Acne

Acne is the most common skin disorder world wide, affecting persons of all ages and races. Potential outcomes include physical scars, persistent hyperpigmentation, and psychological sequelae.

Pathogenesis
Acne is a chronic inflammatory disease involving the pilosebaceous unit. It is typified by the eruption of a comedo within the follicle, which is preceded by a microcom edo.

Four main factors lead to the formation of acne lesions:
 (1) increased sebum production by sebaceous glands, in which androgens have an important role;

(2) hyperkeratinization of the follicle, leading to a microcomedo that eventually enlarges into a comedo;

(3) colonization of the follicle by the anaerobe Propionibacterium acnes; and

 (4) an inflammatory reaction.2 The inflam- matory events may begin before hyperkera- tinization of the follicle.3 Current therapies target these four factors for acute control of flare-ups and long-term maintenance.

Evaluation
Acne is diagnosed by the identification of lesions. The spectrum of acne lesions ranges from noninflammatory open or closed comedones (blackheads and whiteheads) to inflammatory lesions, which may be papules, pustules, or nodules .

Lesions are most likely to occur on the face, neck, chest, and back, where there is a higher concentration of sebaceous glands. Other conditions can mimic acne, and even include the term acne in their nomenclature, but they lack the presence of comedones.

Grading acne based on the type of lesions and their severity can help in deciding which therapies are warranted. however, there is no consensus on the best grading system.

closed comodones

Open comodones

Treatment
TOPICAL THERAPIES:
Topical retinoids are versatile agents in the treatment of acne. They prevent the formation and reduce the number of comedones, making them useful against noninflammatory lesions. Topical retinoids also possess anti-inflammatory properties, making them somewhat useful in the treatment of inflammatory lesions.

Topical retinoids are indicated as monotherapy for noninflammatory acne and as combination therapy with antibiotics to treat inflammatory acne. Additionally, they are useful for maintenance after treatment goals have been reached and systemic drugs are discontinued..

Overall, adapalene (Differin) is the best tolerated topical retinoid. Limited evidence suggests that tazarotene (Tazorac) is more effective than adapalene and tretinoin (Retin-A). There is no evidence that any for mulation is superior to another.

Topical antibiotics are used predominantly for the treatment of mild to moderate inflammatory or mixed acne. Clindamycin and erythromycin are the most studied. They are sometimes used as monotherapy, but are more effective in combination with topical retinoids. Because of the possibil- ity that topical antibiotics may induce resistance, it is recommended that benzoyl peroxide be added to these regimens.

Note:Treatment of acne depends on severity and is individualized so better you consult your doctor, and plan the management together.

Home remidies.

You can reduce your acne by following these skin care tips from dermatologists.

1. Wash twice a day and after sweating. Perspiration, especially when wearing a hat or helmet, can make acne worse, so wash your skin as soon as possible after sweating.
   
   
2. Use your fingertips to apply a gentle, non-abrasive cleanser. Using a washcloth, mesh sponge, or anything else can irritate the skin.
   
   
3. Be gentle with your skin. Use gentle products, such as those that are alcohol-free. Do not use products that irritate your skin, which may include astringents, toners and exfoliants. Dry, red skin makes acne appear worse.
   
   
4. Scrubbing your skin can make acne worse. Avoid the temptation to scrub your skin.
   
   
5. Rinse with lukewarm water
   
   
6. Shampoo regularly. If you have oily hair, shampoo daily.
   
   
7. Let your skin heal naturally. If you pick, pop or squeeze your acne, your skin will take longer to clear and you increase the risk of getting acne scars.
   
   
8. Keep your hands off your face. Touching your skin throughout the day can cause flare-ups.
   
   
9. Stay out of the sun and tanning beds. Tanning damages you skin. In addition, some acne medications make the skin very sensitive to ultraviolet (UV) light, which you get from both the sun and indoor tanning devices.
   • Using tanning beds increases your risk for melanoma, the deadliest form of skin cancer, by 75%.
     
     
10. Consult a dermatologist if:
    • Your acne makes you shy or embarrassed.
    • The products you've tried have not worked.
    • Your acne is leaving scars or darkening your skin.