Acne vulgaris (an inflammatory skin disease) Treatment

Acne vulgaris is a chronic inflammatory disease of the sebaceous glands, It's usually associated with a high rail of sebum secretion and occurs on areas of the body that have sebaceous glands, such as the face, neck, chest, back, and shoulders. Excessive sebum is usually secreted into the dilated hair follicles. The sebum joins with the bacteria and keratin in the hair follicles to form a plug. There are two types of acne:

• inflammatory, in which the hair follicle is blocked by sebum, causing bacteria to grow and eventually rupture the follicle
• noninflammatory, in which the follicle doesn't rupture but remains dilated.

Acne vulgaris develops in approximately 85% of the population, primarily between ages 15 and 18. Although the lesions can appear as early as age 8 or as late as age 58, acne primarily affects adolescents. Although the severity and overall incidence of acne is usually greater in males, it tends to start at an earlier age and last longer in females.

Causes of Acne vulgaris

The cause of acne is multifactorial. Although many myths exist that chocolate or fatty foods may cause acne, studies have shown that diet isn't a precipitating factor. Possible causes of acne include increased activity of sebaceous glands and blockage of the pilosebaceous ducts (hair follicles).

Factors that may predispose one to, acne include:

• heredity
• androgen stimulation
• certain drugs. including corticosterolds, corticotropin (ACTID, androgens, iodides, bromides, trimethadinile. phenytoin (Dilantin), isoniazid (i NH), lithium (Eskalith), and halothane
• cobalt irradiation
• hyperalimentation
• exposure to heavy oils, greases, or tars
• trauma or rubbing from tight clothing
• cosmetics
• emotional stress (although stressful situations may cause acne to flare. stress itself doesn't cause acne)
• tropical climate
• hormonal contraceptive use. (Many females experience acne flare-up during their first few menses after starting or discontinuing hormonal contraceptives.)

Signs and symptoms

The acne plug may appear as:

• a closed comedo, or whitehead (not protruding from the follicle and covered by the epidermis)
• an open comedo, or blackhead (protruding from the follicle and not covered by the epidermis; melanin or pigment of the follicle causes the black color).

Rupture or leakage of an enlarged plug into the epidemics produces inflammation, characteristic acne pustules, papules or, in severe forms, acne cysts or abscesses (chronic, recurring lesions producing acne scars).

In women, signs and symptoms may include increased severity just before or during menstruation when estrogen levels are lowest.

Complications of acne may include:

• acne conglobata
• scarring (with severe cases)
• impaired self-esteem
• abscesses or secondary bacterial infections

Diagnosis

Diagnosis is confirmed by characteristic acne lesions. especially in adolescents. Additionally, a culture may be taken to identify a Possible secondary bacterial infection. which may present as an exacerbation of pustules or abscesses while on tetracycline or erythromycin drug therapy.

Treatment

Benzoyl peroxide (Benzac 5 or 10) is the treatment of choice for noninflammabled lesions; it may also be used for milder forms of inflamed lesions. However, for more severe inflamed acne, treatment should include the application of antibacterial agents, such as clindamycin, or benzoyl peroxide plus erythromycin (Benzamycin) antibacterial agents. These may applied alone or with tretinoin (Retetin-A; retinoic acid), which is a keratolytic. Keratolytic agents, such as benzoyl peroxide and tretinoin, dry and peel the skin in order to help open blocked follicles, moving the sebum up the skin level.

Special considerations

• Try to identify predisposing factors that may be eliminated or modified.
• Explain the causes of acne to the patient and family. Make sure they understand that the prescribed treatment is more likely to improve acne than a strict diet and harsh scrubbing With soap and water. Provide written instructions regarding treatment.
• Describe the importance of not picking at the lesions because it Will only further inflame the lesion and may lead to permanent facial scarring. Encourage good personal hygiene in order to prevent secondary infections. Instruct women to remove any makeup daily With a mild cleanser and astringent, especially at bedtime. Also, tell the patient to avoid cosmetics or other oily skin or hair products that block pores and to buy only noncomedogenic cosmetics and skin products.
• Inform the patient that acne may take a long time to clear - possibly even years for complete resolution. Encourage continued and regular loral skin care even after acne clears.
• Explain the adverse effects of all drugs.