CAUSES OF ACNE, INDICATION AND RISKS FACTORS.

Acne

Acne is a skin condition that causes whiteheads, blackheads, and inflamed red growth (Papules,   pustules, and   cysts) to form. These growths are commonly called pimples or "zits."

Causes, incidence, and risk factors
Acne occurs when tiny holes on the surface of the skin, called pores, become clogged.

· Each pore is an opening to a follicle, which contains a hair and an oil gland. These oil glands   
   help lubricate     the skin and help remove old skin cells.
· When glands produce too much oil, the pores can become blocked. Dirt, debris, bacteria, and  
   inflammatory cells build up. The blockage is called a plug or comedone.
· The top of the plug may be white or dark.
· If the plug breaks open, the material inside causes swelling and red bumps to form.
· If the inflammation is deep in your skin, the pimples may enlarge to form firm, painful cysts.
Acne is a problem of swelling and inflammation, not a problem caused by bacteria. Acne is most common in teenagers, but it can happen at any age, even in an infant. Three out of four teenagers have some acne. Hormonal changes probably - cause increased oil in the skin. However, people in their 30s and 40s may have acne.

       Acne tends to run in families and can be triggered by:

       Hormonal changes related to menstrual periods, pregnancy, birth control pills, or stress

·     Greasy or oily cosmetic and hair products.

·     Certain drugs (such as steroids, testosterone, estrogen, and phenytoin)

·     High levels of humidity and sweating.

Despite the popular belief that chocolate, nuts, and greasy foods cause acne, research does not confirm this idea. Diets high in refined sugars may be related to acne.

Symptoms

Acne commonly appears on the face and shoulders, but it may also occur on the trunk, arms, legs, and buttocks.

·         Blackheads
·         Crusting of skin bumps
·         Cysts
·         Papules (small red bumps)
·         Pustules
·         Redness around the skin eruptions
·         Scarring of the skin
·         Whiteheads
Signs and tests
Your doctor can diagnose acne based on the appearance of the skin. Testing is usually 
not required.
Treatment

 SELF-CARE

        

 Steps you can take to help your acne:

· Clean your skin gently with a mild, nondrying soap (such as Dove, Neutrogena, Cetaphil, CeraVe,or Basics). Remove all dirt or make-up. Wash once or twice a day, including after exercising.  However,   avoid scrubbing or repeated skin washing.

·  Shampoo your hair daily, especially if it is oily. Comb or pull your hair back to keep the hair  
out of your face.

What NOT to do:

·  Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this,

 It can lead to skin infections and scarring.

· Avoid wearing tight headbands, baseball caps, and other hats

· Avoid touching your face with your hands or fingers.

· Avoid greasy cosmetics or creams. Take off make-up at night. Look for water-based or

"noncomedogenic" formulas. Noncomedogenic products have been tested and proven not to clog, pores and cause acne.

If these steps do not clear up the blemishes, try over-the-counter acne medications.

You apply these products directly to your skin.

· They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid.

· They work by killing bacteria, drying up skin oils, or causing the top layer of your skin to peel.

· They may cause redness or peeling of the skin. A small amount of sun exposure may improve acne a little, but mostly it just hides the acne. However, too much exposure to sunlight or ultraviolet rays is not recommended because it increases the risk for skin cancer.
PRESCRIPTION MEDICINES

If the pimples are still a problem, a health care provider can prescribe stronger medications and discuss other options with you. Antibiotics may help some people with acne:

· Oral antibiotics (taken by mouth) such as tetracycline, minocycline, 

   erythromycin, trimethoprim and amoxicillin. 

· Topical antibiotics (applied to the skin) such as, or Creams or gels applied to the skin may be  
   prescribed:

· Retinoic acid cream or gel ( tretrinoin, Retin-A)

· Prescription formulas of peroxides, sulfur, resorcinol, or salicylic acid.

· Topical azelaic acid, for women whose acne is caused or made worse by hormones: 

A pill called spironolactone; may help Birth control. Pills may help in some cases, though may make acne   worse minor procedures or treatments may also be helpful.

· A laser procedure called photodynamic therapy.

· Your doctor may also suggest chemical skin peeling, removal of scars by dermabrasion,

or removal, drainage, or injection of cysts with cortisone.

People who have cystic acne and scarring may try a medicine called isotretinoin (Accutane). 
You will be watched closely when taking this medicine because of its side effects.

Pregnant women should NOT take Accutane, because it causes severe birth defects.

Women taking Accutane must use two forms of birth control before starting the drug, and enroll in the pledge program. Your doctor will follow you on this drug, and you will have regular blood tests.
Expectations (prognosis)

Acne usually goes away after the teenage years, but it may last into middle age.

The condition often responds well to treatment after 6 - 8 weeks, but it may flare up from time to time.

Scarring may occur if severe acne is not treated. Some people, especially teenagers, can become very depressed if acne is not treated.
Calling your health care provider

Call your doctor or a dermatologist if:

· Self-care measures and over-the-counter medicine have not helped after several months

· Your acne is severe (for example, you have a lot of redness around the pimples or you have cysts)

· Your acne is getting worse

· You develop scars as your acne clears up

Call your baby's health care provider if your baby has acne that does not clear up on its own within 3 months.

You can do a lot to treat your acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, you should consult a physician for treatment options.

What causes acne?

No one factor causes acne. Acne happens when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty by elevated levels of male hormones.

Sebum (oil) is a natural substance which lubricates and protects the skin.  Associated with increased oil production is a change in the manner in which the skin cells mature:

So that they are predisposed to clog the follicular openings or pores. The clogged hair follicle gradually enlarges, producing a bump. As the follicle enlarges,

The wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation. Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead."If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black,

And the result is a "blackhead." Blackheads are therefore not dirt and do not reflect poor hygiene.

Here are some factors that don't usually play a role in acne:

Heredity: 
With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life. Food: Parents often tell kids to avoid pizza, chocolate, greasy and fried foods, and junk food. Whele" this food may not be good for overall health; they don't cause acne or make it worse Although some recent studies have implicated milk and pure chocolate in aggravating acne, these findings are very far from established.Dirt:  As mentioned above, "blackheads" are oxidized oil, not dirt.  sweet does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin. Some people get so upset by their pimples that they pick at them and make them last longer.Stress: however, does not play much of a direct role in causing acne.Pressure: In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can      aggravate acne.Drugs:  Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisiun [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes take).Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium. (Eskalith, Lithobid), which is used to treat bipolar disorder most cases of acne.Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.
Cosmetics: Some cosmetics and skin-care products are pore clogging (comedogenic) Of the many available brands of skin-care products, it is important to read the list of ingredients and choose those which have water listed first or second if you are concerned about acne. These "water based" products are usually safe.