The clinical hallmark of acne vulgaris is the comedone, which may be closed (whitehead) or open (blackhead). Closed comedones appear as 1- to 2-mm pebbly white papules, which are accentuated when the skin is stretched. They are the precursors of inflammatory lesions of acne vulgaris. The contents of closed comedones are not easily expressed.
Open comedones, which rarely result in inflammatory acne lesions, have a large dilated follicular orifice and are filled with easily expressible oxidized, darkened, oily debris. Comedones are usually accompanied by inflammatory lesions: papules, pustules, or nodules.
The earliest lesions seen in early adolescence are generally mildly inflamed or noninflammatory comedones on the forehead. Subsequently, more typical inflammatory lesions develop on the cheeks, nose, and chin (Fig. 47-7). The most common location for acne is the face, but involvement of the chest and back is not uncommon.
Most disease remains mild and does not lead to scarring. However, a small number of patients develop large inflammatory cysts and nodules, which may drain and result in significant scarring.
Exogenous and endogenous factors can alter the expression of acne vulgaris.
Friction and trauma may rupture preexisting microcomedones and elicit inflammatory acne lesions. This is commonly seen with headbands or chin straps of athletic helmets. Application of comedogenic topical agents in cosmetics or hair preparations or chronic topical exposure to certain industrial compounds that are comedogenic may elicit or aggravate acne. Glucocorticoids, applied topically or administered systemically in high doses, may also elicit acne. Other systemic medications such as lithium, isoniazid, halogens, phenytoin, and phenobarbital may produce cneiform eruptions, or aggravate preexisting acne.
Acne is a dermatological problem that faces many people especially adolescence and youth.
Fighting Acne is not easy and it may take years , also anti-acne drugs are expensive and not effective 100%.
These are simple 8 tips to fight acne vulgaris naturally :
- Wash your face continuously at least twice per day.
- Dont pop pimples.
- Buy Non-acnegenic products only.
- Drink water as much as possible.
- Avoid sun rays.
- Dont make your hair "oily" touch your face.
- Dont touch your face many times by your hand.
- Eat balanced diet , walnuts , watermelon , yogurt.
Treatment of acne vulgaris is directed toward elimination of comedones by normalization of follicular keratinization, decreasing sebaceous gland activity, decreasing the population of P. acnes, and decreasing inflammation. Acne vulgaris may be treated with either local or systemic medications. Minimal to moderate, pauci-inflammatory disease may respond adequately to local therapy alone. Although areas affected with acne should be kept clean, there is little evidence to suggest that removal of surface oils plays an important role in therapy.
Overly vigorous scrubbing may aggravate acne due to mechanical rupture of comedones.
Topical agents such as retinoic acid, benzoyl peroxide, or salicylic acid may alter the pattern of epidermal desquamation, preventing the formation of comedones and aiding in the resolution of preexisting cysts. Topical antibacterial agents such as benzoyl peroxide, azelaic acid, topical erythromycin (with or without zinc), or clindamycin are also useful adjuncts to therapy.
Patients with moderate to severe acne with a prominent inflammatory component will benefit from the addition of systemic therapy, such as tetracycline or erythromycin, in doses of 250 to 1000 mg/d.
Such antibiotics appear to have an anti-inflammatory effect independent of their antibacterial effect. Female patients who do not respond to oral antibiotics may benefit from hormonal therapy. Women placed on oral contraceptives containing ethinyl estradiol and norgestimate have demonstrated improvement in their acne when compared to a placebo control.
Patients with severe nodulocystic acne unresponsive to the therapies discussed above may benefit from treatment with the synthetic retinoid, isotretinoin. Its use is highly regulated due to its potential for severe adverse events, primarily teratogenicity. Recently there have also been concerns that it is associated with severe depression in some patients.
The latter has not been proved. At present, prescribers must receive from the manufacturer training, certification, and stickers to affix to each prescription. These measures are imposed to ensure that all prescribers are familiar with the risks of isotretinoin; that all female patients have two negative pregnancy tests prior to initiating therapy and a negative pregnancy test prior to each refill; and that all patients have been warned about the risks associated with isotretinoin, including depression. Additionally, patients receiving this medication develop extremely dry skin and cheilitis and must be followed for development of hypertriglyceridemia.