Do you know about - Acne Vulgaris
American Physical Therapy Association! Again, for I know. Ready to share new things that are useful. You and your friends.Risk factors/Triggers
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1. Food/Diet
Foods such as nuts, cola, milk, cheese, fried foods and iodised salts have been concerned as triggers of acne vulgaris; however, the connections between nourishment and acne has not without fail 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 citizen based studies have found links between smoking and acne whilst some others have not [4].
Important!
Contrary to beloved 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 separate 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 generally in patients with darker skin complexions) [1]
Clinical manifestations
In general, acne is puny 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 succeed of four considerable processes as described below [1, 6],
1. Increased sebum yield in the pilosebaceous follicle. Sebum is the lipid-rich secretion goods of sebaceous glands, which has a central role in the improvement of acne and also provides a increase medium for Propionibacterium acnes (P acnes), an anaerobic bacterium which is a normal constituent of the skin flora. Compared with unaffected individuals, citizen 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 convert 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 improvement 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 succeed of the rapid and excessive increase of P acnes [1].
Non-inflammatory acne lesions consist of 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 consist of papules, pustules, and nodules; papules and pustules "result from superficial or deep inflammation associated with puny 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 consist of scarring and hyperpigmentation, which can succeed in broad disfigurement [1].
Psychological Aspects
Numerous psychological problems such as diminished self-esteem, public embarrassment, public withdrawal, depression and even unemployment stem from acne. However, differential determination 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]. Agreeing 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 health characterised by an ultimate level of discontentment 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 regularly while adolescence, and it occurs equally in both male and female. Base areas of concern consist of the skin, hair and nose, with acne being one of the most Base concerns with Bdd patients [3].
According to the Diagnostic and Statistics hand-operated of mental Disorders (2000), Bdd has three diagnostic criteria,
1. A preoccupation with an imagined defect in appearance; where a puny corporeal anomaly is present, the person's concern is markedly excessive,
2. The preoccupation causes clinically considerable distress or impairment in social, occupational, or other foremost areas of functioning,
3. The preoccupation is not caused by other mental disorder (e.g. Anorexia Nervosa)
Characteristic behaviours consist of skin picking, mirror checking, and camouflaging by wearing a hat or excessive make up. Apart from these, patients often seek reassurance oftentimes by request questions such as "Can you see this pimple?" or "Does my skin look okay?" Some patients also have a tendency to physician shop, which is essentially going from one specialist to other in crusade of a dermatologist or plastic surgeon, willing to carry out a desired procedure or dispense a determined drug, to improve their perceived defect [3, 5].
Although it is a relatively Base disease, Bdd is still an under diagnosed psychiatric disorder and is estimated to sway 0.7 to 5% of the normal population. Other psychiatric conditions associated with Bdd consist of 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 ability 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 consist of 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 defiant to topical treatment or which manifests as scarring or nodular lesions. Medications consist of 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 consist of 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 useful succeed on acne [10].
5. Light therapy, which is becoming more beloved due to the growing examine for a convenient, low risk and sufficient therapy, as many patients fail to acknowledge adequately to treatment or construct side effects, from the use of discrete oral and topical treatments available for the treatment of acne [11]. Methods consist of the use of descriptive 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 hereafter directions. Eur Acad Dermatol Venereol 2001; 15 (Suppl. 3):1-4.
7. American Psychiatric Association. Diagnostic and Statistics hand-operated 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. Allinclusive 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 narrative is only for informative purposes. It is not intended to be a medical advice and is not a substitute for expert medical advice. Please consult your physician for all your medical concerns. Friendly succeed any data given in this narrative only after consulting your physician or marvelous medical professional. The author is not liable for any outcome or damage resulting from any data obtained from this article.
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