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July 01 , 2013

Acne, medically known as Acne Vulgaris (cystic acne or simply acne) is a skin disease, characterized by areas of skin with seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules) and possibly scarring. It is a skin disease that involves the oil glands at the base of hair follicles. It commonly occurs during puberty when the sebaceous glands come to life - the glands are stimulated by hormones produced by the adrenal glands of both males and females. 

In adolescence, acne is usually caused by an increase in testosterone, which accrues during puberty, regardless of sex. Acne affects mostly skin with areas such as the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in non-inflammatory forms.

Types of acne

• Whiteheads – these remain under the skin and are very small. 

• Blackheads – these are clearly visible, they are black and appear on the surface of the skin. 

• Papules - visible on the surface of the skin. They are small bumps, usually pink. 

• Pustules - clearly visible on the surface of the skin. They are red at their base and have pus at the top. 

• Nodules - clearly visible on the surface of the skin. They are large, solid pimples. They are painful and are embedded deep in the skin. 

• Cysts - clearly visible on the surface of the skin. They are painful, and are filled with pus. Cysts can easily cause scars. 

Causes of acne

Acne develops as a result of blockages in the follicles. Experts believe the primary cause is a rise in androgen levels which makes the oil glands under the skin grow, producing more oil. Excessive sebum can break down cellular walls in your pores, causing bacteria to grow. The causes may be due to: 

- Hormonal:   Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in androgens causes the follicular glands to grow larger and make more sebum.

- Genetic.

- Psychological: Increased acne severity is significantly associated with increased stress levels. The National Institutes of Health (USA) lists stress as a factor that ”can cause an acne flare.”

- Infectious: Infectious agents like Propionibacterium acnes (P. Acne) causes acne, also Staphylococcus epidermidis contributes to acne formation.

- Diet: a high glycemic load diet is associated with worsening acne.

 Rare causes of acne

Rarely, certain diseases in girls and women may cause acne, or make acne worse. For example, polycystic ovary syndrome, and conditions that cause excess male hormone to be made in the ovary or adrenal gland. These conditions cause other symptoms in addition to acne, such as thinning of scalp hair, excess growth of facial or body hair (hirsutism), and other problems. 

Another rare cause of acne is exposure to halogenated hydrocarbons.


Topical treatments Topical preparations for acne include:

- Benzoyl peroxide: This is a common topical treatment. It has three actions; it kills bacteria, reduces inflammation, and helps to unplug blocked pores.

- Retinoids: includes tretinoin, adapalene, and tazarotene.

- Azelaic acid.

Tablets for treating acne includes:

- Erythromycin, Clindamycin, and Tetracyclines.

Hormonal therapy:

In females, acne can be improved with hormonal treatments. The common combined estrogen/progestogen methods of hormonal contraception have some effect, but the anti-androgen cyproterone in combination with an estrogen is particularly effective at reducing androgenic hormone levels.

Maintenance after treatment

Once the spots have cleared, acne commonly flares up again if you stop treatment, so maintenance treatment to prevent acne from flaring up again may be done for 4-5 years to keep acne away. If there is severe acne which does not respond to the treatments, see a hospital specialist. 

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