Acne Vulgaris

Risk factors/Triggers

1. Food/Diet

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

2. Genetics

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

3. Hormones

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

4. Nicotine

Smoking has also been named as a risk factor for acne vulgaris; however, conflicting data exists as to the link between smoking and acne. Some population based studies have found links between smoking and acne whilst some others have not [4].

Important!

Contrary to popular misconceptions by young patients and occasionally their parents, acne does not come from bad behaviour nor is it a disease of poor hygiene. It also has nothing to do with lack of cleanliness [2].

Types of acne vulgaris

There are two main types of acne vulgaris, inflammatory and non-inflammatory; these can be manifested in different ways,

1. Comedonal acne, which is a non-inflammatory acne

2. Papules and pustules of inflammatory acne

3. Nodular acne (inflammatory acne)

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

Clinical manifestations

In general, acne is limited to the parts of the body, which have 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 manifestation of acne vulgaris is the result of four essential processes as described below [1, 6],

1. Increased sebum production in the pilosebaceous follicle. Sebum is the lipid-rich secretion product of sebaceous glands, which has a central role in the development of acne and also provides a growth medium for Propionibacterium acnes (P acnes), an anaerobic bacterium which is a normal constituent of the skin flora. Compared with unaffected individuals, people with acne have higher rates of sebum production. Apart from this, the severity of acne is often proportional to the amount of sebum produced [1, 6].

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

3. Colonisation of serum-rich obstructed follicle with Propionibacterium acnes (P acnes). P acnes is an anaerobic bacterium which is a normal constituent of the skin flora and which populates 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 higher counts 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 plugging a duct of the skin, particularly sebaceous glands. Open comedones, also known as blackheads, "appear as flat or slightly raised brown to black plugs that distend the follicular orifices". Closed comedones, also known as whiteheads, "appear as whitish to flesh-coloured papules with an apparently closed overlying surface" [1].

Inflammatory lesions on the other hand include papules, pustules, and nodules; papules and pustules "result from superficial or deep inflammation associated with microscopic rupture of comedones". Nodules are large, deep-seated abscesses, which when palpated may be compressible. In addition to the typical lesions in acne, other features may also be present. These include scarring and hyperpigmentation, which can result in substantial disfigurement [1].

Psychological Aspects

Numerous psychological problems such as diminished self-esteem, social embarrassment, social withdrawal, depression and even unemployment stem from acne. However, differential diagnosis from a psychosomatic point of view indicates two serious psychological problems, which can arise from acne. These are,

1. Psychogenic excoriation, and

2. Body dysmorphic disorder (BDD)

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

Body dysmorphic disorder (BDD) "is a condition characterised by an extreme level of dissatisfaction or preoccupation with a normal appearance that causes disruption in daily functioning" [3]. Niemeier et al (2006) described it as "a syndrome characterised by distress, secondary to imagined or minor defects in one's appearance." The onset of BDD is usually during adolescence, and it occurs equally in both male and female. Common areas of concern include the skin, hair and nose, with acne being one of the most common concerns with BDD patients [3].

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

1. A preoccupation with an imagined defect in appearance; where a slight physical anomaly is present, the person's concern is markedly excessive,

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

3. The preoccupation is not caused by another mental disorder (e.g. Anorexia Nervosa)

Characteristic behaviours include skin picking, mirror checking, and camouflaging by wearing a hat or excessive make up. Apart from these, patients often seek reassurance frequently by asking questions such as "Can you see this pimple?" or "Does my skin look okay?" Some patients also have a tendency to doctor shop, which is essentially going from one specialist to another in search of a dermatologist or plastic surgeon, willing to carry out a desired procedure or dispense a certain drug, to improve their perceived defect [3, 5].

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

Acne Treatment

1. Topical treatment, particularly for individuals with non-inflammatory comedones or mild to moderate inflammatory acne (See types of acne vulgaris). Medications include tretinoin (available as gels, creams, and solutions), adapalene gel, salicylic acid (available as solutions, cleansers, and soaps), isotretinoin gel, azelaic acid cream, benzoyl peroxide (available as gels, lotions, creams, soaps, and washes), to mention a few [1, 2].

2. Oral treatment, particularly for acne that is resistant to topical treatment or which manifests as scarring or nodular lesions. Medications include oral antibiotics (e.g. tetracycline, doxycycline, minocycline, erythromycin, and co-trimoxazole), oral isotretinoin, and hormonal agents (e.g. oral contraception, oral corticosteroid, cyproterone acetate, or spironolactone) [1, 2].

3. Physical or surgical methods of treatment, which are sometimes useful as adjuvant to medical therapy. Methods include comedo extraction, intralesional injections of corticosteroids, dermabrasion, chemical peeling, and collagen injections, to mention a few [1, 9].

4. Sun exposure, reported by up to 70% of patients to have a beneficial effect on acne [10].

5. Light therapy, which is becoming more popular due to the growing demand for a convenient, low risk and effective therapy, as many patients fail to respond adequately to treatment or develop side effects, from the use of various oral and topical treatments available for the treatment of acne [11]. Methods include the use of visible light (e.g. 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.

Recommended Products for Acne

References

1. Brown SK, Shalita AR. Acne vulgaris. Lancet 1998; 351:1871-1876.

2. Webster GF. Acne vulgaris. Br Med J 2002; 325: 475-479.

3. Bowe WP et al. Body dysmorphic disorder symptoms among patients with acne vulgaris. J Am Acad Dermatol 2007; DOI: 10.1016/j.jaad.2007.03.030.

4. Rzany B, Kahl C. Epidemiology of acne vulgaris. JDDG 2006; DOI: 10.1111/j.1610-0387.2006.05876.x

5. Niemeier V, Kupfer J, Gieler U. Acne vulgaris-Psychosomatic aspects. JDDG 2006; DOI: 10.1111/j.1610-0387.2006.06110.x

6. Gollnick H. Current perspectives on the treatment of acne vulgaris and implications for future directions. Eur Acad Dermatol Venereol 2001; 15 (Suppl. 3):1-4.

7. American Psychiatric Association. Diagnostic and Statistics Manual of Mental Disorders. 4th Ed. Accessed via: BehaveNet® Clinical CapsuleTM; http://www.behavenet.com/capsules/disorders/bodydysdis.htm. Accessed on: 28th June 2007.

8. Phillips KA et al. A retrospective follow-up study of body dysmorphic disorder. Comprehensive Psychiatry 2005; 46: 315-321.

9. Taub AF. Procedural treatments of acne vulgaris. Dermatol Surg 2007; 33: 1-22.

10. Cunliffe WJ, Goulden V. Phototherapy and acne vulgaris.Br J Dermatol 2000; 142 (5): 855-856.

11. Dierickx CC. Lasers, Light and Radiofrequency for treatment of acne. Med Laser Appl 2004; 19: 196-204.

Disclaimer

This article is only for informative purposes. It is not intended to be a medical advice and is not a substitute for professional medical advice. Please consult your doctor for all your medical concerns. Kindly follow any information given in this article only after consulting your doctor or qualified medical professional. The author is not liable for any outcome or damage resulting from any information obtained from this article.

http://www.allergymatters.com

14 things you should know about adult Acne

Have you ever looked in the mirror and uttered these words under your breath, 'Why am I still breaking out'? Did you wonder why, even in your adult years, you still have to put up with acne? The idea that acne should be a thing of the past - a teenage problem - can leave adults frustrated not knowing what is causing their skin breakouts. Here are 14 things you should know to help you identify the causes of your flare-ups and ways to prevent them.

#1 Blame it on the hormones
Androgens, like testosterone, are male hormones (present in women too) which are responsible for causing acne. Women undergo sharp hormonal changes more often than men, so women are twice as likely as men to be afflicted with acne during adulthood. Given this fact, it is no wonder why acne can strike anytime in a woman's life - during puberty, ovulation, menstruation, pregnancy, menopause, and even after menopause. Female acne can also be a symptom of Polycystic Ovarian Syndrome (PCOS) which is a disorder caused by hormonal imbalances; however, usually, these individuals are overweight, have fertility issues, do not have regular periods and grow excess hair in unwanted areas, such as the upper lip, chin and chest (more manly distribution of hair). In addition, some people who have thyroid problems may also have trouble with acne. It is also interesting to know that although men are at a lower risk for adult acne, men are more prone than women to have more severe forms of acne because of the higher levels of testosterone naturally circulating within a man's body.

#2 Quit smoking
Did you ever notice the complexion of a longtime smoker? It is not supple and often looks dry, rough and leathery. Recent studies have discovered a phenomenon labeled as 'smoker's acne'; the acne in smoking individuals is non-inflammatory (bumps with no swelling or redness), commonly known as blackheads and whiteheads. Inflammatory acne, on the contrary, is when the spots are red, pus-like and swollen. Research shows that for people who had acne as teens, the probability of suffering from adult acne is four times higher in smokers than non-smokers. According to a British Journal of Dermatology, a study of 1000 women aged 25 to 50 found that 42 per cent of smokers had acne compared to only 10 per cent of non-smokers. It is a good idea to kick the habit, not only for health reasons, but also for the reason that smoking has long been associated with premature aging of the skin, wrinkles and a bad complexion.

#3 Check skin products
Sometimes the products you are applying on your face can trigger breakouts so pay close attention to your cosmetics, shaving creams, cleansers, moisturizers and makeup. Steer away from products with an oil-base which can block pores resulting in acne. Allow your skin to breathe and only put oil-free (noncomedogenic) products on your skin.

#4 Side effects of drugs
Since hormones are the main cause of acne and most acne cases are not drug-related, do not stop using your medications. However, bear in mind that some medications can cause acne breakouts. Phenobarbital (medication used for seizures), steroids (prescribed and illegal use in bodybuilding), lithium (medication for bipolar disorder), isoniazid and rifampin (medication used in tuberculosis), DHEA supplements (marketed as the extremely controversial anti-aging pill which causes serious side effects and has not been proven to work), hormone therapies and certain birth control treatments can cause or worsen acne. Again, talk to your doctor before discontinuing any medication.

#5 Your skin is what you eat
Although skepticism still exists in the dermatology community linking diet with acne, some people swear that certain foods cause them to break out. Until more solid evidence is out, the link between certain foods causing acne remains to be controversial. With that said, if you notice something you eat causes you to break out in pimples, avoid the food; by the same token, there is no guarantee that avoidance will necessarily cure your acne, but it is worth a try.
-Nuts: Although nuts are healthy snacks that calm our hunger pangs quickly because they are satiating, they can provoke acne in some individuals.
-Dairy: Recent studies have shown that milk and dairy products may trigger acne. It is not recommended to stop dairy as a means to improve your skin until more studies are conducted. Calcium is abundant in dairy products and is crucial for osteoporosis prevention. If your dairy intake is low, make sure to take dietary supplements to keep your bones strong.
-Chocolate: Some people experience pimples when they eat chocolate while it may not even faze others. It is not proven that chocolate causes acne and some claims have gone as far as saying 'a bar a day keeps the spots away' suggesting that chocolate can even cure acne!
-High glycemic foods: There is some evidence that foods with high-glycemic indices (sugared drinks, sweets, white bread and carbohydrate-rich foods) produce a quick spike in blood sugar which may aggravate acne. Although debate still exists in the scientific community around the notion that greasy and fatty foods worsen acne, many still carry the belief that it is definitely a contributor to acne. It has also been proposed that switching to a plant-based, low-fat, high-fiber diet can reduce acne flare-ups since vegetables and fruits are natural anti-oxidants and have anti-inflammatory properties. Eating more fish may also pave the way for clearer skin as they are rich in omega 3-oils which is known to reduce inflammation.
-Acne-fighting foods: Essential fatty acids (flax seeds, fish), Vitamin A (carrots, green leafy vegetables, sweet potatoes), zinc (whole grains, spinach), Vitamin E (green leafy vegetables), Vitamin C (citrus fruits, green peppers) Vitamin B-complex (brown rice, bananas), chromium (whole wheat breads, broccoli) and selenium (fish, lean meat, garlic, barley) are a sample list of foods that are rich in acne-suppressing vitamins and minerals. It is best to get these nutrients by eating enriched foods; do not take supplements without consulting a medical professional as overdosing can occur.

#6 Stay regular
Constipation can trigger acne by keeping toxins in your body. Eating a diet rich in fiber, drinking water and maintaining an active lifestyle will help prevent constipation and may be just what you need to clear up your skin.

#7 Stress-management
Stress-induced acne has been a highly debated topic and, recently, numerous studies have proven that stress does, in fact, worsen acne. Stress causes acne by lowering our immune system's ability to heal and causing androgens and cortisol to be activated which are acne promoting hormones.

#8 It is in the genes
Your genes may control your skin type. Adults with oilier skin are more prone to acne breakouts; also if acne runs in your family, chances are you will develop acne in your adult years. People who have the 'perfect-skin gene' should really know how lucky they are.

#9 Climate
Does the weather affect acne? It is not hard to believe that hot and humid weather may cause more break-outs due to excess sweating; however, sweating alone does not clog pores, rather the mix of sweat with exposure to oils and polluted air provides a better environment for acne to erupt. It is also important not to use the sun to dry out your acne as over-exposure will prematurely age the skin, darkens spots and may flare up acne, let alone the cancerous effects of the sun's harmful ultraviolet rays. How about the cold weather? Winter tends to worsen acne since cold weather causes the skin to dry out and the pores to shrink, leading to more clogging of pores. It is essential to moisturize, year-around, to help keep acne from worsening. Just because the weather is cold, does not mean you should skip the sunscreen since the sun's rays are still strong and can penetrate even on a cloudy day or through the windshield while driving. Sunscreens should, not only be used in the summer, but also in the winter.

#10 Pressure and Friction
Adult acne can be caused by certain types of constant physical pressure to the skin, such as tucking a phone under the chin, or the friction from the straps of a backpack or purse. Tight clothing and undergarments, such as tight bra straps, and even excessive phone use can contribute to acne.

#11 Dehydration
Not only does too much sun exposure and cold weather worsen acne by drying out the skin, but dehydration from lack of fluid intake can also cause breakouts. Hydrating the skin by hydrating the inside of your body will help prevent clogging of pores. Any caffeinated drinks, such as soda, tea and coffee, are dehydrating because they have diuretic properties (increase urination) so limit their intake. Water is the best fluid for your skin.

#12 Dirt
Clogged pores cause acne. Acne strikes when bacteria, excess oils and clogged pores are present. Although, dirt itself does not cause acne, it is essential to maintain a daily hygienic skin regimen in order to remove dead cells, dirt and excess oils to prevent blockage of pores. Avoid touching your face because your fingers have oils that can exacerbate acne. Dirty, oily hair touching your skin can also clog pores.

#13 Work out
There is strong evidence suggesting that exercise may clear up skin by lowering stress levels. Sweating is a normal bodily function and does not directly cause acne; nonetheless, it is still recommended to pull your hair away from your face during exercise to avoid oils from your hair touching your face and wash away or towel off sweat when you finish working out.

#14 Get good sleep
Not getting enough sleep increases stress which can lead to acne. In addition, studies have shown that sleep deprivation increases inflammation, thus exacerbating acne.

Sometimes, more than one factor may be causing your acne and it is not always easy to figure it out. Achieving clear skin may be as simple as switching your facial cream to a complex problem that requires a specialist. You might be surprised that just by lowering your stress, your complexion might improve. Remember sometimes, you might feel worse than your face actually looks and, without a doubt, you are your own worst enemy. Keep in mind that a natural glow comes from within, not just from an absence of pimples.

Dr Sandy Zabaneh is a US board-certified Doctor in Pharmacy who holds a Bachelor of Science degree in Psychology, as well as a Bachelor of Science degree in Physiology from University of California, Davis. She is the Health Editor of U Magazine, clinical pharmacy consultant and life coach. Dr Sandy likes to follow the motto set forth by the World Health Organization in 1948: Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. Check out her blog at http://www.sandyzabanehblog.com

Over The Counter Ideas For Treating Your Acne

There are many products designed to treat acne. Some of these products are formulated to serve a specific purpose while others are dedicated to treating the general symptoms of acne.
This article discusses some of the basic products sold over-the-counter that can help prevent and combat acne. Remember, if products sold in most drugstores aren't helping your condition, it may be advisable to seek medical attention.

Soap and water is the most basic product to help fight acne. Depending on your skin type, sensitivity, and possible allergies, you may want to choose a soap carefully so as to prevent further breakouts or irritation.

When you wash your face, you are removing excess oils that build up on your skin, clogging pores and causing pimples to form. Although it is strongly recommended that you not wash your face too often, and that you don't scrub vigorously, as this can remove too much oil and irritate the skin, washing your face twice or even three times daily can remove unwanted dirt and oils and help control your breakouts.

Benzoyl peroxide is another very common remedy that can be purchased over-the-counter to help fight acne. It is often recommended by physicians, it is usually used to treat mild forms of acne. It is present in many acne treatment products, and was the first product to be proven effective in treating acne.

Benzoyl Peroxide is helpful in fighting bacteria and stops excess oil from clogging pores. It is available in the forms of a lotion or a cream.

Salicylic acid is commonly used in many over-the-counter acne cleansers and treatments, and when applied to the skin, helps to correct the abnormal shedding of cells. In milder forms of acne, it helps to unclog pores and prevent lesions we know of as pimples.
Salicylic acid does not stop oil production. Like Benzoyl Peroxide, it must be used continually in order to see its effects.

Sulfur is also another common product found in many over-the-counter acne treatments. It has been used for years in conjunction with other products to help combat acne. Due to its unpleasant odor, sulfur is less often used by itself to treat acne.

Although it is widely used, and common in many treatments, it is not known exactly what characteristics help heal acne. Nevertheless, results have been shown and it continues to be used.

Herbal and natural products are often available for purchase over-the-counter to treat acne. Most of these products are organic, and have not been tested clinically to determine their effectiveness. In spite of this, they are sometimes preferred, and their usage is said to be increasing.

There are many over-the-counter options available to help heal and prevent acne. Different products react differently to different skin types, and the effects are different for everyone. It is important to find what works for you and stick to it.

For more acne treatment education, visit our post on Acne home treatments.

Treating Your Acne Scars

Without a doubt, one of the most challenging effects of acne is the physical scarring it can leave behind. Even the mildest type of acne can scar, but the more severe types can leave very visible scars that won't go away on their own.

There are things you can do to try to minimize these scars, like properly cleansing your skin, or refraining from popping zits, as this can cause scarring, but this doesn't mean scars won't develop. This is particularly true in more severe types of acne where the lesions are on the skin for longer periods of time than in milder forms. In cystic acne, the nodules or cysts can stay on the skin for weeks, or even months, and can leave behind very visible scars.

There are different types of acne scars, and differing treatments available for each.

• Ice pick scars for example are characterized by the appearance of deep pits on the skin and are a most common sign of classic acne scarring.

• Boxcar scars are angular scars, usually occurring on the temple and cheeks, and can be superficial or deep. They are similar to the scars left by a bout of the Chickenpox.

• Rolling scars give the skin a wave-like texture.

• Hypertrophic scars are thickened scars


To get rid of acne scars, seek treatment through a dermatologist. A combination of treatments are available that show positive results for many people. Treatment for acne scarring depends on the number of scars you have, as well as your skin type.

Most of the success of treating acne scars has been for those on the face. Back and chest scars are more difficult to treat and do not react as well to treatment.

One of the optimal ways to prevent acne scarring is to prevent acne. Taking steps to fight and prevent this condition will minimize the chance for scarring. Also treating the acne you do have as quickly as possible after it appears can help prevent acne scars.

It is also prudent to seek the help of a physician when you aren't sure how to best treat your acne or its scars. Some scar treatment requires medical attention, and a physician can help you find the treatment that will work best for you.

knowing your skin type, type of acne, and type of scarring associated with it is also important. If you treat your specific type of acne from the onset, you can prevent the rise of deep, lasting scars.

In some cases the scar can be removed by laser treatment, but this is only in more serious cases where the scars are deep.

Understanding your problem will help you work toward a constructive solution.

For more information on Acne Education, visit www.acne-education.com

Facing Acne: How to Cope With its Effects on Teenagers

Facing Acne:

As we are all aware of, there are various emotional effects caused by acne. More than the physical appearance, there are effects of acne that are at times not as easily healed by any cream or acne solution.

Severe acne can leave emotional scars. As much as they might try, dermatologists cannot always address the difficult emotional impact caused by acne.

For teenagers experiencing the pains of acne, it is especially difficult to face the social impacts. Depression and self-pity can easily arise. As a parent of a teenager who faces this problem, it’s important to remember that while acne isn’t a life threatening disease, to the teenager that suffers from it, it certainly feels that way.

Remind your child that acne is temporary

Give encouragement to your child. Remind them that it will not last forever.

Most importantly, don’t wait for your teen’s acne problem to get worse before you go and see a dermatologist. The earlier the better, this may be cliché but very true for this matter and you could realize the truth behind this.

Be with your teen as you have visits to the dermatologist. Also, help your teen follow the reminders and instructions of the dermatologist.

Guide your teenager

There are some things that may worsen acne. See to it that you are near your teen to remind them what is the right thing to do and it would just cause bad effects. Explain the cause and effect of acne problems and be sure t answer questions that your teen has.

Boost your teen’s self-confidence

Self-confidence can fall drastically when acne flares up. Be there to boost the esteem he or she has inside. Be generous with praises but do not use them just to flatter. Tell your teen about how wonderful they are, but most importantly show them that you understand the difficulty and depression they feel.

For more information on Acne Education, visit www.acne-education.com