MELASMA
Melasma (also known as "Chloasma faciei" or the mask of pregnancy when present in pregnant women) is a tan or dark skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications.
Symptoms
The symptoms of melasma are dark, irregular patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration.
Cause
Melasma is thought to be the stimulation of melanocytes or pigment-producing cells by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.
Genetic predisposition is also a major factor in determining whether someone will develop melasma.
The incidence of melasma also increases in patients with thyroid disease.
It is thought that the overproduction of melanocyte-stimulating hormone (MSH) brought on by stress can cause outbreaks of this condition.
Other rare causes of melasma include allergic reaction to medications and cosmetics.
Diagnosis
Melasma is usually diagnosed visually or with assistance of a Wood's lamp (340 - 400 nm wavelength). Under Wood's lamp, excess melanin in the epidermis can be distinguished from that of the dermis.
Treatment
The discoloration usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.
Treatments to hasten the fading of the discolored patches include:
Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melanin.
Tretinoin, an acid that increases skin cell (keratinocyte) turnover. This treatment cannot be used during pregnancy.
Azelaic acid (20%), thought to decrease the activity of melanocytes.
Facial peel with alpha hydroxyacids or chemical peels with glycolic acid.
Laser treatment. A Wood's lamp test should be used to determine whether the melasma is epidermal or dermal. If the melasma is dermal, Fraxel laser has been shown in studies to provide improvement in many patients. Intense pulsed light has also been effective in the treatment of melasma. Dermal melasma is generally unresponsive to most treatments, and has only been found to lighten with products containing mandelic acid (such as Triluma cream) or Fraxel laser.
In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.
Cosmetic cover-ups can also be used to reduce the appearance of melasma.
Saturday, August 14, 2010
HOW TO FADE DARK SPOTS
How to Fade Post-Acne Red Marks, Dark Spots, Pigmentation, Etc.
Post acne marks, or macules, are also commonly referred to as “acne scars”. Real acne scars, however, are the indentations or protrusions left behind by acne. Acne marks, on the other hand, are the flat red or brown dots left behind by pimples.
Other dark spots and types of hyperpigmentation can come from aging, sun damage, and even using birth control pills.
Most of the time, acne marks will go away on their own. However, sometimes it can take anywhere from six months to many years for them to lighten completely. Sometimes they may even stick around for the rest of your life! Other forms of hyperpigmentation (ones from aging, allergies, etc) don't fade on their own and may even get darker as time goes on.
To treat these red marks and pigmentation issues, consider the following options:
1) Sunscreen
Wearing sunscreen is essential, whether or not you are trying to fade any marks. Sunscreen protects your skin and will prevent cancerous lesions. However, if you want to help speed up the fading of your hyperpigmentation, then it is extra important to use sunscreen consistently because it will prevent macules and other dark spots from darkening even more.
2) Exfoliation
Exfoliating helps fade your marks faster by shedding old skin and bringing newer skin to the surface. There are lots of options for exfoliation; you could use scrubs and washcloths, but I think chemical exfoliation will give you your desired results a bit quicker (and maybe with less irritation as well).
To get rid of red acne marks or hyperpigmentation, you can consider using prescription retinoids, can try over-the-counter products with AHAs as the active ingredient.
However, be aware that these types of topical products can also cause irritation such as redness, peeling, and dryness.
3) Skin Lighteners
Aside from exfoliating to help the skin renew itself faster, you can attack your spots with skin lighteners such as kojic acid, licorice extract, arbutin, mulberry extract, or vitamin C.
Hydroquinone is also a skin lightener
Many Asian products target lightening and whitening of the skin. However, before purchasing any of them, make sure you check the ingredients to see if there are effective skin lighteners in the product.
Some people also say to apply vitamin E (either a vitamin E product, 100% vitamin E oil, or vitamin E poked from a gel capsule) but in my experience, vitamin E is very irritating on its own.
The thing about exfoliating or using topical products is that even though they shorten the amount of time it takes to fade red marks, it still takes time for them to work. Consistent use will give you results in around two to three months.
However, if you are impatient, you can opt for facial procedures such as chemical peels, laser, and/or microdermabrasion. Facial procedures do not perform miracles either because it also takes two to three sessions for you to get your desired results.
Post acne marks, or macules, are also commonly referred to as “acne scars”. Real acne scars, however, are the indentations or protrusions left behind by acne. Acne marks, on the other hand, are the flat red or brown dots left behind by pimples.
Other dark spots and types of hyperpigmentation can come from aging, sun damage, and even using birth control pills.
Most of the time, acne marks will go away on their own. However, sometimes it can take anywhere from six months to many years for them to lighten completely. Sometimes they may even stick around for the rest of your life! Other forms of hyperpigmentation (ones from aging, allergies, etc) don't fade on their own and may even get darker as time goes on.
To treat these red marks and pigmentation issues, consider the following options:
1) Sunscreen
Wearing sunscreen is essential, whether or not you are trying to fade any marks. Sunscreen protects your skin and will prevent cancerous lesions. However, if you want to help speed up the fading of your hyperpigmentation, then it is extra important to use sunscreen consistently because it will prevent macules and other dark spots from darkening even more.
2) Exfoliation
Exfoliating helps fade your marks faster by shedding old skin and bringing newer skin to the surface. There are lots of options for exfoliation; you could use scrubs and washcloths, but I think chemical exfoliation will give you your desired results a bit quicker (and maybe with less irritation as well).
To get rid of red acne marks or hyperpigmentation, you can consider using prescription retinoids, can try over-the-counter products with AHAs as the active ingredient.
However, be aware that these types of topical products can also cause irritation such as redness, peeling, and dryness.
3) Skin Lighteners
Aside from exfoliating to help the skin renew itself faster, you can attack your spots with skin lighteners such as kojic acid, licorice extract, arbutin, mulberry extract, or vitamin C.
Hydroquinone is also a skin lightener
Many Asian products target lightening and whitening of the skin. However, before purchasing any of them, make sure you check the ingredients to see if there are effective skin lighteners in the product.
Some people also say to apply vitamin E (either a vitamin E product, 100% vitamin E oil, or vitamin E poked from a gel capsule) but in my experience, vitamin E is very irritating on its own.
The thing about exfoliating or using topical products is that even though they shorten the amount of time it takes to fade red marks, it still takes time for them to work. Consistent use will give you results in around two to three months.
However, if you are impatient, you can opt for facial procedures such as chemical peels, laser, and/or microdermabrasion. Facial procedures do not perform miracles either because it also takes two to three sessions for you to get your desired results.
If you want a quick fix, a good concealer will do the
trick!
Thursday, August 12, 2010
WHAT ARE PEELS?HOW ARE THEY USEFUL?
A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skinThere are several types of chemical peels.
Alpha hydroxy acid peels
Alpha hydroxy acids (AHAs) are naturally occurring organic carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.
There are five main fruit acids: citric acids (citrus-derived), glycolic (derived from sugar cane), lactic acid (although derived from milk, this is still considered a "fruit acid"), malic (derived from apples) and tartaric (derived from grapes)
Alpha hydroxy acid peels
Alpha hydroxy acids (AHAs) are naturally occurring organic carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.
There are five main fruit acids: citric acids (citrus-derived), glycolic (derived from sugar cane), lactic acid (although derived from milk, this is still considered a "fruit acid"), malic (derived from apples) and tartaric (derived from grapes)
AHA peels are used to:
reduce fine wrinkling
treat areas of dryness
reduce uneven pigmentation
aid in the control of acne
smooth rough dry skin
improve the texture of sun-damaged skin
AHA peels may:
cause stinging
cause skin redness
cause mild skin irritation
cause dryness
take multiple treatments for desired results
Beta hydroxy acid peels
It is becoming common for beta hydroxy acid (BHA) peels to be used instead of the stronger alpha hydroxy acid (AHA) peels due to BHA's ability to get deeper into the pore than AHA. BHA peels control oil, acne as well as remove dead skin cells to a certain extent better than AHAs due to AHAs only working on the surface of the skin.
Salicylic acid (from the Latin Salix meaning: willow tree) is a biosynthesized, organic, beta hydroxy acid that is often used.
Trichloroacetic acid peels
Trichloroacetic acid (TCA) is used as an intermediate to deep peeling agent in concentrations ranging from 20-50%. Depth of penetration is increased as concentration increases.
Trichloroacetic acid peels:
are preferred for darker-skinned patients over Phenol
smooth out fine surface wrinkles
remove superficial blemishes
correct skin pigment problems
Trichloroacetic acid peels may:
require pre-treatment with Retin-A or AHA creams
require repeat treatment to maintain results
require the use of sunblock for several months (this is a must)
take several days to heal depending on the peel depth
These are the common peels used in the dermatology practice.There are also other peels like phenol peels,Retinol peels,Jessners' peels which are less commonly used.
IS BOTOX SAFE?
Cosmetic Use
Using Botox to paralyze the facial muscles thus rendering them unable to move is a common practice by dermatologists and other doctors to achieve aesthetic goals. The point is to prevent the formation of wrinkles and creases by blocking the movement of the muscles. Not all areas of the face can be injected with Botox in consideration of appearing natural. The effects actually lasts for about three to eight months and the patient can go back for another batch of injections if he or she wishes. There is no immunity to the effects so one can go back as often as one wants. Safety concerns are brushed aside by those who use this product since the toxin is processed and applied in very small doses
Using Botox to paralyze the facial muscles thus rendering them unable to move is a common practice by dermatologists and other doctors to achieve aesthetic goals. The point is to prevent the formation of wrinkles and creases by blocking the movement of the muscles. Not all areas of the face can be injected with Botox in consideration of appearing natural. The effects actually lasts for about three to eight months and the patient can go back for another batch of injections if he or she wishes. There is no immunity to the effects so one can go back as often as one wants. Safety concerns are brushed aside by those who use this product since the toxin is processed and applied in very small doses
Friday, June 4, 2010
ACNE SCARRING
Different Types of Acne
Scars from acne can seem like double punishment — first you had to deal with the pimples, now you have marks as a reminder.
It helps to understand the different kinds of acne so you can figure out what to do about different types of scarring:
Acne lesions or pimples happen when the hair follicles (or "pores") on the skin become plugged with oil and dead skin cells. A plugged follicle is the perfect place for bacteria to grow and create the red bumps and pus-filled red bumps known as pimples.
Acne comes in different forms:
-mild acne, which refers to the whiteheads or blackheads that most of us get at various times
-moderately severe acne, which includes red inflamed pimples called papules and red pimples with white centers called pustules
-severe acne, which causes nodules — painful, pus-filled cysts or lumps — to appear under the skin
Most serious scarring is caused by the more severe forms of acne, with nodules more likely to leave permanent scars than other types of acne.
The best approach is to get treatment for acne soon after it appears to prevent further severe acne and more scarring. If you have nodules
Treating Acne Scars
Most of the time, those reddish or brownish acne marks that are left behind after a pimple eventually fade with no need for treatment. Picking or squeezing acne can increase the risk for scarring, though.
Acne scars take two forms:
-scars with a gradual dip or depression (sometimes called "rolling" scars)
-scars that are deep and narrow
A person's acne needs to be under control before scars can be treated.
Mild vs. Severe Scarring
Treatments depend on how severe the scars are. In some cases, a doctor or dermatologist may suggest a chemical peel or microdermabrasion to help improve the appearance of scarred areas. These milder treatments can be done right in the office.
If you have serious scarring from previous bouts with acne, there are several things you can do:
Laser resurfacing. This procedure can be done in the doctor's or dermatologist's office. The laser removes the damaged top layer of skin and tightens the middle layer, leaving skin smoother. It can take anywhere from a few minutes to an hour. The doctor will try to lessen any pain by first numbing the skin with local anesthesia. It usually takes between 3 and 10 days for the skin to heal completely.
Dermabrasion. This treatment uses a rotating wire brush or spinning diamond instrument to wear down the surface of the skin. As the skin heals, a new, smoother layer replaces the abraded skin. It may take a bit longer for skin to heal using dermabrasion — usually between 10 days and 3 weeks.
Fractional laser therapy. This type of treatment works at a deeper level than laser resurfacing or dermabrasion, Because fractional laser therapy doesn't wound the top layer of tissue, healing time is shorter. Someone who has had this type of treatment may just look a bit sunburned for a couple of days.
For "rolling" scars, doctors sometimes inject material under the scar to raise it to the level of normal skin. Finally, in some cases, a doctor may recommend surgery to remove deeply indented scars.
One thing you shouldn't do to deal with acne scars is load up your face with masks or fancy lotions — these won't help and may irritate your skin further, making the scars red and even more noticeable.
If you have a red or brownish mark on your face that you got from a bad zit, it should eventually fade, just like the scars on your knees from falling off your bike as a kid. However, it may take 12 months or longer. So your best bet is to avoid these kinds of marks by not squeezing or popping zits.
Scars from acne can seem like double punishment — first you had to deal with the pimples, now you have marks as a reminder.
It helps to understand the different kinds of acne so you can figure out what to do about different types of scarring:
Acne lesions or pimples happen when the hair follicles (or "pores") on the skin become plugged with oil and dead skin cells. A plugged follicle is the perfect place for bacteria to grow and create the red bumps and pus-filled red bumps known as pimples.
Acne comes in different forms:
-mild acne, which refers to the whiteheads or blackheads that most of us get at various times
-moderately severe acne, which includes red inflamed pimples called papules and red pimples with white centers called pustules
-severe acne, which causes nodules — painful, pus-filled cysts or lumps — to appear under the skin
Most serious scarring is caused by the more severe forms of acne, with nodules more likely to leave permanent scars than other types of acne.
The best approach is to get treatment for acne soon after it appears to prevent further severe acne and more scarring. If you have nodules
Treating Acne Scars
Most of the time, those reddish or brownish acne marks that are left behind after a pimple eventually fade with no need for treatment. Picking or squeezing acne can increase the risk for scarring, though.
Acne scars take two forms:
-scars with a gradual dip or depression (sometimes called "rolling" scars)
-scars that are deep and narrow
A person's acne needs to be under control before scars can be treated.
Mild vs. Severe Scarring
Treatments depend on how severe the scars are. In some cases, a doctor or dermatologist may suggest a chemical peel or microdermabrasion to help improve the appearance of scarred areas. These milder treatments can be done right in the office.
If you have serious scarring from previous bouts with acne, there are several things you can do:
Laser resurfacing. This procedure can be done in the doctor's or dermatologist's office. The laser removes the damaged top layer of skin and tightens the middle layer, leaving skin smoother. It can take anywhere from a few minutes to an hour. The doctor will try to lessen any pain by first numbing the skin with local anesthesia. It usually takes between 3 and 10 days for the skin to heal completely.
Dermabrasion. This treatment uses a rotating wire brush or spinning diamond instrument to wear down the surface of the skin. As the skin heals, a new, smoother layer replaces the abraded skin. It may take a bit longer for skin to heal using dermabrasion — usually between 10 days and 3 weeks.
Fractional laser therapy. This type of treatment works at a deeper level than laser resurfacing or dermabrasion, Because fractional laser therapy doesn't wound the top layer of tissue, healing time is shorter. Someone who has had this type of treatment may just look a bit sunburned for a couple of days.
For "rolling" scars, doctors sometimes inject material under the scar to raise it to the level of normal skin. Finally, in some cases, a doctor may recommend surgery to remove deeply indented scars.
One thing you shouldn't do to deal with acne scars is load up your face with masks or fancy lotions — these won't help and may irritate your skin further, making the scars red and even more noticeable.
If you have a red or brownish mark on your face that you got from a bad zit, it should eventually fade, just like the scars on your knees from falling off your bike as a kid. However, it may take 12 months or longer. So your best bet is to avoid these kinds of marks by not squeezing or popping zits.
Thursday, May 27, 2010
ACNE
Acne vulgaris (commonly called acne) is a common human skin disease, characterized by areas of skin with multiple noninflammatory follicular papules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. Acne vulgaris mostly affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms. Acne lesions are commonly referred to as pimples, blemishes, spots, zits, or simply acne. Acne lesions are caused by changes in pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes which require androgen stimulation.
Acne occurs most commonly during adolescence, affecting more than 96% of teenagers, and often continues into adulthood. In adolescence, acne is usually caused by an increase in male sex hormones, which people of both genders accrue during puberty.
SIGNS AND SYMPTOMS
.
1)Scars
Acne often leaves small scars where the skin gets a "volcanic" shape.
Physical acne scars are often referred to as "Icepick" scars. This is because the scars tend to cause an indentation in the skin's surface. Ice pick scars: Deep pits, that are the most common and a classic sign of acne scarring.
Box car scars: Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
Rolling scars: Scars that give the skin a wave-like appearance.
Hypertrophic scars: Thickened, or keloid scars.
2)Pigmentation
Pigmented scars is a slightly misleading term as it suggests a change in the skin's pigmentation and that they are true scars; however, neither is true. Pigmented scars are usually the result of nodular or cystic acne (the painful 'bumps' lying under the skin). They often leave behind an inflamed red mark. Often, the pigmentation scars can be avoided simply by avoiding aggravation of the nodule or cyst. When sufferers try to 'pop' cysts or nodules, pigmentation scarring becomes significantly worse and may even bruise the affected area. Pigmentation scars nearly always fade with time taking between three months to two years to do so, although rarely can persist.
On the other hand, some people—particularly those with naturally tanned skin—do develop brown hyperpigmentation scars due to increased production of the pigment melanin. These too typically fade over time.
CAUSES OF ACNE
Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone .Comedones are the direct result of sebaceous glands becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation
Hormones
Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the follicular glands to grow larger and make more sebum. Use of anabolic steroids Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I).
Development of acne vulgaris in later years is uncommon, although this is the age group for Rosacea which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).
Genetics
The tendency to develop acne runs in families. For example, school-age boys with acne often have other members in their family with acne as well. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.
Psychological
While the connection between acne and stress has been debated, scientific research indicates that "increased acne severity" is "significantly associated with increased stress levels."The National Institutes of Health (USA) list stress as a factor that "can cause an acne flare." A study of adolescents in Singapore "observed a statistically significant positive correlation between stress levels and severity of acne.
Infections
Bacteria in the pores. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. In-vitro resistance of P. acnes to commonly used antibiotics has been increasing.
Diet
A high glycemic load diet and cow's milk have been associated with worsening acne. Other associations such as chocolate and salt are not supported by the evidence.
MANAGEMENT
Many different treatments exist for acne including: benzoyl peroxide, antibiotics, retinoids, antiseborrheic medications, salicylic acid, alpha hydroxy acid, azelaic acid, nicotinamide, and kera-tolytic soaps.
Benzoyl peroxide
Benzoyl peroxide a first line treatment for mild and moderate acne vulgarus due to its effectiveness It has been found to be nearly as effective as antibiotics Products containing azelaic acid are also used in the treatment of P. acnes
Antibiotics
Commonly used antibiotics either topically or orally include: erythromycin, clindamycin and tetracycline.
Hormonal treatments
In females, acne can be improved with hormonal treatments. The common combined estrogen/progestogen methods of hormonal contraception have some effect, but the antiandrogen, Cyproterone, in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels. Along with this, treatment with low dose spironolactone can have anti-androgenetic properties, especially in patients with polycystic ovarian syndrome.
Intralesional steroid
If a pimple is large and/or does not seem to be affected by other treatments, a dermatologist may administer an injection of cortisone directly into it, which will usually reduce redness and inflammation almost immediately. This has the effect of flattening the pimple, thereby making it easier to cover up with makeup, and can also aid in the healing process.
Topical retinoids
A group of medications for normalizing the follicle cell lifecycle are topical retinoids such as tretinoin , adapalene , and tazarotene .Like isotretinoin, they are related to vitamin A, but they are administered as topicals and generally have much milder side effects. . The retinoids appear to influence the cell creation and death lifecycle of cells in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar but milder effects and is used in many over-the-counter moisturizers and other topical products. . Topical retinoids often cause an initial flare up of acne and facial flushing.
Oral retinoids
A daily oral intake of vitamin A derivative isotretinoin over a period of 4–6 months can cause long-term resolution or reduction of acne. It is believed that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin has been shown to be very effective in treating severe acne and can either improve or clear well over 80% of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects . It is often recommended that one lets a few months pass between the two treatments, because the condition can actually improve somewhat in the time after stopping the treatment and waiting a few months also gives the body a chance to recover. Occasionally a third or even a fourth course is used, but the benefits are often less substantial. The most common side effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa). Oral retinoids also often cause an initial flare up of acne within a month or so, which can be severe. . . Blood triglycerides also need to be monitored. However, routine testing are part of the official guidelines for the use of the drug in many countries. . The drug also causes birth defects if women become pregnant while taking it or take it while pregnant. For this reason, female patients are required to use two separate forms of birth control or vow abstinence while on the drug
Anti-inflammatories
Nicotinamide, (Vitamin B3) used topically in the form of a gel, has been shown in a 1995 study to be of comparable efficacy to topical clindamycin topical antibiotic used for comparison.Topical nicotinamide is available both on prescription and over-the-counter. The property of topical nicotinamide's benefit in treating acne seems to be its anti-inflammatory nature. It is also purported to result in increased synthesis of collagen, keratin, involucrin and flaggrin and may also according to a cosmetic company be useful for reducing skin hyperpigmentation (acne scars), increased skin moisture and reducing fine wrinkles
Rofecoxib was shown to improve premenstrual acne vulgaris in a placebo controlled study, although this drug has since been withdrawn
Naproxen or ibuprofen are used for some moderate acne for their anti-inflammatory effect.
Calendula used in suspension is used as an anti-inflammatory agent.
Sulfur
Sulfur is probably the oldest acne remedy known to medicine and its origins as an anti-acne treatment date to ancient Greek, Roman, and Chinese texts citing its efficacy in balneotherapy. Sulfur formulations are effective both as a micro-exfoliant and as a mild antiseptic. Sulfur is hydrophilic and can easily penetrate sebaceous pores where its antiseptic properties can assist local immune response in rapidly eliminating infection resulting from acne proliferation. Because the growth of acne bacteria is limited naturally by the skin's slightly acidic pH, alkaline cleansers (including soaps and detergents) can have a detrimental effect on controlling acne proliferation. Sulfur-based cleansers with a balancing or neutral pH can help eliminate acne and prevent future breakouts by maintaining the hydrolipidic layer's acidity and thereby controlling acne populations on the surface of the skin. Sulfur is abundant in keratin and its use is also helpful in promoting collagen synthesis. An active ingredient in prescription and over-the-counter lotions, creams, gels, washes, and shampoos, sulfur is also very effective in controlling seborrheic dermatitis, rosacea, eczema, psoriasis, pityriasis versicolor, scabies, and lice
Micro dermabrasion
. Microdermabrasion is a more natural skin care that is a gentler, less invasive technology for doing an exfoliation on the skin. The goal of the microdermabrasion is to eliminate the superficial layer of the skin called the epidermis. If the surface of the abraded skin is touched, a roughness of the skin will be noticed. The roughness is keratinocytes, which are better hydrated than the surface corneocytes. Keratinocytes appear in the basal layer from the proliferation of keratinocyte stem cells. They are pushed up through the cells of the epidermis, experiencing gradual specialization until they reach the stratum corneum where they form a layer of dead, flattened, strongly keratinized cells called squamous cells. This layer creates an efficient barrier to the entry of foreign matter and infectious elements into the body and reduces moisture loss. Keratinocytes are shed and restored continuously from the stratum corneum.
The time of transit from basal layer to shedding is generally one month. Corneocytes are cells derived from keratinocytes in the late stages of terminal specialization of squamous epithelia. The microdermabrasion is done to eliminate some of the corneocytes. These cells are responsible for the impermeability of the skin. The minimizing or elimination of scars, skin lesions, blotchiness and stretch marks from the skin can be an easy process with the use of skin exfoliation. The result depends on how well the procedure known as "skin remodeling" works. Results are optimal and fewer treatments are needed with more recent and/or superficial scars. Still, microdermabrasion can be used on scars that showed up during puberty or many years later.
Phototherapy
'Blue' and red light
Light exposure has long been used as a short term treatment for acne. Recently, visible light has been successfully employed to treat mild to moderate acne (phototherapy or deep penetrating light therapy) - in particular intense violet light (405-420 nm) generated by purpose-built fluorescent lighting, dichroic bulbs, LEDs or lasers. Used twice weekly, this has been shown to reduce the number of acne lesions by about 64% and is even more effective when applied daily. The mechanism appears to be that a porphyrin (Coproporphyrin III) produced within P. acnes generates free radicals when irradiated by 420 nm and shorter wavelengths of light. Particularly when applied over several days, these free radicals ultimately kill the bacteria. Since porphyrins are not otherwise present in skin, and no UV light is employed, it appears to be safe, and has been licensed by the U.S. FDA.
The treatment apparently works even better if used with a mixture of the violet light and red visible light (660 nanometer) resulting in a 76% reduction of lesions after three months of daily treatment for 80% of the patients; and overall clearance was similar or better than benzoyl peroxide. Unlike most of the other treatments few if any negative side effects are typically experienced, and the development of bacterial resistance to the treatment seems very unlikely. After treatment, clearance can be longer lived than is typical with topical or oral antibiotic treatments; several months is not uncommon. The equipment or treatment, however, is relatively new and reasonably expensive to buy initially, although the total cost of ownership can be similar to many other treatment methods (such as the total cost of benzoyl peroxide, moisturizer, washes) over a couple of years of use.
Photodynamic therapy
In addition, basic science and clinical work by dermatologists Yoram Harth and Alan Shalita and others has produced evidence that intense blue/violet light (405-425 nanometer) can decrease the number of inflammatory acne lesion by 60-70% in four weeks of therapy, particularly when the P. acnes is pretreated with delta-aminolevulinic acid (ALA), which increases the production of porphyrins. However this photodynamic therapy is controversial and apparently not published in a peer reviewed journal. A phase II trial, while it showed improvement occurred, failed to show improved response compared to the blue/violet light alone.
Surgery
For patients with cystic acne, boils can be drained through surgical lancing.
Laser treatment
Laser surgery has been in use for some time to reduce the scars left behind by acne, but research has been done on lasers for prevention of acne formation itself. The laser is used to produce one of the following effects:
to burn away the follicle sac from which the hair grows
to burn away the sebaceous gland which produces the oil
to induce formation of oxygen in the bacteria, killing them
Since lasers and intense pulsed light sources cause thermal damage to the skin, there are concerns that laser or intense pulsed light treatments for acne will induce hyperpigmented macules (spots) or cause long-term dryness of the skin.
Less widely used treatments
Aloe vera: there are treatments for acne mentioned in Ayurveda using herbs such as Aloe vera, Neem, Haldi (Turmeric) and Papaya. There is limited evidence from medical studies on these products.Products from Rubia cordifolia, Curcuma longa (commonly known as Turmeric), Hemidesmus indicus (known as ananthamoola or anantmula), and Azadirachta indica (Neem) have been shown to have anti-inflammatory effects, but not aloe vera.
Azelaic acid (brand names Azelex, Finevin and Skinoren) is suitable for mild, comedonal acne.
Heat: local heating may be used to kill the bacteria in a developing pimple and so speed healing.
Pantothenic acid, (high dosage vitamin B5)
Tea tree oil (melaleuca oil) dissolved in a carrier (5% strength) has been used with some success, where it is comparable to benzoyl peroxide but without excessive drying, kills P. acnes, and has been shown to be an effective anti-inflammatory in skin infections.The reason it is a good substitution for benzoyl peroxide is because it also has the ability to kill bacteria on the surface of the skin but mostly due to fact that some people are allergic to benzoyl peroxide or have sensitive skin. Tea tree oil is a gentler and more natural solution.
Zinc: Orally administered zinc gluconate has been shown to be effective in the treatment of inflammatory acne, although less so than tetracyclines.
Prognosis
Acne usually improves around the age of 20 but may persist into adulthood.
Acne occurs most commonly during adolescence, affecting more than 96% of teenagers, and often continues into adulthood. In adolescence, acne is usually caused by an increase in male sex hormones, which people of both genders accrue during puberty.
SIGNS AND SYMPTOMS
.
1)Scars
Acne often leaves small scars where the skin gets a "volcanic" shape.
Physical acne scars are often referred to as "Icepick" scars. This is because the scars tend to cause an indentation in the skin's surface. Ice pick scars: Deep pits, that are the most common and a classic sign of acne scarring.
Box car scars: Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
Rolling scars: Scars that give the skin a wave-like appearance.
Hypertrophic scars: Thickened, or keloid scars.
2)Pigmentation
Pigmented scars is a slightly misleading term as it suggests a change in the skin's pigmentation and that they are true scars; however, neither is true. Pigmented scars are usually the result of nodular or cystic acne (the painful 'bumps' lying under the skin). They often leave behind an inflamed red mark. Often, the pigmentation scars can be avoided simply by avoiding aggravation of the nodule or cyst. When sufferers try to 'pop' cysts or nodules, pigmentation scarring becomes significantly worse and may even bruise the affected area. Pigmentation scars nearly always fade with time taking between three months to two years to do so, although rarely can persist.
On the other hand, some people—particularly those with naturally tanned skin—do develop brown hyperpigmentation scars due to increased production of the pigment melanin. These too typically fade over time.
CAUSES OF ACNE
Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone .Comedones are the direct result of sebaceous glands becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation
Hormones
Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the follicular glands to grow larger and make more sebum. Use of anabolic steroids Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I).
Development of acne vulgaris in later years is uncommon, although this is the age group for Rosacea which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).
Genetics
The tendency to develop acne runs in families. For example, school-age boys with acne often have other members in their family with acne as well. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.
Psychological
While the connection between acne and stress has been debated, scientific research indicates that "increased acne severity" is "significantly associated with increased stress levels."The National Institutes of Health (USA) list stress as a factor that "can cause an acne flare." A study of adolescents in Singapore "observed a statistically significant positive correlation between stress levels and severity of acne.
Infections
Bacteria in the pores. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. In-vitro resistance of P. acnes to commonly used antibiotics has been increasing.
Diet
A high glycemic load diet and cow's milk have been associated with worsening acne. Other associations such as chocolate and salt are not supported by the evidence.
MANAGEMENT
Many different treatments exist for acne including: benzoyl peroxide, antibiotics, retinoids, antiseborrheic medications, salicylic acid, alpha hydroxy acid, azelaic acid, nicotinamide, and kera-tolytic soaps.
Benzoyl peroxide
Benzoyl peroxide a first line treatment for mild and moderate acne vulgarus due to its effectiveness It has been found to be nearly as effective as antibiotics Products containing azelaic acid are also used in the treatment of P. acnes
Antibiotics
Commonly used antibiotics either topically or orally include: erythromycin, clindamycin and tetracycline.
Hormonal treatments
In females, acne can be improved with hormonal treatments. The common combined estrogen/progestogen methods of hormonal contraception have some effect, but the antiandrogen, Cyproterone, in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels. Along with this, treatment with low dose spironolactone can have anti-androgenetic properties, especially in patients with polycystic ovarian syndrome.
Intralesional steroid
If a pimple is large and/or does not seem to be affected by other treatments, a dermatologist may administer an injection of cortisone directly into it, which will usually reduce redness and inflammation almost immediately. This has the effect of flattening the pimple, thereby making it easier to cover up with makeup, and can also aid in the healing process.
Topical retinoids
A group of medications for normalizing the follicle cell lifecycle are topical retinoids such as tretinoin , adapalene , and tazarotene .Like isotretinoin, they are related to vitamin A, but they are administered as topicals and generally have much milder side effects. . The retinoids appear to influence the cell creation and death lifecycle of cells in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar but milder effects and is used in many over-the-counter moisturizers and other topical products. . Topical retinoids often cause an initial flare up of acne and facial flushing.
Oral retinoids
A daily oral intake of vitamin A derivative isotretinoin over a period of 4–6 months can cause long-term resolution or reduction of acne. It is believed that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin has been shown to be very effective in treating severe acne and can either improve or clear well over 80% of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects . It is often recommended that one lets a few months pass between the two treatments, because the condition can actually improve somewhat in the time after stopping the treatment and waiting a few months also gives the body a chance to recover. Occasionally a third or even a fourth course is used, but the benefits are often less substantial. The most common side effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa). Oral retinoids also often cause an initial flare up of acne within a month or so, which can be severe. . . Blood triglycerides also need to be monitored. However, routine testing are part of the official guidelines for the use of the drug in many countries. . The drug also causes birth defects if women become pregnant while taking it or take it while pregnant. For this reason, female patients are required to use two separate forms of birth control or vow abstinence while on the drug
Anti-inflammatories
Nicotinamide, (Vitamin B3) used topically in the form of a gel, has been shown in a 1995 study to be of comparable efficacy to topical clindamycin topical antibiotic used for comparison.Topical nicotinamide is available both on prescription and over-the-counter. The property of topical nicotinamide's benefit in treating acne seems to be its anti-inflammatory nature. It is also purported to result in increased synthesis of collagen, keratin, involucrin and flaggrin and may also according to a cosmetic company be useful for reducing skin hyperpigmentation (acne scars), increased skin moisture and reducing fine wrinkles
Rofecoxib was shown to improve premenstrual acne vulgaris in a placebo controlled study, although this drug has since been withdrawn
Naproxen or ibuprofen are used for some moderate acne for their anti-inflammatory effect.
Calendula used in suspension is used as an anti-inflammatory agent.
Sulfur
Sulfur is probably the oldest acne remedy known to medicine and its origins as an anti-acne treatment date to ancient Greek, Roman, and Chinese texts citing its efficacy in balneotherapy. Sulfur formulations are effective both as a micro-exfoliant and as a mild antiseptic. Sulfur is hydrophilic and can easily penetrate sebaceous pores where its antiseptic properties can assist local immune response in rapidly eliminating infection resulting from acne proliferation. Because the growth of acne bacteria is limited naturally by the skin's slightly acidic pH, alkaline cleansers (including soaps and detergents) can have a detrimental effect on controlling acne proliferation. Sulfur-based cleansers with a balancing or neutral pH can help eliminate acne and prevent future breakouts by maintaining the hydrolipidic layer's acidity and thereby controlling acne populations on the surface of the skin. Sulfur is abundant in keratin and its use is also helpful in promoting collagen synthesis. An active ingredient in prescription and over-the-counter lotions, creams, gels, washes, and shampoos, sulfur is also very effective in controlling seborrheic dermatitis, rosacea, eczema, psoriasis, pityriasis versicolor, scabies, and lice
Micro dermabrasion
. Microdermabrasion is a more natural skin care that is a gentler, less invasive technology for doing an exfoliation on the skin. The goal of the microdermabrasion is to eliminate the superficial layer of the skin called the epidermis. If the surface of the abraded skin is touched, a roughness of the skin will be noticed. The roughness is keratinocytes, which are better hydrated than the surface corneocytes. Keratinocytes appear in the basal layer from the proliferation of keratinocyte stem cells. They are pushed up through the cells of the epidermis, experiencing gradual specialization until they reach the stratum corneum where they form a layer of dead, flattened, strongly keratinized cells called squamous cells. This layer creates an efficient barrier to the entry of foreign matter and infectious elements into the body and reduces moisture loss. Keratinocytes are shed and restored continuously from the stratum corneum.
The time of transit from basal layer to shedding is generally one month. Corneocytes are cells derived from keratinocytes in the late stages of terminal specialization of squamous epithelia. The microdermabrasion is done to eliminate some of the corneocytes. These cells are responsible for the impermeability of the skin. The minimizing or elimination of scars, skin lesions, blotchiness and stretch marks from the skin can be an easy process with the use of skin exfoliation. The result depends on how well the procedure known as "skin remodeling" works. Results are optimal and fewer treatments are needed with more recent and/or superficial scars. Still, microdermabrasion can be used on scars that showed up during puberty or many years later.
Phototherapy
'Blue' and red light
Light exposure has long been used as a short term treatment for acne. Recently, visible light has been successfully employed to treat mild to moderate acne (phototherapy or deep penetrating light therapy) - in particular intense violet light (405-420 nm) generated by purpose-built fluorescent lighting, dichroic bulbs, LEDs or lasers. Used twice weekly, this has been shown to reduce the number of acne lesions by about 64% and is even more effective when applied daily. The mechanism appears to be that a porphyrin (Coproporphyrin III) produced within P. acnes generates free radicals when irradiated by 420 nm and shorter wavelengths of light. Particularly when applied over several days, these free radicals ultimately kill the bacteria. Since porphyrins are not otherwise present in skin, and no UV light is employed, it appears to be safe, and has been licensed by the U.S. FDA.
The treatment apparently works even better if used with a mixture of the violet light and red visible light (660 nanometer) resulting in a 76% reduction of lesions after three months of daily treatment for 80% of the patients; and overall clearance was similar or better than benzoyl peroxide. Unlike most of the other treatments few if any negative side effects are typically experienced, and the development of bacterial resistance to the treatment seems very unlikely. After treatment, clearance can be longer lived than is typical with topical or oral antibiotic treatments; several months is not uncommon. The equipment or treatment, however, is relatively new and reasonably expensive to buy initially, although the total cost of ownership can be similar to many other treatment methods (such as the total cost of benzoyl peroxide, moisturizer, washes) over a couple of years of use.
Photodynamic therapy
In addition, basic science and clinical work by dermatologists Yoram Harth and Alan Shalita and others has produced evidence that intense blue/violet light (405-425 nanometer) can decrease the number of inflammatory acne lesion by 60-70% in four weeks of therapy, particularly when the P. acnes is pretreated with delta-aminolevulinic acid (ALA), which increases the production of porphyrins. However this photodynamic therapy is controversial and apparently not published in a peer reviewed journal. A phase II trial, while it showed improvement occurred, failed to show improved response compared to the blue/violet light alone.
Surgery
For patients with cystic acne, boils can be drained through surgical lancing.
Laser treatment
Laser surgery has been in use for some time to reduce the scars left behind by acne, but research has been done on lasers for prevention of acne formation itself. The laser is used to produce one of the following effects:
to burn away the follicle sac from which the hair grows
to burn away the sebaceous gland which produces the oil
to induce formation of oxygen in the bacteria, killing them
Since lasers and intense pulsed light sources cause thermal damage to the skin, there are concerns that laser or intense pulsed light treatments for acne will induce hyperpigmented macules (spots) or cause long-term dryness of the skin.
Less widely used treatments
Aloe vera: there are treatments for acne mentioned in Ayurveda using herbs such as Aloe vera, Neem, Haldi (Turmeric) and Papaya. There is limited evidence from medical studies on these products.Products from Rubia cordifolia, Curcuma longa (commonly known as Turmeric), Hemidesmus indicus (known as ananthamoola or anantmula), and Azadirachta indica (Neem) have been shown to have anti-inflammatory effects, but not aloe vera.
Azelaic acid (brand names Azelex, Finevin and Skinoren) is suitable for mild, comedonal acne.
Heat: local heating may be used to kill the bacteria in a developing pimple and so speed healing.
Pantothenic acid, (high dosage vitamin B5)
Tea tree oil (melaleuca oil) dissolved in a carrier (5% strength) has been used with some success, where it is comparable to benzoyl peroxide but without excessive drying, kills P. acnes, and has been shown to be an effective anti-inflammatory in skin infections.The reason it is a good substitution for benzoyl peroxide is because it also has the ability to kill bacteria on the surface of the skin but mostly due to fact that some people are allergic to benzoyl peroxide or have sensitive skin. Tea tree oil is a gentler and more natural solution.
Zinc: Orally administered zinc gluconate has been shown to be effective in the treatment of inflammatory acne, although less so than tetracyclines.
Prognosis
Acne usually improves around the age of 20 but may persist into adulthood.
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