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Acne therapy can continue for months and even years. Patients who conscientiously follow the prescribed regimen greatly increase their chances for improvement and the prevention of permanent scarring and pitting of the skin.
When acne has left permanent, disfiguring scars, there are medical techniques that can remove or improve the blemishes. One method is planing with a rotary, high-speed brush. This removes the outer layer of pitted skin, leaving the growing layer and the layers containing the glands and hair follicles. New epithelium grows from the layers underneath; it is rosy at first and gradually becomes normal in color. The technique has also been used successfully in removing some types of disfigurations resulting from accidents. This so-called “sand-paper surgery” or dermabrasion is recommended only for selected cases of acne and results are not always satisfying.
Laypersons often are misinformed about the cause and effects of acne. It is not a contagious disease, nor is it due to uncleanliness or poor personal hygiene. It is not caused or made worse by lack of sleep, constipation, masturbation, venereal disease, or by anger or hostility. Dietary indiscretion can sometimes contribute to the appearance of lesions, but there are very few people who can find a cause-effect relationship between certain foods they have eaten and the appearance of acne lesions. In general, cola drinks, chocolate, and fried foods need not be restricted or eliminated from the diet in hopes that acne can be avoided or cured. A well-balanced diet is all that is recommended for the management of acne.
Scrubbing the skin and using harsh soaps is not recommended because this only serves to damage the skin and predispose it to breakdown. A mild soap is as effective as special medicated soaps. If the hair is excessively oily, it may help to shampoo regularly and keep the hair off the face.
Pimples and pustules should not be squeezed. This can press the sebum and accumulated debris more firmly into the clogged duct and increase the chance of inflammation and the spread of infection. Blackheads and whiteheads are best removed by applying a prescription medication that causes peeling of the skin.
Since the management of acne can go on for years, requiring periodic evaluation by a dermatologist, patients and their families will need continued support and encouragement. Patients taking prescription medications will need to know the expected results, any adverse reactions that might occur, their symptoms, and to whom they should be reported.
See also: acne.
acne vulgarisA condition caused by chronic sebaceous gland inflammation and characterised by comedones, papules and pustules of sebaceous areas (face, chest, back) and resolving with scarring reaction; acne vulgaris is the most common disease seen by dermatologists, affecting ± 5% of Americans.
Comedolytics—e.g., retinoic acid, benzoyl peroxide; antibiotics—e.g., clindamycin, erythromycin, tetracycline.
Nonresponsive acne vulgaris may evolve to cystic acne.
Possibly linked to keratin plugging of follicles, androgen-induced increase in sebum secretion and secondary proliferation of Propionibacterium acnes, an anaerobic follicular diphtheroid.
acne vulgarisAcne, common acne Dermatology A condition caused by chronic sebaceous gland inflammation characterized by comedones, papules and pustules of sebaceous areas–face, chest, back and resolving with scarring reaction; AV is the most common disease seen by dermatologists, affecting ± 5% of Americans Treatment Comedolytics–eg, retinoic acid, benzoyl peroxide; antibiotics–eg, clindamycin, erythromycin, tetracycline Complications Nonresponsive AV may evolve to cystic acne. See Cystic acne, Isoretinoin.
ac·ne vul·ga·ris(ak'nē vŭl-gā'ris)
acne(ak'ne) [Ult. fr. acme]
The cause is unknown, but predisposing factors include hereditary tendencies and disturbances in the androgen-estrogen balance. Acne begins at puberty when the increased secretion of androgen in both males and females increases the size and activity of the pilosebaceous glands. Specific inciting factors may include food allergies, endocrine disorders, therapy with adrenal corticosteroid hormones, and psychogenic factors. Vitamin deficiencies, ingestion of halogens, and contact with chemicals such as tar and chlorinated hydrocarbons may be specific causative factors. The fact that bacteria are important once the disease is present is indicated by the successful results following antibiotic therapy. The lesions may become worse in women and girls before the menstrual period.
Acne vulgaris is marked by either papules, comedones with black centers (pustules), or hypertrophied nodules caused by overgrowth of connective tissue. In the indurative type, the lesions are deep-seated and cause scarring. The face, neck, and shoulders are common sites. Acne may be obstinate and recurrent.
Treatments include skin cleansing, topical agents (e.g., azelaic acid or benzoyl peroxide or vitamin A derivatives), and oral or topical antibacterial drugs.
The patient is instructed to wash the skin thoroughly but gently, avoiding intense scrubbing and skin abrasion; to keep hands away from the face and other sites of lesions; to limit the use of cosmetics; and to observe for, recognize, and avoid or modify predisposing factors that may cause exacerbations. The need to reduce sun exposure is explained, and the patient is advised to use a sunscreen agent when vitamin A acid or tetracycline is prescribed. Information is provided to fill knowledge gaps or correct misconceptions, and emotional support and understanding are offered, particularly if the patient is an adolescent. Patients (and others) need to be aware that extensive use of antibiotic treatment for acne increases the prevalence of antibiotic-resistant facial bacteria and can affect treatment response. Most improvement occurs during the first 6 weeks of therapy, whatever the regimen. More than half of all patients respond to therapy. Colonization with tetracycline-resistant propionibacteria diminishes response to all oral antibiotic regimens. Skin irritation as an adverse effect to treatment occurs most commonly with topical benzoyl peroxide alone, which is the most cost-effective treatment. Adding topical erythromycin may help reduce irritation and increase efficacy.
CAUTION!Because of the teratogenicity of some acne medications (such as isotretinoin), pregnancy must be avoided during their use.
Isotretinoin, a vitamin A derivative, has been effective in treating this condition. For Caution concerning its use, See: isotretinoin
keloid acneAcne keloidalis nuchae .
acne keloidalis nuchae
acne vulgarisface, neck, upper back and chest acne occurring primarily during puberty and adolescence, but associated in young adult women with polycystic ovary syndrome
ac·ne vul·ga·ris(ak'nē vŭl-gā'ris)
Patient discussion about acne vulgaris
Q. what is the best treatment for acne vulgaris
Generally, the widely used treatment for acne that doesn't respond to local treatment is retinoid, which are different forms of Vitamin A. There are several products, and they should require prescription by a doctor. They have side effects, some of them more problematic, and they require the use of contraceptives, but they are very efficient.
You can read more about it here: http://www.nlm.nih.gov/medlineplus/acne.html#cat3 and here: http://www.skincarephysicians.com/acnenet/treatingmoderatesevereacne.html)