Acne
Acne is the most common skin disorder in the United States. Acne more commonly occurs from puberty – 17 years of age for females, and from 14 -19 in males. Usually the disease will stop before the age of 25. However, some people may continue to have acne throughout their adult years.
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles. It most commonly affects the face, neck, chest, shoulders and upper back, which have a high concentration of sebaceous follicles. Acne occurs when keratinous material (dead skin cells) in the follicle does not shed normally. This material becomes dense and blocks the secretion of sebum (oil). These plugs are a type of acne lesion known as comedones (black and white heads). As the follicle opening becomes more plugged up, the lower portion of the follicle becomes more enlarged due to the trapped sebum. This leads to inflammation in the pilosebaceous unit. The distended follicle wall eventually will break, and the contents will enter into the dermis of the skin. This provokes an inflammatory response in the skin and leads to the papules, pustules, nodules and cysts of acne. This all occurs due to a complex interaction between bacteria (propionibacterium acnes) and androgens (hormones). Androgens stimulate the sebaceous glands to produce larger amounts of sebum.
There are contributory factors that can aggravate existing acne such as certain medications, occlusion, and pressure (for example: leaning face on hands, chin straps, hats). Also, scrubbing of the face during washing will increase irritation and often worsen the acne due to friction. Though people commonly believe that fatty foods and chocolate make acne worse, no evidence exists that dietary choices have an effect on the severity of acne.
Treatment
Treatment varies depending on the type of acne. Options include: topical medications that are applied directly to the skin surface, oral antibiotics, oral hormonal therapy or oral isotretinoin therapy. Topical medications may take 8 weeks or more before improvement starts to occur. The topical medications are to be applied to the entire affected area, not just the lesions. Oral antibiotics are taken by mouth in pill form, and it generally takes about 6 to 8 weeks to begin to see improvement. Isotretinoin is a medication taken by mouth for usually about 6 months. This medication is used in people with severe cystic acne, or in people with acne not responding well to other treatments. There are potential serious side effects while taking isotretinoin, so monthly follow-up while on this medication is mandatory.