Common forms of Acne

You have notices a cystic lesion over your face and you are thinking whether it can be acne. Well, let me tell you yes, most probably it is acne.

There are two major types of acne – Acne vulgaris and Acne rosasea. Acne vulgaris is the most common form of acne. It begins with a cystic lesion, and then it ruptures and ultimately gets infected. Although Acne vulgaris is a self limiting disease mainly of the adolescent and teenagers, 10-15% of the adults continue to suffer some form of this disorder. The primary cause of the disease in teenagers is increased production of sebum when they attain the age of puberty. Sebum is secreted from a specific type of gland, called the Sebaceous gland present in the epidermal layer of skin. Tiny cyst like lesion named – Comedones, emerges in the hair follicles as a result of blockage of the follicular opening due to retention of sebum and many other keratinous materials.

With favorable conditions, bacteria continue to infect these lesions. The most common bacterium responsible for the lesion is ‘Proprioniobacterium acnes’. The action of this organism inside the comedones releases some material from the sebum which is mainly acidic in nature – in fact these are different free fatty acids. All these materials lead to inflammation of the skin. When inflammation occurs within the cyst, there is rupture of the cyst wall. An inflammatory foreign body type reaction (type II hypersensitivity reaction) as a result of discharge of the oily and keratinous residues from the cyst. The cysts may be open, it is then called the blackheads; and sometimes closed – called the whiteheads. Blackheads are consists of easily expressible high colored oily debris. Whiteheads are tiny cystic lesions that are accentuated when the skin is stretched. This is the precursor of the inflammation in case of Acne vulgaris. Comedones generally exist with other types of inflammatory lesions – papules, nodules and pustules. The lesions seen in the adolescent and teenagers in the beginning are usually mildly inflamed whiteheads. There may not be presence of redness even. This is predominantly seen in the middle part of the forehead. As a result, more distinguishing inflammatory lesions develop on the nose, chin and the cheeks. Most common area affected by this cyst is face, however extensive lesion in the back, trunk and chest are also seen.

It is to be noted that acne is self limiting. In some cases which involves large area and becomes resistant to the different medications, scarring do occur leading to an ugly look.

There are some aspects that may change the end result of acne. External trauma and rubbing of the inflamed skin may rupture the existing benign cyst. Thus, the lesions which may not rupture at all in normal circumstances become exposed to the deleterious action of bacteria and deep scarring occurs. Application of irritable tropical creams, cosmetics and hair care preparations or constant contact to certain industrial compounds, which are comedogenic in nature may bring out or worsen the condition. Moreover, there are some medicines like lithium, glucocorticoid cream, isoniazide, halogens and phenytoins which may produce comedones or may exacerbate existing acne.

So, should you find any cyst like wound over your face or on the back, do not forget to pay attention and rush to your doctor for an expert opinion.

Birth control pills and acne

You are taking birth control pills for a long time. One fine morning you notice a tiny cyst like lesion on your face. You ask your friend, what it could be. And she says it may be acne. Can it be true? Well, let me tell you yes, most certainly it could be acne. Birth control pills have potentiality to promote the formation of acne.

At times we do not consult our doctor before buying or taking a low profile medicine which is readily available over the counter. After couple of days or months, we discover some kind of disease process has started within our body. Because of this, we have to accept many other complications and our purse looses weight.

Birth control pills, Oral Contraceptive Pills or simply OCPs, are one of the most infamous medicines in this class. OCP is actually a combination of two major naturally occurring hormones – progesterone and estrogen. Interestingly, doctors frequently prescribe estrogen creams for the treatment of acne. Estrogen is a gonadal hormone and it benefits the outcome of acne by suppressing the production of androgens from the ovary. The mechanism involves inhibition of a specific hormone secretion from the pituitary gland situated in the skull – called gonadotropin. Cyclical treatment along with added progestin is quite effective to manage the case.

Now let us discuss the matter in depth. How does acne formed and what is their outcome. Acne is of two types, Acne vulgaris and Acne rosasea. Acne vulgaris is the predominant form of Acne and most commonly found. It is mostly seen in the adolescents and the teenagers owing to increase sebum production from the sebaceous glands present in the epidermal layer of the skin. The production of sebum increases during puberty, reaches its highest level during adulthood and then gradually decreases with age. Androgens like testosterone accelerate its production from the sebaceous gland. Small sized cystic lesion, named comedones, become visible in the follicles of the hair due to blockage of the follicular opening. This is because of the deposition of sebum and other keratinized materials. Then some bacteria play their role. Bacteria dissolve these sebum and other materials to produce free fatty acids which are corrosive to the already vulnerable skin. This in turn gives rise to inflammation inside the cyst and in due course the cyst ruptures. The end result is what we see as acne.

Now, we must know that estrogen has its own side effects. These include decreased sexual desire (libido), increase in the size of the breast and others. Sometimes the enlargement of breast occurs in the male also (feminization). Women, those who have stopped menstruation, have a 5-10 times increased risk of developing cancer of the uterus. Even there is information of breast cancer also. Long time therapy with birth control pill increases the risk of formation of gall stone by twice. Use of estrogen cream in the men is out of question. Estrogen has the power to suppress the growth of the children if prescribed. Breast tenderness is very common during long term use of birth control pills. In addition, there are various other grave complications if birth control pills are used for prolonged time. There is episode of heart attack due to blockage of the blood vessels that supplies nutrition to the heart muscle, obstruction of long veins of legs, arms and lungs, increase in the blood pressure, increase in the cholesterol level – to name a few.

For the treatment of acne, you need to use the estrogen cream for a long time. So consult your doctor and do accordingly to his advice.

Acne prone skin

Acne is one of the commonest nagging skin diseases. It attacks mainly face and back side. Most of us may have suffered from this pesky problem in some part of our life. The main reason for prolongation of acne is our lack of knowledge as to how to handle the problem. Let us discuss something about acne prone skin.

Acne is of two types, Acne vulgaris and Acne rosasea. Acne vulgaris is more commonly seen than the second one. Both of them are having their characteristic properties. Acne vulgaris mainly affects the young age group and the Acne rosasea targets the persons of middle age. It is a fact that the skin condition of both these groups are not common, the skin of younger ones has lot more firm owing to the abundance of fibrofatty tissue. There are much more sebaceous glands in the epidermal layer (the layer of the skin which is situated just below the upper thick layer).

Now let us have an idea of the skin conditions of Acne vulgaris –

Persons whose skin is oily in nature and those who are prone to sweating mostly suffer from Acne vulgaris. The principal etiology of this disease is the increase in the sebum production from the sebaceous glands, which are abundant in the epidermal layer of the skin. The secretion of sebum is much less during infancy. It is highly increased during the time of puberty, reaching its highest level during adulthood and then slowly decreasing with age.

The black heads and white heads form in the hair follicle due to retention of sebum. Retention is due to blockage of the follicular openings. The persons who are having oily skin tend to experience more of this blockage as oils jams the opening. Moreover, dust particles from the environment get adhered to this oil and are deposited. All of these cumulatively block the opening of the follicle. Persons who experience too much sweating are also prone to Acne vulgaris. The excessive sweating is called ‘Seborrhea’. This is a disease where there is hyper secretion of the sebaceous glands of the skin and the scalp. It causes the skin turn out to be extremely oily. Again, some hormones also take part in the release of sebum also. Among them, Androgens takes the leading role. Our diet rich in saturated fatty acids also jeopardizes the condition. Persons who are having thick skin are more acne prone. Thick layer of skin contains more sebaceous glands. This in turn leads to more available oil for the hair follicle.

You need to do something to counteract your oily skin. You can not change your skin type. But you can surely do the following –

Increase your daily water intake. You must take 2-2.5 liters of water everyday. Your diet should contain plenty of green leafy vegetables and fruits. Try to avoid junk foods as far as possible. It contains much oil. Do not shampoo your hair daily. Do not use any toiletries, which aggressively remove oil from your face. It will cause rebound production of oil. Wash your face 5-6 times daily. You must Pat dry with a clean cotton towel.

Now let us be familiar with the skin conditions of Acne rosasea –

It is mainly noticed in adults. People whose skin is generally flushes or blushes are extremely prone to Acne rosasea. Actually, it is an inflammatory condition of the facial skin. Classically, Acne rosasea affects middle aged women. Bright red colored papule erupts over face with surrounding flush and crowned by tiny pus forming areas characterizes this disease. Avoidance of sunlight, any kind of alcohol, hot spicy food is favorable.

Acne complex

Truly, Acne is a complex type of disease. Both the sexes have to suffer from this irritating problem. Let us discuss about acne and its treatment in detail. I shall try to simplify the medical terminology as far as feasible.

Acne is of two types – Acne vulgaris and Acne rosasea. Acne vulgaris is the principal form that we see regularly. We shall know about both of them, but first Acne vulgaris.

It is a self-limiting disorder primarily of the adolescents and the teenagers, though there are some adults who face the same disease. The etiology of the disorder is increased production in the sebum from the sebaceous glands which is situated in the epidermis (the part of the skin just below the keratinized layer of the skin). This excess production is usually seen when the child attains puberty. Comedones, a tiny cystic structure form in the opening of the hair follicles as there is obstruction due to retention of sebum and some keratinized debris. This is the time when the normally occurring bacteria turn hostile and play some deleterious role. They dissolve the sebum and other materials inside the comedones. This releases some free fatty acids which are irritable to the skin. Ultimately the cyst ruptures. The end result is what as we as acne.

Acne vulgais most commonly occur in face. But the chest and the back side can also be involved. In most of the cases, acne remains mild and does not necessarily cause scar formation. It is notices in some patients that the tiny cysts collapse together and major scar formation occurred.

Now let us discuss about the treatment of acne. The affected area of the skin must be kept clean and dry. You should clean our face three to four times a day. Any brand of good quality oil free face wash will suffice. However, there is no need to scrub actively. It may aggravate the situation by opening up the cysts that would not rupture in normal course. Specific antimicrobial creams (which contain Azelaic acid, Benzoyl peroxide, Clindamycin or Erythromycin cream) are the first line of medicine. It should be applied over the whole affected area three times a day after washing with oil free face wash. The technique should not involve rubbing, only gentle laying keeping a thin layer will do. Some topical creams such as Benzoyl peroxide and Retinoic acid are also helpful. They act via changing the pattern of desquamation of skin, as a result lowering the formation of comedones. The dose of these two creams is also same – three times a day. In women, synthetic estrogen cream or oral contraceptive pills are prescribed. Estrogen acts by inhibiting the production of androgen in body. Low level of androgen will reduce the chance of production of sebum. In resistant cases of acne, use of synthetic retinoids is extensively prescribed. Only drawback of synthetic retinoids is that it can not be used in the pregnant women as there is chance of fetal anomaly.

Now let us discuss something about Acne rosasea –

Acne rosasea is mostly seen in the women although most severe cases are found in the men. Persons, who suffer from flush or blush, are prone to develop the disease. After a prolonged and active flushing period, rosasea develop. The other triggering factors are alcohol, spicy food, emotional stress and hot drinks.

It responds well to sodium sulfacetamide or metronidazole cream. More severe and resistant cases may require oral tetracycline.