Acne Vulgaris : What Is It ? Natural Treatment, Diagnosis Management,
And Advice For Patient
Acne vulgaris is a common skin disease that affects 85-100% of people at
some time during their lives. It is characterized by noninflammatory
follicular papules or comedones and by inflammatory papules, pustules, and
nodules in its more severe forms. Acne vulgaris affects the areas of skin
with the densest population of sebaceous follicles; these areas include the
face, the upper part of the chest, and the back.
Four key factors are responsible for the development of an acne lesion:
1. Follicular epidermal hyperproliferation and hyperkeratinization
, the increased level of adrenal derived androgen, dehydroepiandrosterone
sulfate induces hyperproliferation.
2. Excess sebum
, - Excess sebum is also a key factor in the development of acne vulgaris.
The amount of sebum produced and the degree and the severity of the acne
are strongly correlated. Sebum excretion is under hormonal control.
Androgens stimulate sebocyte differentiation and sebum production, whereas
estrogens have an inhibitory effect. Most men and women with acne have
normal circulating levels of androgen hormones. An end-organ
hyperresponsiveness to androgens has been hypothesized.
3. Propionibacterium acnes
,
- P acnes is a microaerophilic organism present in many acne
lesions. P acnes stimulate inflammation by producing
proinflammatory mediators that diffuse through the follicle wall.
4. Inflammation - Inflammation may be a primary phenomenon
or a secondary phenomenon and plays a role in the development of acne
comedones, papules, pustules, and nodules in a sebaceous distribution
characterize acne vulgaris. The face may be the only involved skin surface,
but the chest, the back, and the upper arms are often involved.
5. Genetic predisposition
– but mode of inheritance is unknown
6. Mechanical factors
– excessive rubbing of the skin and use of oily cosmetics may induce acne
lesion
An external cause is seldom identifiable in acne vulgaris. Some cosmetic
agents and hair pomades may worsen acne. Medications that can promote acne
include steroids, lithium, some antiepileptics, and iodides.
Congenital adrenal hyperplasia, polycystic ovary syndrome, and other endocrine disorders with excess androgens may trigger the development of acne vulgaris. Acne vulgaris may also be influenced by genetic factors.
Treatment
TIALS
Treatment should be directed toward the known pathogenic factors involved
in acne. These include follicular hyperproliferation, excess sebum, P acnes, and inflammation.
The grade and the severity of the acne help in determining, which of the
following treatments, alone or in combination, is most appropriate.
Topical treatments
Each works a little differently. Benzoyl peroxide (2.5-10%) at night is best at killing P. acnes and may reduce oil production. Resorcinol, salicylic acid, and sulfur help break down blackheads and whiteheads. Salicylic acid also helps cut down the shedding of cells lining the follicles of the oil glands. Topical medications are available in many forms, such as gel, lotion, cream, soap, or pad.
o Topical antibiotic; -Topical antibiotics are mainly used for their role against P acnes. They may also have anti-inflammatory properties. The development of resistance is lessened if topical antibiotics are used in combination with benzoyl peroxide. Erythromycin and clindamycin alone or in combination with benzoyl peroxide.
o Topical retinoids are comedolytic and anti-inflammatory. They cause epidermal differentiation and, thus, normalize follicular hyperproliferation and hyperkeratinization. Adapalene, tazarotene, and tretinoin are in common use. They are applied once daily to clean, dry skin.
Systemic treatment
Tetracycline, (minocycline, docycyline and tetracycline, erythromycin 1g daily for one month then 250 bid for 4-6 moths). Trimethoprim, alone or in combination with sulfamethoxazole, are systemic antibiotics and anti-inflammatory. Isotretinoin is a systemic retinoid that is highly effective in the treatment of severe, recalcitrant acne vulgaris
Patients with moderate to severe inflammatory acne may be treated with prescription of topical or oral medicines, alone or in combination.
Advice needs to be given to the patient
1. Chronicity of the problem
2. Not to squeeze acne lesion
3. washing with warm water but has to avoid irritants
4. Not to use cortisone cream
0 comments:
Post a Comment