Acne

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What is it?

Acne may also be called cystic acne or can be referred to by its medical name: acne vulgaris. It is a common disease of human skin. WebMD says that acne starts when dead skin cells and oil clog up an individual’s pores. It is generally characterized with blackheads, whiteheads, pimples, scaly red skin and large papules and, sometimes, scarring as well. Severe acne acne can be inflammatory. The face, back and the chest are the most common areas where acne can be found. For most people, acne starts during adolescence when puberty hits. It can last well into adulthood.

Causes

Acne appears as a result of follicles being blocked. The reasons for these blockages can be psychological, genetic, dietary, and/or infections.

The psychological cause of acne is believed to be stress. Although many would argue against this cause, there have been many studies that show a connection between stress and acne.

The genetic cause of acne is believed to be polygenic. Some of the genes that are believed to be connected with acne are TNF-alpha, polymorphisms, CYP1A1 and IL-1 alpha. Studies with twins and first degree relatives have shown conclusive evidence in support of genetics being a cause of acne.

It has been commonly believed that sugar causes acne. It is actually a high glycemic load that causes acne. These are foods with high counts of carbohydrates. Generally, obesity is linked with acne. There have also been links made with drinking milk.

There is a strain of bacteria known as Propionibacterium acnes that has been circulating around Europe for 87 years. It is unknown how this strain is introduced or develops in the human body. Depending on the person it could be pathogenically acquired or caused by adverse conditions.

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Symptoms

WebMD states that the symptoms of acne include pimples, whiteheads and blackheads which can be found on the shoulders, face, back, neck and chest. Sometimes pimples can grow quite large. These are called cystic lesions. If they get infected they can be really painful and maybe also result in some scarring.

Diagnosis

There are a lot of different grading used in determining the severity of acne. Three of the more popular ones include the Leeds acne grading technique, the Cook’s acne grading scale and the Pillsbury scale. The Leeds acne grading technique categorieses and counts lesions into non-inflammatory and inflammatory. The grading ranges from 0-10.0. The Cook’s acne grading scale involves rating photos of the individual’s acne from 0 to 8. Finally, the Pillbury scale rates the severity from 1 to 4. This is one of the simpler grading systems.

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Treatment

The 4 ways in which acne is treated are through: hormonal manipulation, killing Propionibacterium acnes, anti-inflammatory effects and normalising shedding into the pore to prevent blockage. Hormonal treatments, benzoyl peroxide, salicylic acid, azelaic acid, antiseborrheic medications, anti-androgen medications, keratolytic soaps, nicotinamide, alpha hydroxy acid, retinoids and antibiotics are all known treatments.
Hormonal treatments are only successful when working with women. The combination of oestrogen and anti-androgen cyproterone are what help to reduce high androgenic hormone levels. Benzoyl peroxide is one of the most popular treatments for acne due to its high success rate and low risk of side effects. Also, unlike antibiotics, there is no risk of it producing a bacterial resistance. Antibiotics like clindamycin, erythromycin, miocycline and tetracyclines are all losing their effectiveness as the P. acnes strain’s resistance increases. Retinoids such as adapalene, tretinoin, and tazarotene have been known to be effective against acne. They help to normalize the life cycle of the follicle cell. Certain antiseptics, such as the salt of hydroxyquinoline, are known to be effective in the fight against acne.