Acne Vulgaris :
Acne vulgaris is a long term skin condition that take place due to the obstruction of the hair follicles in your skin. This acne take place as whiteheads, blackheads, pimples, pustules, and cysts. Acnetor AD Gel is a safe and beneficial medicine for treatment of Acne vulgaris in adolescents and adults. It helps in lowering excess oil production from your skin.
The formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland)is Acne vulgaris. Acne grow on the face and upper trunk. It most frequently affects adolescents. Diagnosis is by examination. Treatment, based on seriousness, can include a variety of topical and systemic agents directed at decreasing sebum production, comedone formation, inflammation, and bacterial counts and at normalizing keratinization.
Acne is the most ussual skin disease in the US and affects 80% of the population at some point in life.
Acne take place from the interplay of 4 major factors:
• Excess sebum production,
• Follicular plugging with sebum and keratinocytes,
• Colonization of follicles with Cutibacterium acnes (formerly Propionibacterium acnes), a normal human anaerobe,
• Release of multiple inflammatory mediators.
Acne can be classified as:
Noninflammatory: Distinguish by comedones
Inflammatory: Distinguish by papules, pustules, nodules, and cysts
Noninflammatory acne:
Comedones are sebaceous plugs impacted within follicles. They are entitled open or closed depending on whether the follicle is dilated or closed at the skin surface. Plugs are easily extruded from open comedones but they are more hard to remove from closed comedones. Closed comedones are precursor lesions to inflammatory acne.
Inflammatory acne:
Papules and pustules take place when C. acnes colonizes the closed comedones, breaking down sebum into free fatty acids that irritate the follicular epithelium and eliciting an inflammatory response by neutrophils and then lymphocytes, that further disrupts the epithelium. The inflamed follicle ruptures into the dermis (sometimes precipitated by physical manipulation or harsh scrubbing), where the comedone contents elicit a further local inflammatory reaction, generating papules. If the inflammation is severe, grossly purulent pustules occur.
Etiology of Acne Vulgaris:
The most normal activator is-
Puberty:
While puberty, surges in androgens stimulate sebum production and hyperproliferation of keratinocytes.
Other activators include:
Hormonal changes that take place with pregnancy or the menstrual cycle
Occlusive cosmetics, cleansers, lotions, and clothing
High humidity and sweating
Connections between acne exacerbations and inadequate face washing, masturbation, and sex are unfounded. Some studies recommend a possible linked with milk products and high-glycemic diets. Acne can abate in summer months due to sunlight’s anti-inflammatory effects. Proposed connection between acne and hyperinsulinism needed further investigation. Some drugs (eg, corticosteroids, lithium, phenytoin, isoniazid) worsen acne or give rise to acneiform eruptions.
Symptoms and Signs of Acne Vulgaris:
Skin lesions and scarring can be a source of specific emotional distress. Nodules and cysts can be painful. Lesion types often coexist at different stages.
Comedones appear as whiteheads or blackheads. Whiteheads (closed comedones) are flesh-colored or whitish palpable lesions 1 to 3 mm in diameter
blackheads (open comedones) are common in appearance but with a dark center.
Papules and pustules are red lesions with diameter 2 to 5 mm. Papules are relatively deep and more superficial.
Nodules are big, deeper, and more solid than papules. Such lesions take after inflamed epidermoid cysts, although they lack true cystic structure.
Cysts are suppurative nodules. Rarely, cysts form deep abscesses. Long-term cystic acne can give rise to scarring that manifests as small and deep pits (icepick scars), larger pits, shallow depressions, or hypertrophic scarring or keloids.
Acne conglobata is the most critical form of acne vulgaris, which affect men more than women. Patients have abscesses, draining sinuses, fistulated comedones, and keloidal and atrophic scars. The back and chest are critically involved. The arms, abdomen, buttocks, and even the scalp can also be affected.
Acne fulminans is acute, febrile, ulcerative acne, which is characterized by the immediate appearance of confluent abscesses leading to hemorrhagic necrosis. Leukocytosis and joint pain and swelling can also be present.
Pyoderma faciale (also called rosacea fulminans) take place suddenly on the midface of young women. It can be analogous to acne fulminans. The eruption consists of erythematous plaques and pustules, involving the chin, cheeks, and forehead. Papules and nodules can develop and become confluent.
Diagnosis of Acne Vulgaris:
Evaluation for contributing factors (eg, hormonal, mechanical, or drug-related)
Determination of severity (leninet, moderate, severe)
Evaluation of psychosocial impact
Diagnosis of acne vulgaris is by examination.
Differential diagnosis includes rosacea (in which no comedones are seen), corticosteroid-induced acne (which lacks comedones and in which pustules are normally in the same stage of development), perioral dermatitis (normally with a more perioral and periorbital distribution), and acneiform drug eruptions (see Table: Types of Drug Reactions and Typical Causative Agents). Acne severity is graded lenient, moderate, or critical based on the number and type of lesions; one example of a standardized system is outlined in table Classification of Acne Severity.
Prognosis for Acne Vulgaris:
Acne of any severity usually remits spontaneously by the early to mid 20s, but a substantial minority of patients, normally women, can have acne into their 40s, options for treatment can be limited because of childbearing. Many adults generally develop mild, isolated acne lesions. Noninflammatory and lenient inflammatory acne normally heals without scars. Moderate to critical inflammatory acne heals but frequently leaves scarring. Scarring is not only physical, acne can be a huge emotional stressor for adolescents who may withdraw, using the acne as an excuse to avoid difficult personal adjustments. Supportive counseling for patients and parents can be indicated in critical cases.
Treatment of Acne Vulgaris:
Comedones: Topical tretinoin
Mild inflammatory acne: Topical retinoid alone or with a topical antibiotic, benzoyl peroxide, or both
Moderate acne: Oral antibiotic plus topical therapy as for lenient acne
Severe acne: Oral isotretinoin
Cystic acne: Intralesional triamcinolone
It is important to prevent acne to reduce the extent of disease, scarring, and psychologic distress.
Treatment of acne includes a variety of topical and systemic agents directed at reducing sebum production, comedone formation, inflammation, and bacterial counts and at normalizing keratinization. Selection of treatment is commonly based on severity.
Affected areas should be cleaned once or twice in a day, but extra washing, use of antibacterial soaps, and scrubbing confer no added benefit.
A lower glycemic diet and moderation of milk intake can be considered for treatment-resistant adolescent acne, but the effectiveness of these measures in treating acne stays controversial.
Peeling agents like sulfur, salicylic acid, glycolic acid, and resorcinol can be useful therapeutic adjuncts.
Oral contraceptives are helpfull in treating inflammatory and noninflammatory acne, and spironolactone (beginning at 50 mg orally once a day, increased to 100 to 150 mg [maximum 200 mg] orally once a day after a few months if required) is another antiandrogen that is occasionally useful in women.
Various light therapies, with and without topical photosensitizers, have been used effectively, likely for inflammatory acne.
Treatment should include educating the patient and tailoring the plan to one that is realistic for the patient. Treatment failure can often be attributed to lack of adherence to the plan and also to lack of follow-up. Consultation with a specialist can be important.
Mild acne:
Treatment of lenient acne should be continued for 6 weeks or until lesions respond. Maintenance treatment can be necessary to keep control.
Moderate acne:
Oral systemic therapy with antibiotics is the best way for the treatment of moderate acne. Antibiotics helpfull for acne include tetracycline, minocycline, erythromycin, doxycycline, and sarecycline. Takes 12 weeks for full benefits.
Topical therapy as for mild acne is commonly used concomitantly with oral antibiotics.
Severe acne:
Oral isotretinoin is the best treatment for patients with moderate acne in whom antibiotics are unsuccessful and for those with serious inflammatory acne. Dosage of isotretinoin is usually 1 mg/kg once a day for 16 to 20 weeks, but the dosage can be increased to 2 mg/kg once a day. If adverse effects make this dosage intolerable, it can be reduced to 0.5 mg/kg once a day. After therapy, acne can continue to improve.
Cystic acne:
Intralesional injection of 0.1 mL triamcinolone acetonide suspension 2.5 mg/mL (the 10 mg/mL suspension must be diluted) is indicated for patients with firm (cystic) acne who take quick clinical improvement with reduced scarring. Local atrophy can take place but is usually transient. For isolated, very boggy lesions, incision and drainage are frequently beneficial but can result in residual scarring.
Other forms of acne:
Pyoderma faciale is prevented with oral corticosteroids and isotretinoin.
Acne fulminans is ussually treated with oral corticosteroids and systemic antibiotics.
Acne conglobata is treated with oral isotretinoin and systemic corticosteroids if critical and if systemic antibiotics fail.
For acne lead by endocrine abnormalities (eg, polycystic ovary syndrome, virilizing adrenal tumors in females), antiandrogens are indicated. Spironolactone, has some antiandrogen effects, is sometimes prescribed to treat acne at a dose of 50 to 150 mg (maximum 200 mg) orally once a day. Cyproterone acetate is used in Europe. When other measures fail, an estrogen/progesterone–containing contraceptive can be tried, therapy 6 months is required to evaluate effect.
Scarring:
Small scars can be prevented with chemical peels, laser resurfacing, or dermabrasion. Deeper, discrete scars can be excised. Wide, shallow depressions can be prevent with subcision or injection of collagen or another filler. Fillers, involve collagen, hyaluronic acid, and polymethylmethacrylate, are temporary and must be repeated periodically.