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Information & Treatment

Consultations for acne are more frequent than for any other skin disease.
Acne is a disorder of the pilosebaceous follicles that primarily affects adolescents and young adults. It may be divided into noninflammatory and inflammatory types. Noninflammatory acne is characterized by open and closed whiteheads and blackheads (comedones), consisting of compact masses of keratin, sebum, and bacteria dilating the follicular duct. In inflammatory acne, the skin is inflamed, and there are papules, pustules, and nodulocysyic lesions with a tendency for destructiveness and scarring. The lesions are found in areas of greatest concentration of the sebaceous glands---the face, neck, and upper trunk.

Casual Factors. A convenient working hypothesis for the production of acne lesions is as follows:

Increased androgenic influence (or perhaps increased end-organ responsiveness) produces sebaceous gland hyperplasia and seborrhea. Comedo formation results from an abnormality of the keratinization of the follicular mouth. Follicular damage occurs mainly in follicles with large sebaceous glands and weak hair growth and in follicles that have small blocked openings. Fatty acids are freed by hydrolysis from triglycerides in the sebum along with bacterial esterases from Propionibacterium acnes high in the follicles. (It is possible that Staphylococcus epidermidis contributes to the lipolysis.) The fatty acids diffuse through the follicular walls and cause inflammation and follicular destruction. Keratin freed from the injured follicles produces a granulomatous response in the dermis.

Treatment. Since acne vulgaris is associated with increased sebum excretion, obstruction of the pilosebaceous duct, and alteration of the lipid composition of the skin surface, treatment generally attacks one or more of these areas. Oral contraceptives may be of use in very severe or otherwise unresponsive cases in young women. This is effective because of the medication's estrogen content. Some researchers have found oral contraceptive therapy to be particularly effective in preventing the common premenstrual flare of acne. Oral contraceptive therapy is particularly helpful for treating acne in women in their twenties and thirties. It is important to continue the pill for a minimum of three to four cycles and to know that there may be an increase in pustule formation initially. The use of anti-androgens in a topical medication base is a possible helpful future development. Topical corticosteroids are not helpful in treating acne and may, in fact, make it worse.

Retin-A can be a a useful preparation for people affected by comedones and early inflammatory lesions. You are advised to avoid excessive exposure to ultraviolet light, excessive face washing, and excessive use of the Retin-A. Care must be taken that the Retin-A does not come in contact with the corners of the mouth, nose, eyes, and mucous membrane.

A wide variety of therapeutic agents have been used in hope of modifying the skin flora. Tetracycline is widely used and is often effective. Treatment with tetracycline for a period of 2 to 3 months is effective in about 80 per cent of people with moderate and severe pustular acne.

Young people benefit from being taught in their preadolescent years about the natural course and care of acne, called management and prevention of severe acne. Frequent washing of oily hair and skin is desirable, as is a hairdo in which the hair is not touching the face. Children and their parents may be taught the use of the comedo extractor, extracting only those blackheads that come out easily and doing about 10 at one sitting. Squeezing, rubbing, and picking are discouraged. The person with acne should eat a balanced diet; avoid undue stress, fatigue, and perspiration.

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