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Acne is a condition
that affects areas of the skin that contain a large number
of oil glands. This would include the nose, the forehead,
cheeks, chin, back, and trunk. It is very common in adolescents
and generally disappears by age 30. Males are more likely
to get acne and tend to have more severe cases. In females
acne seems to last longer. Acne is caused by a disorder
of the oil glands that result in clogged pores and outbreaks
of lesions known as pimples. Although it is not a serious
health threat, severe acne can be painful and may cause
permanent scarring. It can also make people miserable and
cause social and psychological problems. |
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Signs
and Symptoms |
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There are
various types of acne lesions:
Comedone – general term for an enlarged hair follicle
plugged with oil and bacteria. This is the smallest type
of lesion.
Open comedone (blackhead) – a plugged follicle that reaches
the surface of the skin. Although dark in appearance,
blackheads do not indicate the present of dirt.
Closed comedones (whitehead) – are clogged follicles
that stay beneath the skin. Whiteheads usually appear
on the skin as round, white bumps roughly 1 to 2 mm in
diameter.
Papule - inflamed lesions that appear as small, pink
bumps on the skin
Pustules (pimples) – inflamed pus-filled lesions that
are red at the base
Cysts and nodules – large, inflamed, pus-filled lesions
that are lodged deep and can drain, causing pain and scarring
In some cases acne can lead to scarring. Picking at or
squeezing the pimples can often leave a pitted appearance
that may or may not be permanent. |
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Causes |
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Acne is a disorder
of the skin’s oil glands. It develops because the sebaceous
glands are overactive. Oil glands make a substance called
sebum that normally rises up through a hair-containing canal
called a follicle and empties onto the skin surface. During
adolescence , rising hormone levels are thought to increase
the number of oil glands and the amount of sebum produced.
This overproduction of sebum causes blockage of the hair
follicle, leading to the formation of small bacteria filled
cysts called comedones. If the comedones remain intact and
don’t rupture, they progress to open comedones (whiteheads)
or closed comedones (blackheads). When comedones rupture,
and inflammatory reaction occurs and spreads into the surrounding
tissues, the inflammatory lesions are papules, pustules,
cysts, and nodules. |
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Risk
factors |
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- Family history of acne
- Greasy /oily cosmetics, or workplace
environment
- Hormonal changes associated with
adolescence, pregnancy or menstruation (acne tends to
flare up 2-7 days before menstruation begins)
- High levels of humidity
- Sweating and friction from items
such as headbands , back packs, bicycle helmets
Note – There is no evidence that
fatty foods, candies or chocolate either cause or aggravate
acne. |
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Making the Diagnosis |
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Acne has a characteristic
appearance and is not difficult to diagnose. A Family physician
can treat most patients with mild and moderate acne. People
with severe cases of acne are referred to a dermatologist.
Your doctor will take a complete medical history including
questions about cosmetic use, any medications you may be
on, or factors that trigger flare-ups, and your work environment.
This is done to rule out the other possible skin conditions.
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Treatment
Approach |
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The main goals
of acne treatment are to prevent scarring, reduce the number
of lesions and prevent recurrence. Wash your face twice
a day using a gentle, unscented soap, and pat dry. Creams
and lotions containing benzoyl peroxide are widely available
without a prescription. They are designed to wear away the
top layer of skin (exfoliate) as well as to unplug the clogged
pores. The skin improves over two weeks and the cream or
lotion is used afterwards to maintain its effectiveness.
Sunlight is helpful for many people. For some women, taking
birth control pills can help regulate the hormones that
cause acne flare-ups. For more severe acne, an antibiotic
lotion or retinoic acid (a derivative of vitamin A) usually
works. For inflamed acne, antibiotic pills may be given.
If there is a risk of scarring, an oral retinol may be used
- but they should be used with caution by women. It’s important
to discuss benefits and risks of these drugs with your doctor.
For deep acne scarring, collagen injections and laser resurfacing
may be used. |
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Controlling
Acne |
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- Don’t pick at pimples because this may worsen the
condition and result in scarring.
- Wash your face twice a day using a gentle soap.
- Use a fresh washcloth every day.
- Use an astringent such as alcohol after washing your
face.
- Use “noncomedogenic” cosmetics, which won’t cause
acne.
- Wash off sweat and oil as soon as possible.
- Blackheads should be removed by your doctor.
- Shampoo your hair at least twice a week.
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