Acne Vulgaris

Posted on Friday, December 9, 2011 by Zhan

sizcache = "0" sizset = "67">

Risk Factors / Triggers

1 Food / Diet

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

2 Genetics

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

3 Hormones

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

4 Nicotine

Smoking has also been appointed as a risk factor for acne vulgaris, however, conflicting data exist as a link between smoking and acne. Some population based studies have found links between smoking and acne, while others have not [4 ].

Important!

Contrary to popular misconceptions of young patients and their parents from time to time, acne does not come out of bad behavior, or disease is poor hygiene. It also has to do with the lack of clarity [2 ].

types of acne vulgaris

There are two main types of acne vulgaris, inflammatory and non-inflammatory, and can manifest itself in different ways,

1 Comedonal acne, which is non-inflammatory acne

2 Papules and pustules of inflammatory acne

3 Nodular acne (inflammatory acne)

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

clinical manifestations

In general, acne is limited to body parts, which are 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 manifestations of acne vulgaris is the result of four basic processes, as described below [1, 6 ],

1 Increased production of sebum in the follicle of fat. Sebum is a lipid-rich secretion of the sebaceous gland product, which plays a central role in the development of acne, and also provides a medium for the growth of Propionibacterium acnes (P acnes), anaerobic bacteria that are normally part of the skin flora. Compared with unaffected individuals, people with acne have higher rates of sebum. In addition, the severity of acne is often proportional to the amount of sebum [1, 6 ].

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

3 Colonization in serum-rich obstructed follicle with Propionibacterium acnes (P acnes). P acnes is anaerobic bacteria that are normally part of the skin flora and that completes 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 a higher number 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 of the channel in the skin, particularly sebaceous glands. Open comedones, also known as blackheads, "appear as flat or slightly raised brown to black plugs that distend the follicle openings." Closed comedones, also known as whiteheads, "appear as a whitish-colored papules with apparently closed overlying surface" [1 ].

inflammatory lesions, on the other side of the papules, pustules and nodules, papules, pustules "result from the superficial or deep inflammation associated with microscopic rupture of comedones". Nodules are large, deep abscesses, which when palpated may be compressible. Besides the typical lesions of acne and other features May also be present. These include scarring and hyperpigmentation, which can result in significant disfigurement [1 ].

Psychological aspects of the

A number of psychological problems, such as decreased self-esteem, social embarrassment, social withdrawal, depression and even unemployment stem from acne. However, the differential diagnosis of a psychosomatic point of view indicates two serious psychological problems that may arise from acne. These are the

1 Psychogenic conviction, and the

2 Body dysmorphic disorder (bdd)

Psychogenic sentence also referred to as neurotic conviction, pathological or compulsive skin picking, "characterized by excessive scratching or picking of normal skin or skin with minor irregularities" [5]. According to Niemeier et al (2006) estimated to occur in 2% of dermatological patients. Patients with this disorder may have a psychological disorder, such as mood and anxiety disorders, as well as related disorders such as obsessive compulsive disorder, substance abuse disorder, obsessive compulsive personality disorder, compulsive buying, eating disorders and borderline personality disorder, to mention a few [5 ].

body dysmorphic disorder (bdd) "is a condition characterized by extreme levels of dissatisfaction or preoccupation with a normal appearance that causes disruption in daily functioning" [3]. Niemeier et al (2006) has described as "a syndrome characterized by distress, secondary to imagined or minor defects in a single figure." Bdd attack is usually during adolescence, and it occurs equally in both men and women. Common areas of interest include skin, hair and nose, acne is one of the most common problem with patients bdd [3 ].

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

1.Zaokupljenost imagined defect in appearance, where a slight physical anomaly is present, the person concerned a very excessive,

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

3.Preokupacija not caused by another mental disorder (eg anorexia)

Characteristic behaviors include skin picking, mirror checking, and camouflaging wear a hat or excessive make up. In addition, patients often require insurance often ask questions like "Can you see this pimple?" or "Does my skin look good?" Some patients also tend to doctor shop, which is essentially going from one specialist to another in search of a dermatologist or plastic surgeon willing to perform the desired operation or share some drugs, to improve their perceived defect [3, 5].

Although a relatively common disease, bdd is still under diagnosed psychiatric disorder and is estimated to affect at 0.7 to 5% of the general population. Other psychiatric conditions associated with bdd include 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 extremely poor quality of life [3, 5, 8 ].

acne treatment

1 Topical treatments, especially for people with non-inflammatory comedones or mild to moderate inflammatory acne (See types of acne vulgaris). Drugs are tretinoin (available as gels, creams and solutions), adapalene gel, salicylic acid (available solutions, cleaners, and soaps), isotretinoin gel, azelaic acid cream, benzoyl peroxide (available as gels, lotions, creams, soaps, and washes ), to name just a few [1, 2 ].

2 Oral treatment, especially for acne that is resistant to topical treatment or which manifests as scarring or nodular lesions. Drugs were oral antibiotics (eg tetracycline, doxycycline, minocycline, erythromycin, and co-trimoxazole), oral isotretinoin, and hormonal agents (eg oral contraceptives, oral corticosteroid, cyproterone acetate, spironolactone, or) [1, 2].

3 Natural or surgical treatments, which are sometimes useful as an adjuvant to medical therapy. The methods include extraction of blackheads, Intralesional corticosteroid injections, dermabrasion, chemical peel and collagen injections, to mention only a few [1, 9 ].

4 Sun exposure, according to 70% of patients had a beneficial effect on acne [10 ].

5 Light therapy, which is becoming increasingly popular due to rising demand for convenient, low risk and effective therapy, and many patients do not respond adequately to treatment or develop side effects from the use of various oral and topical treatments available for acne treatment [11]. The methods include the use of visible light (eg 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.

Acne Vulgaris

What's on Your Mind...