Acne is a disease rarely associated with systemic medical problems; however, the importance and morbidity of acne should not be underestimated because its disfiguring can have important negative psychosocial consequences for affected individuals including diminished self-esteem, social embarrassment, social withdrawal, depression and even unemployment [1, 3].

Risk factors/Triggers

1. Food/Diet

Foods such as nuts, cola, milk, cheese, fried foods and iodised salts have been implicated as triggers of acne vulgaris; however, the connections between nutrition and acne has not definitely been proven as they are rarely supported by good analytical, epidemiological or therapeutic studies [4, 5]. On the other hand, recurrent acne as noted by Niemeier et al (2006) may be a cutaneous sign of an underlying eating disorder.

2. Genetics

A genetic background is supported by a case control study by Goulden et al, as noted by Rzany et al (2006). This stated that the risk of adult acne vulgaris in relatives of patients with acne as compared with those of patients without acne is significantly higher [4].

3. Hormones

According to Rzany et al (2006), hormonal influences on acne vulgaris are undisputed as shown by the higher incidence of acne in male adolescents. Premenstrual flare has also been recorded as causing acne [5].

4. Nicotine

Smoking has also been named as a risk factor for acne vulgaris; however, conflicting data exists as to the link between smoking and acne. Some population based studies have found links between smoking and acne whilst some others have not [4].

Important!

Contrary to popular misconceptions by young patients and occasionally their parents, acne does not come from bad behaviour nor is it a disease of poor hygiene. It also has nothing to do with lack of cleanliness [2].

Types of acne vulgaris

There are two main types of acne vulgaris, inflammatory and non-inflammatory; these can be manifested in different ways,

1. Comedonal acne, which is a non-inflammatory acne

2. Papules and pustules of inflammatory acne

3. Nodular acne (inflammatory acne)

4. Inflammatory acne with hyperpigmentation (this occurs more commonly in patients with darker skin complexions) [1]

Clinical manifestations

In general, acne is limited to the parts of the body, which have the largest and most abundant sebaceous glands such as the face, neck, chest, upper back and upper arms. Among dermatologists, it is almost universally accepted that the clinical manifestation of acne vulgaris is the result of four essential processes as described below [1, 6],

1. Increased sebum production in the pilosebaceous follicle. Sebum is the lipid-rich secretion product of sebaceous glands, which has a central role in the development of acne and also provides a growth medium for Propionibacterium acnes (P acnes), an anaerobic bacterium which is a normal constituent of the skin flora. Compared with unaffected individuals, people with acne have higher rates of sebum production. Apart from this, the severity of acne is often proportional to the amount of sebum produced [1, 6].

2. Abnormal follicular differentiation, which is the earliest structural change in the pilosebaceous unit in acne vulgaris [1].

3. Colonisation of serum-rich obstructed follicle with Propionibacterium acnes (P acnes). P acnes is an anaerobic bacterium which is a normal constituent of the skin flora and which populates the androgen-stimulated sebaceous follicle [androgen is a steroid hormone such as testosterone or androsterone, that controls the development and maintenance of masculine characteristics]. Individuals with acne have higher counts of P acnes compared with those without acne [1, 6].

4. Inflammation. This is a direct or indirect result of the rapid and excessive increase of P acnes [1].

Non-inflammatory acne lesions include open and closed comedones, which are thickened secretions plugging a duct of the skin, particularly sebaceous glands. Open comedones, also known as blackheads, “appear as flat or slightly raised brown to black plugs that distend the follicular orifices”. Closed comedones, also known as whiteheads, “appear as whitish to flesh-coloured papules with an apparently closed overlying surface” [1].

Inflammatory lesions on the other hand include papules, pustules, and nodules; papules and pustules “result from superficial or deep inflammation associated with microscopic rupture of comedones”. Nodules are large, deep-seated abscesses, which when palpated may be compressible. In addition to the typical lesions in acne, other features may also be present. These include scarring and hyperpigmentation, which can result in substantial disfigurement [1].

Psychological Aspects

Numerous psychological problems such as diminished self-esteem, social embarrassment, social withdrawal, depression and even unemployment stem from acne. However, differential diagnosis from a psychosomatic point of view indicates two serious psychological problems, which can arise from acne. These are,

1. Psychogenic excoriation, and

2. Body dysmorphic disorder (BDD)

Psychogenic excoriation also referred to as neurotic excoriation, pathological or compulsive skin picking “is characterised by excessive scratching or picking of normal skin or skin with minor irregularities” [5]. According to Niemeier et al (2006) it is estimated to occur in 2% of dermatological patients. Patients with this disorder can also have psychiatric disorders such as mood and anxiety disorders, as well as associated disorders such as obsessive compulsive disorder, substance abuse disorder, obsessive compulsive personality disorder, compulsive buying, eating disorder, and borderline personality disorder, to mention a few [5].

Body dysmorphic disorder (BDD) “is a condition characterised by an extreme level of dissatisfaction or preoccupation with a normal appearance that causes disruption in daily functioning” [3]. Niemeier et al (2006) described it as “a syndrome characterised by distress, secondary to imagined or minor defects in one’s appearance.” The onset of BDD is usually during adolescence, and it occurs equally in both male and female. Common areas of concern include the skin, hair and nose, with acne being one of the most common concerns with BDD patients [3].

According to the Diagnostic and Statistics Manual of Mental Disorders (2000), BDD has three diagnostic criteria,

1. A preoccupation with an imagined defect in appearance; where a slight physical anomaly is present, the person’s concern is markedly excessive,

2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning,

3. The preoccupation is not caused by another mental disorder (e.g. Anorexia Nervosa)

Characteristic behaviours include skin picking, mirror checking, and camouflaging by wearing a hat or excessive make up. Apart from these, patients often seek reassurance frequently by asking questions such as “Can you see this pimple?” or “Does my skin look okay?” Some patients also have a tendency to doctor shop, which is essentially going from one specialist to another in search of a dermatologist or plastic surgeon, willing to carry out a desired procedure or dispense a certain drug, to improve their perceived defect [3, 5].

Although it is a relatively common disease, BDD is still an under diagnosed psychiatric disorder and is estimated to affect 0.7 to 5% of the general population. Other psychiatric conditions associated with BDD include major depression, anxiety, and obsessive compulsive disorder. It is also associated with high rates of functional impairment and suicide attempts, high levels of perceived stress, and markedly poor quality of life [3, 5, 8].

Acne Treatment

1. Topical treatment, particularly for individuals with non-inflammatory comedones or mild to moderate inflammatory acne (See types of acne vulgaris). Medications include tretinoin (available as gels, creams, and solutions), adapalene gel, salicylic acid (available as solutions, cleansers, and soaps), isotretinoin gel, azelaic acid cream, benzoyl peroxide (available as gels, lotions, creams, soaps, and washes), to mention a few [1, 2].

2. Oral treatment, particularly for acne that is resistant to topical treatment or which manifests as scarring or nodular lesions. Medications include oral antibiotics (e.g. tetracycline, doxycycline, minocycline, erythromycin, and co-trimoxazole), oral isotretinoin, and hormonal agents (e.g. oral contraception, oral corticosteroid, cyproterone acetate, or spironolactone) [1, 2].

3. Physical or surgical methods of treatment, which are sometimes useful as adjuvant to medical therapy. Methods include comedo extraction, intralesional injections of corticosteroids, dermabrasion, chemical peeling, and collagen injections, to mention a few [1, 9].

4. Sun exposure, reported by up to 70% of patients to have a beneficial effect on acne [10].

5. Light therapy, which is becoming more popular due to the growing demand for a convenient, low risk and effective therapy, as many patients fail to respond adequately to treatment or develop side effects, from the use of various oral and topical treatments available for the treatment of acne [11]. Methods include the use of visible light (e.g. blue light, blue/red light combinations, yellow light, and green light), laser treatment and monopolar radiofrequency [11]. Many of these light therapy treatments can be used at home.

Recommended Products for Acne

References

1. Brown SK, Shalita AR. Acne vulgaris. Lancet 1998; 351:1871-1876.

2. Webster GF. Acne vulgaris. Br Med J 2002; 325: 475-479.

3. Bowe WP et al. Body dysmorphic disorder symptoms among patients with acne vulgaris. J Am Acad Dermatol 2007; DOI: 10.1016/j.jaad.2007.03.030.

4. Rzany B, Kahl C. Epidemiology of acne vulgaris. JDDG 2006; DOI: 10.1111/j.1610-0387.2006.05876.x

5. Niemeier V, Kupfer J, Gieler U. Acne vulgaris-Psychosomatic aspects. JDDG 2006; DOI: 10.1111/j.1610-0387.2006.06110.x

6. Gollnick H. Current perspectives on the treatment of acne vulgaris and implications for future directions. Eur Acad Dermatol Venereol 2001; 15 (Suppl. 3):1-4.

7. American Psychiatric Association. Diagnostic and Statistics Manual of Mental Disorders. 4th Ed. Accessed via: BehaveNet® Clinical CapsuleTM; http://www.behavenet.com/capsules/disorders/bodydysdis.htm. Accessed on: 28th June 2007.

8. Phillips KA et al. A retrospective follow-up study of body dysmorphic disorder. Comprehensive Psychiatry 2005; 46: 315-321.

9. Taub AF. Procedural treatments of acne vulgaris. Dermatol Surg 2007; 33: 1-22.

10. Cunliffe WJ, Goulden V. Phototherapy and acne vulgaris.Br J Dermatol 2000; 142 (5): 855-856.

11. Dierickx CC. Lasers, Light and Radiofrequency for treatment of acne. Med Laser Appl 2004; 19: 196-204.

Disclaimer

This article is only for informative purposes. It is not intended to be a medical advice and is not a substitute for professional medical advice. Please consult your doctor for all your medical concerns. Kindly follow any information given in this article only after consulting your doctor or qualified medical professional. The author is not liable for any outcome or damage resulting from any information obtained from this article.

Find out more information: http://www.allergymatters.com/acatalog/Acne_learning_Centre.html

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Thanks to Kunbi Balogun for contributing this article to our Acne blog:

Acne Treatment Benzoyl Peroxide

Your pimples are like a signboard. It is the first thing everybody sees when they look at your face. If you are like most acne sufferers the moment you pass by anything that reflects an image you tend to take a peep at your “pimples laced” face.

If you are reading this then it is only safe for me to assume that you are tired of all the annoying little pains that comes with having acne on your skin. If you suffer from acne it is most likely that your self esteem has taken some “bashing” all because you have those little monsters growing off your face.

It is only normal for everyone especially young adults like us to be concerned about the way we look, after all we all live in an age where appearance seems to be so important in umm “everything”. Well not everything but a lot of things, one of which is social interaction.

Although I never really had problems with teen acne, when I was 17 years old, I started having pimples on my face but they were just one or two appearing sometimes once a week. That was not really a problem. Fast-forward to when I turned twenty and my face was like a “battle field”.

How Many Times have you been disappointed with an acne product?

You must have tried some products that have cleared up some of the pimples on your face, but if you were like me you would later find out that some of those “topical” acne treatments actually lose their intensity to fight your acne problem after a while.

What do Acne sufferers display!!!

I am very sure that we do not need any researcher or “shrink” to tell us what those little “pimples” can do to us socially. It seems mild to severe acne sufferers usually display one of the following:

*Low self-confidence

*Frustration

*Feelings of inadequacy

*Depression

*Refusal to socialize

*Low self-esteem

How do I know these? Well in case you forgot I just you told at age twenty my face was a “WAR ZONE”. Seriously it was. People looked at my face and cringed. The pimples were just too much. Enough of my own tales, this article was meant to educate you on the best acne treatments available to you and from now I will do just that. I promise

Types of Acne medications

Before we start looking for the best acne treatment to clear your up your face, you should have a basic knowledge of the types of medication available to you.

If your acne problem just began, I can guess the form of treatment you are currently using to combat the problem is a bastardized form of “natural acne treatments”. Yeah you guessed right!! - Washing your face like a “quadrillion” times in a day and also picking and “popping” your pimples. Hey in case you have not figured it out that routine will not work!!!

This is not to say that natural acne treatments which ensure proper skin care are not good or do not work, but hello! washing your face more than twice a day has adverse effects on your skin and could lead to even more breakouts (pimples).

Check acne skin to see a comprehensive way of reducing your acne breakouts by achieving proper acne skin care.

Okay aside the natural stuff, medications for your breakouts could be:

*Prescription medications

*Topical medications

*Oral medications

*Laser surgery – which is in its early stages to treat both acne scars and the pimple itself.

There are so many acne sufferers who use prescription medications for their acne problem. Products like accutane, Retin-A, Differin and Tazorac are quite popular and famous because of the large number of dermatologist and doctors who prescribe them to sufferers.

You have to consult with your dermatologist before you even attempt taking those medications. Although these prescribed medications work for some individuals, they could cause birth defects for pregnant women or nursing mothers risk causing severe complications for their babies.

Topical medications are the most popular form of acne medication for a large number of us having trouble with acne. It seems the two most common ingredients in most topical medications are benzoyl peroxide and salicylic acid. These two ingredients in topical medications are very effective in clearing up your “pimple covered face”.

Using these topical medications that contain benzoyl peroxide and salicylic acid, which are usually in the form of facial wash, lotion or gels thoroughly cleanses your skin pores. Products with the right amount of these active ingredients would usually prevent new pimple from forming on your skin to a certain extent, as they protect your skin surface against bacterial infections, which could have been as a result of so many factors like environmental pollution.

In case you did not know this, one of the causes of your acne problem has to do with your hormones being on overdrive. The male hormone testosterone, which is an androgen, is responsible for that.

What’s my reason for saying that? Well it is because of the oral medications now used for combating acne from the inside of your body. These medications work on stabilizing the hormonal imbalance in your body. In simple words these oral medications work on solving the main cause of your acne problem and not on patching up the ugly results that is seen on your skin surface. Although you can take accutane to combat your pimple woes if prescribed by your dermatologist, it comes with side effects that could be really annoying.

A Product like the acnezine system contains oral supplements which work inside the body to rid the system of all internal factors causing your break outs.

A new technique being used by doctors to erase scars left by acne lesions is Laser surgery. This involves the use of laser beams to burn out scar tissues, which enable your skin (if you ever attempt such technique, you are on your on, I didn’t tell you to do it.) to generate new, healthy tissues.

Few doctors have begun to use this technique to prevent acne from developing.

I do not know the side effects resulting from such techniques or even if there are side effects. Laser surgery is a new technique in removing acne so there is not much information available for now.

“If your acne problems have stopped and you are seeking ways to remove the scars left by the pimples, you should try Revitol’s acne scar remover, which is a lot cheaper than laser surgery.”

Which exactly is the best acne treatment

Okay I have been rambling about the types of medications and have not said the best acne treatments currently available to you.

Well there are a large number of useless products offering overnight cures, but that is not to say there are no credible products that are capable of ridding your skin of zits. Clear pores system seems to be the best system considering the level of combination treatment it provides which include:

*Facial/body wash

*Facial/body protection cream

*Herbal supplement

Another very wonderful product is the acnezine system, which I used to rid myself of acne. It consists of a Skin Anti-Oxidant Capsule that fight the root cause of your pimples breakouts from within and a moisturizing crème containing benzoyl peroxide (you remember that ingredient), which fights acne-causing bacteria on your skin.

A number of former acne sufferers have testified to the effectiveness of healthy pores, which is definitely among the best acne treatment available currently in the market.

For more information, tips and reviews on acne and the best acne treatment available to you, visit adult acne treatment. Now!!!



Thanks to Tim Orlando for contributing this article to our Acne blog:

Blemish Treatment For Dark Skin