Acne
What is this condition?
A person with acne experiences persistent, recurrent blemishes on the skin. Acne primarily affects adolescents, but lesions can appear as early as age 8. Although acne strikes boys more often and more severely, it usually occurs in girls at an earlier age and tends to last longer, sometimes into adulthood. The prognosis is good with treatment.
What causes it?
Acne may be caused by many different factors. Research now centers on clogged skin follicles, production of an oily substance called sebum (stimulated by hormones called androgens), and a bacterium called Propionibacterium acnes as possible primary causes. Theories focusing on dietary influences appear to be groundless.
Certain factors – such as heredity and use of oral contraceptives increase a person’s risk of developing acne. Many women experience an acne flare-up during their first few menstrual cycles after starting or discontinuing oral contraceptives. Certain other drugs also seem to increase a person’s risk, including corticosteroids, corticotropin, androgens, iodides, bromides, trimethadione, phenytoin, isoniazid, lithium, and halothane. Other risk factors are injury, rubbing from tight clothing, cosmetics, emotional stress, an unfavorable climate, and exposure to heavy oils, greases, or tars.
What are its symptoms?
The acne plug may appear as a closed comedo, or whitehead (if it doesn’t protrude from the follicle and is covered by the epidermis), or as an open comedo, or blackhead (if it does protrude and isn’t covered by the epidermis). The black coloration is caused by the melanin (pigment) of the follicle. Rupture or leakage of an enlarged plug into the dermis causes inflammation and characteristic acne pustules and papules or, in severe forms, acne cysts or abscesses. Chronic, recurring lesions produce acne scars.
How is it treated?
Common therapy for acne includes ointments such as benzoyl peroxide, a powerful antibacterial, or Retin-A. These drugs may be used in combination and may irritate the skin.
Systemic antibiotics, such as Achromycin (tetracycline), Minocin. and Cleocin, may help reduce the effects of acne by decreasing bacterial growth until the person is in remission. A lower dosage is used for long-term maintenance. Achromycin should not be used during pregnancy because it discolors the teeth of the fetus. E-Mycin is an alternative for pregnant women. If the pustules or abscesses worsen during either type of antibiotic therapy, the doctor will take a culture to identifY a possible secondary bacterial infection.
The drug Accutane taken orally effectively combats acne. But because of its severe side effects, use of this drug is limited to those with severe acne who don’t respond to conventional therapy. Because this drug is known to cause birth defects, special precautions must be taken when using this drug. For example, women must have a pregnancy test before receiving the drug and the pharmacist is allowed to provide no more than a 30-day supply. Pregnancy testing should be repeated throughout the treatment period, and women should use effective contraception during treatment.
Women may benefit from estrogen administration to inhibit androgen activity. Improvement rarely occurs before 2 months, and exacerbations may follow discontinuation of estrogen therapy. Unfortunately, the high estrogen dosage required presents a major risk of severe side effects.
September 20, 2024