ACNE

Acne is an inflammatory skin condition, commonly affecting the face, chest and back. It is one of the most common skin conditions, affecting up to 80-90% of adolescents. Acne may also occur during infancy due to the activation of sebaceous glands by maternal hormones in-utero. It can be a persistent problem, although it spontaneously resolves after a period of 4-5 years in about 70% of people. Approximately 30% of people continue with their acne into adult life. The incidence of acne at the age of 40 is reported to be 1% in men and 5% in women.

Causes

Acne is caused by the over activity of the sebaceous (oil) glands. Sebaceous glands are active due to the hormone testosterone. Testerone is produced in men from the testes and in women from the ovaries and the adrenal glands. Although Testosterone levels are usually normal in people who develop acne, the sebaceous glands are overly sensitive to the hormone. Over production of oil leads to a greasy feel to the skin. In addition , there is a change in the growth of the cells lining the follicular canal (pore). Instead of dislodging normally and being carried away by the oil (sebum) when they die, these cells become sticky and stick to the inner surface of the gland and gradually build up a partial blockage.

Symptoms

The partial blockage of the pore is called a microcomedone and is the precursor of all inflammatory and non-inflammatory spots in the acne. Bacteria start to multiply within the blockage, which leads to inflammatory lesions or red papules. As part of the healing process, the body recruits white blood cells which destroy the bacteria but lead to the formation of puss, leading to comedones (blackheads), small pimples, large pustules, or painful swollen cysts.

There are many myths surrounding the causes of acne, which include:

	Only teenage spots – you’ll grow out of it.
	Eating too much chocolate and too many chips
	Not keeping your skin clean enough

Acne can be a devastating psychological disease commonly affecting the face, neck, chest, shoulders and back. The latest survey be Acne Support Group shows that 12% of people with acne feel suicidal as a result of having the condition. Whilst it is a very common skin condition, it need not be left untreated and leave a person feeling so desperate that they want to take their own life.

Treatments

There are many treatments available, which need to be given at an early stage to prevent scarring. Treatments are generally long-term, however with encouragement and support a person can improve their skin substantially.

First line treatment for acne includes creams or gels containing the active ingredient benzoyl peroxide, which is available from chemists. Salicylic acid is also available from chemist shops and can be effective in comedonal (blackhead) type acne. Antibiotics, topical and orally are very popular treatments for acne. These help to reduce inflammation, whilst killing the bacteria. Topical retinoids are useful in comedonal acne. Adapalene is a new retinoid which helps in acne. This is a modification of the retinoid molecule that is more stable, less irritant and has comedolytic and antiinflammatory activity.

For those who have not responded to standard systemic and topical therapies, isotretinoin, which is a synthetic vitamin A, can be very useful. This is a hospital-only drug and can achieve up to 95% positive results in patients. There are many potential side effects from this drug and hence the patient will need monitoring by their dermatologist.

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