Acne Vulgaris

• Acne vulgaris is a skin disorder characterized by cysts, open and closed comedones (plugged lesions containing a "cottage-cheese" like material), pus pockets, and raised red swellings.
  
• Acne is a very common problem of preteens and teenagers; usually, it starts about 1 to 2 years before the actual onset of puberty.
  

Often occurs in puberty, though may occur in the 20s or 30s May actually occur in neonates (babies) Open and closed comedones Pus pockets Raised, red areas of skin Pustular lesions (infected scabs) Most commonly on face, back, and chest Scarring may occur over time Pain, soreness, and itching may occur. May improve in summer May worsen before menses Males have a more severe form of acne, and a later onset than females.

The true cause is often unknown. Androgens (hormones) tend to trigger acne in those predisposed. There are several reasons that teenagers get acne: Hormonal changes cause an increase in facial oils (a secretion called sebum) and allow increased growth of a bacterium, Propionibacterium acnes. Facial oil and dead skin cells clog oil-secreting pores, causing skin irritation and inflammation. Two types of Pimples (comedones) -- open and closed: Open comedones, or "blackheads," are less severe and are more easily treated. Closed comedones, or "whiteheads," are more severe and more difficult to treat. They also are more likely to lead to development of cysts. Pustules and cysts are collections of infectious pus, fluid, and dead skin cells. They are most likely to cause permanent changes and scarring. Plugging of hair follicles by a protein known as keratin causes the formation of so-called whiteheads and blackheads, which form when the plugged sebaceous glands within the hair follicles continue to secret sebum (an oily secretion). Sebum and skin cells cannot exit, thus accumulating in mass, causing the follicle to swell. If the swelling continues, it may rupture, allowing the surface bacteria (normally found on the skin) to enter and cause local infections (e.g., zits or Pimples). The zits may then enlarge and form cysts. Irritating creams and oils Topical steroid creams Corticosteroid medication taken orally Adolescence, male sex, certain drugs (e.g., Dilantin, steroids), humid/hot weather, supplements (e.g., DHEA), and constant skin friction (e.g., use of motorcycle helmets, telephones) are some of the common risk factors.

Examination by physician to rule out other causes. Usually, diagnosis is self-evident. If oral therapy with Accutane is being considered, most doctors will do some testing before starting the medicine, and periodically thereafter.

Predisposing: Puberty Cushing's syndrome Polycystic ovarian disease

Avoid manipulating or infecting acne lesions by touching with hands. Diet does not seem to play a role unless the patient notices a certain food that makes his acne worse. Comedo extraction done with a comedo extractor Medications: Benzoyl peroxide available over the counter in many forms such as gels, washes, etc. Stronger is not better (2.5% is just as effective as 10% solution, but less irritating). Topical antibiotics such as Clindamycin (Cleocin T), Erythromycin Gel. Antibiotics by mouth such as tetracycline, erythromycin, and minocycline Retin A cream or gel Isoretinoin (Accutane) -- this is a very strong medicine that must be followed carefully by your doctor. This drug causes significant birth defects, so pregnant women must avoid it. - Note: All medications usually take six weeks or more to realize results. Intra-lesion injection: Deep acne lesions and cysts are injected with a corticosteroid medication. Dermabrasion Some young women notice their acne improves with use of oral contraceptives (the "pill"). Some people think their acne gets worse if they eat a high-fat diet or lots of chocolate, or if they are "stressed-out." However, there is no medical evidence to support this.

Acne can cause permanent scarring of the face if not treated. The topical medicines used often cause dryness of the skin. This can be managed by use of moisturizers that are "non-comedogenic" (non-pimple-forming). Retin A can increase the risk of sunburn, so teens using this medicine should wear a sunscreen daily. Accutane causes birth defects in unborn babies. Consequently, most doctors require young women using this medication to receive a negative pregnancy test and use oral contraceptives. It is also associated with an increase the risk of suicide in teens with a history of depression.

Use a mild soap to wash the face twice daily. Young women should use make-up and moisturizers labeled "non-comedogenic" whenever possible.