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Other Names:
Pimples, Zits, Acne Vulgaris

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Definition

The most common skin disease in the industrialized world, Acne is used to define conditions of clogged pores (blackheads and whiteheads), pimples and deeper lumps (cysts or nodules) on the skin. Acne can appear anywhere on the body but usually acne is found on the face, neck, back, shoulders and chest areas. Acne affects people of all ages, particularly teenagers. Acne is not by itself a threat to health but it can lead to scarring of the tissues. Squeezing the acne or picking them open in non-sterile conditions can sometimes lead to infections which in the most severe cases can result in death. It is often a source of discomfort and embarrassment for those suffering from acne, although very often the acne sufferers are overly sensitive and self conscious.

Commonly, acne first appears in patients between the ages of nine and fourteen, typically lasting anywhere from five to ten years at which times it goes away. Sometimes acne can last well into adulthood or appear for the first time in adulthood.

Young men tend to have more severe acne or acne that last longer. Acne tends to appears intermittently in young women and thatís thought to be due to the use of cosmetics or hormonal changes associated with the menstrual cycle.

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Symptoms

There are a variety of Acne lesions, ranging in severity from mild to severe. Mild and moderate acne can often be treated by astringents and other commercially available over-the-counter skin care products, while severe acne is potentially disfiguring and is best treated by a dermatologist.

Mild Acne:

Whiteheads:

Comedones are sebaceous follicle plugged with small sized hairs, sebum, dead body cells from inside the sebaceous follicle and sometimes bacteria. A closed comedo is commonly called a whitehead; its appearance is that of a skin-colored or slightly inflamed "bump" in the skin. A comedo that stays under the skin will enlarge the hair follicle and create a small raised bump with a whitish appearance referred to as a whitehead.

Blackheads:

If a comedo breaches the surface of the skin, it will slowly begin draining its contents onto the skin. When a comedo is open, it is called a blackhead because the surface of the plug in the follicle has a blackish appearance. The blackish hue is not caused by dirt lodged under the skin, as is commonly thought; but a reaction of melanin (skin pigmentation) to oxygen exposure.

The blackhead has a different color from the whitehead acne because the blackhead acne has distended follicular opening whilst in the whitehead acne, the opening of the plugged sebaceous follicle to the skinís surface is either closed or very narrow.

Moderate Acne:

Papules:

Papules are small (5 millimeters or less), tender but solid bumps on the skin caused by a minor infection of a comedo. Some small papules and tiny comedones are almost invisible but make the skin feel rough to the touch. These do not reach the surface of the skin and should not be squeezed. Squeezing a papule will push bacteria deeper into the skin and potentially lead to a nodule or cyst developing. A papule is the localized cellular reaction to the acne.

Pustule:

Pustules are inflamed versions of the whitehead acne. They are usually semi-spherical in shape and are fragile lesions filled with pus consisting of dead skin cells, white blood cells and bacteria. They appear as larger versions of whiteheads with a red, sore base and a white or yellow center. Usually a pustule that forms over a sebaceous follicle has a hair in the center. Improper drainage of a pustule may lead to scabbing and scarring or the spread of acne lesions to nearby areas of the skin. If the acne pustule heals without progressing to cystic form, no scar will remain.

Severe Acne:

Nodule:

A nodule is a solid, large and very painful lesion and is usually semi-spherical in shape, though sometimes it can be irregular in shape. It does not break the surface of the skin and is lodged in deeper layer of the skin. The nodule is usually inflamed and may destroy the tissue and cause scarring. Nodule acne should be treated by a dermatologist who will be able to alleviate swelling and prevent scarring. Nodule acne should not be squeezed under any circumstances as this would lead to prolonged infection and almost certain scarring. Acne nodules are painful and are a severe form of acne that does not readily respond to therapies except isotretinoin.

Cyst:

Cysts appear similar to nodules as large (5mm across or more), painful bumps on the skin. Cysts, however, are filled with pus. Like nodules, cysts are likely to cause scarring and should be treated by a dermatologist. Cysts are larger than pustule acne and are often seriously inflamed. A cyst is normally very painful and the lesion containing liquid or semi-liquid white blood cells, dead cells, and bacteria goes into the deeper layers of the skin. If the cyst is squeezed, the pus could be driven deeper into the skin causing scarring, more severe pain and inflammation and prolong the duration of recovery from the acne. Cysts and nodules tend to appear simultaneously in a severe form of acne called nodulocystic. Treatment is difficult and usually includes isotretinoin.

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Implication

Acne (especially severe cases) is a potentially disfiguring condition. It can lead to scarring and pitting of the skin. People suffering from acne (usually adolescents) are often embarrassed by the blemishes, resulting in diminished self esteem and social interaction. If acne is not properly cared for, the resulting infection may cause complications or death.

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Possible Causes

Strictly defined, acne is caused a clogging of pores by sebus (oil) and bacteria. It is well-known that acne is a common part of adolescence and puberty. This is because male hormones known as androgens undergo an increase in production during this phase of development in both men and women. Androgens such as testosterone increase production of oil in the sebaceous glands, which creates an environment where bacteria that live on the skin increase in numbers by feeding on the oil. The increase of both oil and bacteria often leads to clogged pores and inflammation. This same action caused by androgens is the source of acne problems in people who take steroidal medications, or those who abuse steroids for the enhancement of athletic performance.

Hormonal changes due to pregnancy, some prescription drugs, or stress can increase sebaceous gland production and cause acne as well.

The use of cosmetics may also lead to acne. If left on the skin for prolonged periods of time, cosmetics can clog the pores and cause lesions.

Hot, humid weather causes an abundance of oil to be spread onto the skin through sweat, contributing to potential breakouts.

There are many myths about the causes of acne. It is now known that greasy foods, nuts and chocolate do not cause acne.

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Treatment Options

There are a wide variety of over-the-counter acne treatments and skin cleansers to help manage acne and clear it. These are commonly sold in the form of acne creams or liquids. These acne treatments are often effective in the case of mild or moderate acne. They work by drying the skin of oil and killing bacteria; they commonly cause a tingling or burning sensation. These acne treatments usually contain sulfur, salicylic acid, or benzoyl peroxide.

In severe cases of acne, a dermatologist may prescribe oral antibiotics, topical antibiotics, or a synthetic version of vitamin A called Retin-A. Retin-A helps remove the pore blockages that are the root cause of acne. Using Retin-A is a major concern for women who are pregnant, as it can cause birth defects.

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Home Care & Natural Remedies

Chromium and Zinc are important minerals known to assist in clearing infections of the skin and comprise an effective treatment for many people undergoing an outbreak of acne lesions.

Vitamin A strengthens the skin. Vitamin E is essential in the healing of tissues. Deficiencies in vitamin B6 (pyridoxine) and potassium have both been linked to acne.

Zinc may be helpful in preventing scarring after an outbreak; it also helps keep the sebaceous glands healthy.

Pay attention to hygiene. We suggest that everyone should gently wash the face and body twice a day with a mild soap, pat dry and use a recommended acne treatment for the acne. Always wash your body after exercise. Only use makeup or sunscreens that are labeled "non-comedogenic" or "non-acnegenic." These are formulated to avoid clogging your skin pores. Always remove your cosmetics and makeup completely. Keep hair sprays or gels away from your skin, as they can clog the pores on your skin. Wash your hair regularly to keep the oil away and keep your face clean if your job tends to make your skin dirty (for example if you are working in commercial kitchens or industrial sites). Although there is no evidence to prove that greasy foods, chocolate, coffee and sweets cause acne, many people find that these foods aggravate the acne. It is best to avoid them.

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Acne