Guess what? Who is the guest who came by uninvited?

Acne!!!

Oh no, why is this happen to me? Why did you show up without telling me? If you desperately want to pay a visit, I appreciate it (read Pasrah), but HOW ON EARTH YOU CHOSE TO SIT SNUGLY ON MY NOSE. Huh.

Arghhh! It is too obvious. I have to meet somebody right now. Ottoke…Should I wear a mask?

Adududu… This is an outbreak! End of the world!

*fainted

I think, maybe some of us having the same problem as me. Acne suddenly appear without noticing. Like a plot twist in a movie. But, how well did you know about acne?

Aywah, let’s taaruf with him.

What is Acne?

Acne is a chronic, inflammatory skin condition which is your hair follicles become plugged with oil and dead skin cells that causes whiteheads, blackheads or pimples, especially on:

  • face
  • shoulders
  • back
  • neck
  • chest
  • upper arms

It commonly occurs during teenager (13 to 19 years old) due to puberty, when the sebaceous glands activate, but it can occur at any age.

It is not dangerous, but it can leave skin scars.

What causes acne appeared?

There are four main factors cause acne:

  • Excess oil production
  • Hair follicles clogged by oil and dead skin cells
  • Bacteria
  • Excess activity of a type of hormone (androgens)

Acne appears on your face, shoulers, back, neck, chest and upper arm because these areas of skin have the most oil (sebaceous) glands. Hair follicles are connected to oil glands.

The follicle wall may bulge and produce a whitehead. Or the plug may be open to the surface and darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it’s exposed to the air.

Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation that develop deep inside hair follicles produce cystlike lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren’t usually involved in acne.

Hormonal factors

A range of factors triggers acne, but the main cause is thought to be a rise in androgen levels.

Androgen is a type of hormone, the levels of which rise when adolescence begins. In women, it gets converted into estrogen.

Rising androgen levels cause the oil glands under the skin to grow. The enlarged gland produces more sebum. Excessive sebum can break down cellular walls in the pores, causing bacteria to grow.

These factors can trigger or aggravate acne:

  • Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
  • Certain medications. Examples include drugs containing corticosteroids, testosterone or lithium.
  • Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne. Chocolate has long been suspected of making acne worse. A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.
  • Stress can make acne worse.

Too bored to read facts? Me too. Here, take some sweets.

Acne myths

These factors have little effect on acne:

Greasy foods. Eating greasy food has little to no effect on acne. Though working in a greasy area, such as a kitchen with fry vats, does because the oil can stick to the skin and block the hair follicles. This further irritates the skin or promotes acne.

Acne isn’t caused by dirty skin. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse.

Cosmetics don’t necessarily worsen acne, especially if you use oil-free makeup that doesn’t clog pores (noncomedogenics) and remove makeup regularly. Non oily cosmetics don’t interfere with the effectiveness of acne drugs.

Nasi Minyak Ayam Merah
Treatment

Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.

The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Often topical medications and drugs you take by mouth (oral medication) are used in combination. Pregnant women will not be able to use oral prescription medications for acne.

Treatment is depends on how severe and persistent the acne is.

1. Topical medications

The most common topical prescription medications for acne are as follows:

Retinoids and retinoid-like drugs. 

These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include Tretinoin (Avita, Retin-A, others), Adapalene (Differin) and Tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.

Antibiotics. 

These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance.

Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin). Topical antibiotics alone aren’t recommended.

Salicylic acid and Azelaic acid. 

Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent Azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It’s even more effective when used in combination with erythromycin. Prescription Azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding. Side effects include skin discoloration and minor skin irritation.

Salicylic acid may help prevent plugged hair follicles and is available as both wash-off and leave-on products. Studies showing its effectiveness are limited.

Dapsone. 

Dapsone (Aczone) 5 percent gel twice daily is recommended for inflammatory acne, especially in adult females with acne. Side effects include redness and dryness.

2. Oral medications

Antibiotics. 

For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Usually the first choice for treating acne is Tetracycline such as Minocycline, Doxycycline or a Macrolide.

Oral antibiotics should be used for the shortest time possible to prevent antibiotic resistance.

Oral antibiotics are best used with topical Retinoids and Benzoyl Peroxide. Studies have found that using topical Benzoyl Peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance.

Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin’s sun sensitivity.

Combined oral contraceptives. 

Four combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. They are products that combine estrogen and progestin (Ortho Tri-Cyclen, Yaz, others). You may not see the benefit of this treatment for a few months, so using other acne medications with it the first few weeks may help.

The most common side effects of these drugs are weight gain, breast tenderness and nausea. A serious potential complication is a slightly increased risk of blood clots.

Anti-androgen agents. 

The drug Spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren’t helping. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness and painful periods.

Isotretinoin. 

Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for people whose severe acne doesn’t respond to other treatments.Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug. Potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects. In fact, Isotretinoin carries such serious risk of side effects that all people receiving Isotretinoin must participate in a Food and Drug Administration- approved risk management program.

3. Therapies

These therapies may be suggested in select cases, either alone or in combination with medications.

  • Lasers and photodynamic therapy. A variety of light-based therapies have been tried with some success. But further study is needed to determine the ideal method, light source and dose.
  • Chemical peel. This procedure uses repeated applications of a chemical solution, such as salicylic acid, glycolic acid or retinoic acid. Any improvement in acne is not long lasting, so repeat treatments are usually needed.
  • Extraction of whiteheads and blackheads. Your doctor may use special tools to gently remove whiteheads and blackheads (comedos) that haven’t cleared up with topical medications. This technique may cause scarring.
  • Steroid injection. Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This therapy has resulted in rapid improvement and decreased pain. Side effects may include thinning in the treated area.

Lasers specifically target the sebaceous gland and surrounding inflammation.

Take actions against acne.

You can try to avoid or control mild acne with nonprescription products, good basic skin care and other self-care techniques:

  1. Wash problem areas with a gentle cleanser. Twice a day, use your hands to wash your face with a mild soap and warm water. If you tend to develop acne around your hairline, shampoo your hair every day. And be gentle if you’re shaving affected skin.
  2. Avoid certain products, such as facial scrubs, astringents and masks. They tend to irritate the skin, which can worsen acne. Excessive washing and scrubbing also can irritate the skin.
  3. Try over-the-counter acne products to dry excess oil and promote peeling. Look for products containing benzoyl peroxide as the active ingredient. You might also try products containing salicylic acid, glycolic acid or alpha hydroxy acids, which may help with mild and moderate acne. It may take a few weeks before you see any improvement.
  4. Nonprescription acne medications may cause initial side effects such as redness, dryness and scaling that often improve after the first month of using them.
  5. Avoid irritants. Avoid oily or greasy cosmetics, sunscreens, hairstyling products or acne concealers. Use products labeled water-based or noncomedogenic, which means they are less likely to cause acne.
  6. Protect your skin from the sun. For some people, the sun worsens acne. And some acne medications make you more susceptible to the sun’s rays. Check with your doctor to see if your medication is one of these. If it is, stay out of the sun as much as possible. Regularly use a non-oily (noncomedogenic) moisturizer that includes a sunscreen.
  7. Avoid friction or pressure on your skin. Protect your acne-prone skin from contact with items such as phones, helmets, tight collars or straps, and backpacks.
  8. Avoid touching or picking at the problem areas. Doing so can trigger more acne or lead to infection or scarring.
  9. Shower after strenuous activities. Oil and sweat on your skin can lead to breakouts.

Seek emergency medical help if after using a skin product you experience:

  • Faintness
  • Difficulty breathing
  • Swelling of the eyes, face, lips or tongue
  • Tightness of the throat

References:

Mayoclinic.org

MedicalNewsToday.com

Dermatology, Venerology & Andrology Faculty of Medicine, Alexandria University Textbook

By:

Muhammad Aiman Hakim Ariffin
5th Year Medical Student,
Alexandria University,
Dermatologist to be.

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