predisposition for specific individuals to acne is likely explained in part by a genetic component, which has been supported by twin studies as well as studies that have looked at rates of acne among first degree relatives. Hormonal activity, such as menstrual cycles and puberty , may contribute to the formation of acne. During puberty, an increase in sex hormones called androgens cause the follicular glands to grow larger and make more sebum. Propionibacterium acnes (P. acnes) is the anaerobic bacterium species that is widely suspected to contribute to the development of acne, but its exact role in this process is not entirely clear. It is unclear whether these undesirable strains evolve on-site or are acquired, or possibly both depending on the person. These strains either have the capability of changing, perpetuating, or adapting to, the abnormal cycle of inflammation, oil production, and inadequate sloughing of acne pores. One particularly virulent strain, has been circulating in Europe for at least 87 years. There is weak evidence of a positive association between the consumption of milk and a greater rate and severity of acne. Chocolate does contain a varying amount of sugar that can lead to a high glycemic load and it can be made with or without milk. There may be a relationship between acne and insulin metabolism and one trial found a relationship between acne and obesity . While the connection between acne and stress has been debated, research indicates that increased acne severity is associated with high stress levels. Acne develops as a result of blockages in the skin's follicles . These blockages are thoughts to occur as a result of the following four abnormal processes: a higher than normal amount of sebum production (influenced by androgens ); excessive keratin deposition leading to comedone formation; colonization of the follicle by Propionibacterium acnes bacteria; and the local release of pro-inflammatory chemicals in the skin. The earliest pathologic changes are the excessive deposition of the protein keratin and oily sebum in the hair follicle resulting in the formation of a plug (a microcomedo ). During adrenarche , a higher level of the androgen ( DHEA-S ) results in the enlargement of the sebaceous glands and increases sebum production. A microcomedo may enlarge to form an open comedo (blackhead) or closed comedo. The dark color of a blackhead occurs due to oxidation of the skin pigment melanin . In these conditions, the naturally occurring largely commensal bacterium Propionibacterium acnes can cause inflammation within and around the follicle, leading to inflammatory lesions ( papules , infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation . Age is one factor that may help a physician distinguish between these disorders. Skin disorders such as perioral dermatitis and keratosis pilaris can mimic acne but tend to occur more frequently in childhood whereas rosacea tends to occur more frequently in older adults. Many different treatments exist for acne including benzoyl peroxide , antibiotics, retinoids , antiseborrheic medications, anti-androgen medications, hormonal treatments, salicylic acid , alpha hydroxy acid , azelaic acid , nicotinamide , and keratolytic soaps. They are believed to work in at least four different ways, including the following: normalizing skin cell shedding and sebum production into the pore to prevent blockage, killing P. acnes , anti-inflammatory effects, and hormonal manipulation. Commonly used medical treatments include topical therapies such as retinoids, antibiotics, and benzoyl peroxide and systemic therapies including oral retinoids, antibiotics, and hormonal agents. Procedures such as light therapy and laser therapy are not considered to be first-line treatments and typically have an adjunctive role due to their high cost and limited evidence of efficacy. Benzoyl peroxide is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects (mainly irritant dermatitis ). It works against P. acnes, helps prevent formation of comedones, and has anti-inflammatory properties. This topical does increase sensitivity to the sun as indicated on the package, so sunscreen use is often advised during the treatment to prevent sunburn . Benzoyl peroxide has been found to be nearly as effective as antibiotics with all concentrations being equally effective. Benzoyl peroxide may be paired with a topical antibiotic or retinoid such as benzoyl peroxide/clindamycin and benzoyl peroxide/adapalene , respectively. Oral antibiotics are indicated for moderate to severe cases of inflammatory acne and decrease acne due to their antimicrobial activity against P. acnes in conjunction with anti-inflammatory properties. Commonly used antibiotics, either applied topically or taken orally, include erythromycin ( category B ), clindamycin (category B), metronidazole (category B), and tetracyclines such as doxycycline and minocycline . Nadifloxacin and dapsone are other topical antibiotics that may be used to treat acne in pregnant women, but have received less extensive study. Hormonal therapies should not be used to treat during pregnancy or lactation as they have been associated with certain birth defects such as hypospadias and feminization of the male fetus . They are a first-line acne treatment for people with dark colored skin and are known to lead to faster improvement of post inflammatory hyperpigmentation. but are administered topically and generally have much milder side effects. They can, however, cause significant irritation of the skin. The retinoids appear to influence the cell life cycle in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol is a form of vitamin A that has similar, but milder effects and is used in many over-the-counter moisturizers and other topical products. Topical retinoids often cause an initial flare-up of acne and facial flushing . Improvement is typically seen after one to two months of use. After a single course, about 80% of people report an improvement with more than 50% reporting complete remission. A number of adverse effects may occur including: dry skin, nose bleeds , muscle pains , increased liver enzymes , and increased lipid levels in the blood . If used during pregnancy, there is a high risk of abnormalities in the baby and thus women of child bearing age are required to use effective birth control . There is no clear evidence that use of oral retinoids increases the risk of psychiatric side effects such as depression and suicidality . The aldosterone antagonist spironolactone is an effective treatment for acne in adult women, but is not approved by the United States' Food and Drug Administration for this purpose. Spironolactone is thought to be a useful acne treatment due to its ability to block the androgen receptor at higher doses. Combination therapy using medications of different classes together, each with a different mechanism of action, has been demonstrated to be a more efficacious approach to acne treatment than monotherapy. Light therapy is a method that involves delivering intense pulses of light to the area with acne sometimes following the application of a sensitizing substance (such as aminolevulinic acid ). Light therapy is expensive, and while it appears to provide short-term benefit, there is a lack of long-term outcome data or data in those with severe acne. However, the procedure is painful and has many potential side effects such as skin sensitivity to sunlight , redness , and decreased pigmentation of the skin . Ablative fractional photothermolysis laser resurfacing was found to be more effective for reducing acne scar appearance than non-ablative fractional photothermolysis, but was associated with higher rates of postinflammatory hyperpigmentation (usually about 1-month duration), facial redness (usually for 3–14 days), and pain during the procedure. Mild chemical peels include those using glycolic acne no more summary acid , lactic acid , salicylic acid , Jessner's solution , or a lower concentration (20%) of trichloroacetic acid . These peels only affect the epidermal layer of the skin and can be useful in the treatment of superficial acne scars as well as skin pigmentation changes from inflammatory acne. Higher concentrations of trichloroacetic acid (30-40%) are considered to be medium strength peels and affect skin as deep as the papillary dermis . Medium and deep strength chemical peels are more effective for deeper atrophic scars, but are more likely to cause side effects such as skin pigmentation changes, infection, or milia . There is good evidence to support the idea that acne has a negative psychological impact and worsens mood, lowers self-esteem, and is associated with a higher risk of anxiety , depression , and suicidal thoughts . 1980s: Accutane is introduced in the United States, and later found to be a teratogen , highly likely to cause birth defects if taken during pregnancy. In the United States, more than 2,000 women became pregnant while taking the drug between 1982 and 2003, with most pregnancies ending in abortion or miscarriage . About 160 babies with birth defects were born. The social and economic costs of treating acne vulgaris are substantial. In the United States, acne vulgaris is responsible for more than 5 million doctor visits and costs over $2.5 billion each year in direct costs . In 2007, the first genome sequencing of a P. acnes bacteriophage (PA6) was reported. The authors proposed applying this research toward development of bacteriophage therapy as an acne treatment in order to overcome the problems associated with long-term antibiotic therapy, such as bacterial resistance . A vaccine against inflammatory acne has been tested successfully in mice, but has not yet been proven to be effective in humans. Other workers have voiced concerns related to creating a vaccine designed to neutralize a stable community of normal skin bacteria that is known to protect the skin from colonization by more harmful microorganisms.