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"The Complete Acne Cure"
Also called ACNE VULGARIS
It occurs in 80% of adolescents particularly the comedonal form.
Lesions of acne develop in sebaceous follicles .
The initial lesion of acne is called a comedo which is a dilated follicular sac filled with keratinous material,lipid,and bacteria. There is two types of comedo,an open and closed comedo . An open comedo known as( blackhead) is less commonly to become inflamed than a closed comedo(whitehead).
Other lesions of acne are inflammatory papules or nodules and also pustules.
At puberty ,the sebaceous gland enlarges and sebum production increases in response to the increased activities of androgens of adrenal origin . Comedonal acne is frequently the first sign of pubertal maturation.
In its mildest form ,which is often seen early in adolescence,acne lesions are limited to comedones on the central area of the face.Lesions may also involve the chest ,upper back,and deltoid area.
Acne can be controlled and severe scarring can be prevented by judicious maintenance therapy that is continued until the disease process abated spontaneously.
Diet: Little evidence shows that ingestion of particular foods can trigger acne flares,but when a patient is convinced that certain dietary items exacerbate acne,he or she should omit those foods but no need to impose unwarranted dietary restrictions.
Climate: Seems to influence acne in that improvements occur during summer and flares are more common during winter.
Emotional tension and fatigue: Seems also to exacerbate acne in many individuals,the mechanism may be related to an increased adrenocortical response.
Cleansing: It removes surface lipid and renders the skin less oily.Only superficial drying and peeling are achieved by cleancing,and almost any mild soap or astringent is adequate.Repetitive cleancing can be harmful because it irritates and chaps the skin.
Cleancing agents containing abrasives and keratolytic agents , such as sulfur,resorcinol,and salicylic acid,may temporarily remove sebum from the skin surface and suppress lesions to a limited degree.
Greasy cosmetics and hair preparations must be discontinued because they cause further plugging of follicular pores. Manipulation and squeezing of facial lesions provokes inflammatory reaction.
Topical Therapy: The most effective preparations include the benzoyl peroxide gels,retinoic acid,adapalene,and topical antibiotics
• benzoyl peroxide: Preparations are available in conc. Of 2.5% , 5% ,and 10% prescription gels and also 5% and 10% lotions . It should be applied as a thin film ,initially every other day and proceeding over 2-3 wk to once daily . Incidance of allergic contact dermatitis is 1% .
• Tretinoin(Retin-A): Is the single most effective agent for treatment of comedonal acne . It is available in 0.025%,0.05% and 0.1% creams ,also it is available in 0.01%gel,0.025% gel and 0.025% liquid . It may be applied once daily,30 min. after washing,typically starting with 0.025% cream and the strength of the formulation is increased sequentially until adequate control , Optimal results are not seen for 3-6 mo.
• Adapalene(DifferinGel) : It is a comedolytic and anti-inflammatory agent . A 0.1%gel may be more effective than 0.025% tretinoin gel. It may have a fever as a side effect .
• Topical antibiotics : These include the use of Clindamycin and erythromycin; they may be applied once or twice daily in concurrent use of benzoyl peroxide or tretinion. All topical preparations must be used for 4-8 wk before their effectiveness can be assessed . A popular and effective combination is the use of benzoyl peroxide gel in the morning and tretinion in the night .
Systemic Therapy:
• Antibiotics : Especially Tetracycline and its derivatives which are indicated in patients not responded to topical treatment or who have a propensity for scarring or who have severe papulopustular and nodulocystic acne.Tetracyclines are best administered in combination with topical benzoyl peroxide or tretinoin.For most adolescents therapy may be initiated with tetracycline,1g/24 hr,divided twice daily for at least 6 wk,followed by gradual decrease to the minimal effective dose.It should be taken on an empty stomach 1 hr before or 2 hr after meals.Tetracyclines should not be used during pregnancy or in those younger than 9 yr.Alternatives to tetracyclines are erythromycin,minocycline,doxycycline and clindamycin .
• Hormonal Therapy: It can be tried in women who have acne and hormonal abnormalities and did not respond to antibiotics or who are not candidates for isotretinoin therapy.An effective combination is an antiandrogen such as cyproterone acetate or spironolactone,given on days 5-15 of the menstrual cycle, and ethinyl estradiol,given on day 5-26 of the cycle.
• Isotretinoin: It is indicated for moderate to severe nodulocystic acne that not responded to conventional therapy,and for severe scarring acne, and for acne that is associated with severe psychological disturbance .The recommended dose is 0.5-1.0 mg/kg/24 hr; four months therapy is required for most patients.At the end of one course of isotretinoin,approximately 30% are cured,35% need conventional topical and /or oral medications to maintain adequate control,and 25% have relapses and need an additional course of isotretinoin.Isotretinoin is teratogenic and it is contraindicated in pregnancy. Concomitant use of tetracyclines and isotretinoin is contraindicated because either drug can cause benign intracranial hypertension
• Surgical Therapy : Intralesional injection of low-dose (3mg/ml) of midpotancy glucocorticoids (e.g, triamcinolone),may hasten the healing of individual,nodulocystic lesions.Dermabrasion to minimize scarring should be considered only after the active process is quiescent .
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