What is Acne?
Acne is a general term for pimples and deeper pustules that are clogged pores. If severe enough acne can leave permanent scars.
Acne is an inflammatory skin disorder of the skin's sebaceous glands and hair follicles that affects about 80% of people between the ages of 12 and 24. During puberty high levels of hormones are produced in both girls and boys. This leads to the production of large quantities of sebum. Sebum is an irritant that can clog the pores and form a pimple which may become infected and form a pustule. Hormones don't go away after adolescence. Many women still get premenstrual acne from of the release of progesterone after ovulation.
Normal pilosebaceous unit
Acne is a disease that affects the skin's oil glands. The small holes in your skin (pores) connect to the oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows. Most pimples are found on the face, neck, back, chest, and shoulders. Acne is not a serious health threat but it can cause scars.
What Causes Acne?
§ The exact cause of acne is unknown, several related factors are:
§ Hormonal activity supposed to be responsible, such as menstrual cycles and puberty.
§ Increase in hormones called androgens (male sex hormones), which causes sebaceous glands to enlarge and make more sebum.
§ Hormonal changes related to pregnancy can also cause acne.
§ Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder.
§ Accumulation of dead skin cell.
§ Bacteria in the pores, to which body becomes allergic.
§ Skin irritation or scratching of any sort will active the inflammation.
§ Starting or stopping birth control pills.
§ Heredity (if your parents had acne, you might get it too).
§ Some types of medicine. Greasy makeup.
In some patients, contributing factors may be:
Pressure: In some patients, pressure from helmets, chinstraps, collars, and the like can aggravate acne.
Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids bodybuilders or athletes take.) Most cases of acne, however, are not drug-related. Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne
Pathophysiology of Acne
§ Excessive secretion of oils from the sebaceous glands accompanies the plugging of the pores with naturally occurring dead skin cells (corneocytes) blocking hair follicles.
§ The accumulation of these corneocytes in the duct appears to be due to a failure of the normal keratinization process in the skin which usually leads to shedding of skin cells lining the pores.
§ Oil secretions are said to build up beneath the blocked pore, providing a perfect environment for the skin bacteria Propionibacterium acnes and the lipophilic (oil/lipid-loving) yeast Malassezia to multiply uncontrollably.
§ Under the microscope, however there is no evidence of pooled trapped sebum. Indeed the oil perolates through the plugged duct onto the surface.
§ In response to the bacterial and yeast populations, the skin inflames, producing the vision lesion.
§ The face, chest, back, shoulders and upper arms are especially affected.
Acne describes as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle that contains a fine hair.
People with acne frequently have a variety of lesions, some of which are shown in the diagrams below. The basic acne lesion, called the comedo, is simply an enlarged and plugged hair follicle.
If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead.
A comedo that reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the skin's surface. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.
Acne is a group of skin rashes with different causes named as:-
Acne vulgaris
It is most commonly experienced around puberty, typically of the face and shoulders / chest.
Acne rosacea
A red rash predominantly on the face.
Acne keloidalis nuchae (pseudofolliculitis nuchae)
A rash caused by shaving.
Acne conglobata (Hidradenitis suppurativa)
Chronic abscesses or boils of sweat gland and hair follicle; in the underarms, groin, buttocks and under the breasts in women.
Acne cosmetica
Acne caused by use of cosmetics.
Acne fulminans
An extreme form of acne conglobata.
Acne medicamentosa
Acne cause by starting or stopping medicine.
Baby acne
A rash seen on the cheeks, chin, and forehead of infants.
Chloracne
Acne caused by exposure to chlorinated hydrocarbons such as dioxins or PCBs.
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Acne vulgaris
Acne vulgaris is an inflammatory disease of the skin, which is caused by changes in the pilosebaceous units
Cystic acne on the face
It is the most common form of acne. Large number of teenagers suffers from this, during the period of puberty. In most of the cases it tends to disappear or atleast decreases after one reaches early twenties. There is no fix prediction how long time it will take to disappear entirely,
Signs and symptoms of Acne
Acne typically appears on face, neck, chest, back, shoulders and the areas of skin with the largest number of functional oil glands. People with acne frequently have a variety of lesions, some of which are shown in the diagrams below. The basic acne lesion, called the comedo, is simply an enlarged and plugged hair follicle. Acne can take the following forms;
Whiteheads: These are created when the openings of hair follicles become clogged and blocked with oil secretions and dead skin.
If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produceswhite bump called a whitehead.
Blackheads: These are similar to whiteheads, but are open to the skin surface and darken.
Whiteheads: These are created when the openings of hair follicles become clogged and blocked with oil secretions and dead skin.
If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produceswhite bump called a whitehead.
Blackheads: These are similar to whiteheads, but are open to the skin surface and darken.
A comedo that reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the skin's surface. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.
Other troublesome acne lesions can develop, including the following:
§ Papules – inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
Macule - A macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well defined border.
MACULE
A macule may persist for days to weeks before disappearing. When a number of macules are present at one time they can contribute to the "inflamed face" appearance of acne. It shows the "red face" appearance.
§ Pustules (pimples) – These are raised; reddish spots that signal inflammation or infection in the macule may persist for days to weeks before disappearing. When a number of macules are present at one time they can contribute to the "inflamed face" appearance of acne. It shows the "red face" appearance.
§ Pustules (pimples) – These are raised; reddish spots that signal inflammation or infection in the hair follicles. Papules topped by white or yellow pus-filled lesions that may be red at the base
PUSTULES
§ Nodules – large, painful, solid lesions that are lodged deep within the skin
Cysts – These are thick lumps beneath the surface of the skin, which are formed by the buildup of secretions deep within hair follicles. Deep, painful, pus-filled lesions that can cause scarring.
CYSTS
After resolution of acne lesions their may be prominent unsightly scars
Acne Rosacea
Acne rosacea is a skin disorder leading to redness and pimples on the nose, forehead, cheekbones, and chin. The inflamed pimples and redness of rosacea can look a great deal like acne, but blackheads are almost never present. Fair-skinned individuals and people who flush easily seem to be more susceptible to this condition.
Rosacea becomes progressively worse in many of those affected. The real cause of rosacea is now thought to be a tendency to flush and blush in a person with sun damage. Sun damages the supporting fibers of the small blood vessels just under the surface of the skin, allowing the vessels to stretch out (become permanently dilated). The damaged blood vessels leak fluid when flushing occurs, resulting in blotchy red areas. Swelling occurs, but is not usually so prominent to be very visible. The first sign most people see are small red pimples and pustules (pus-filled whiteheads). The redness can come and go and may be tender, inflamed and sensitive to the touch. Later, the skin tissue can swell and thicken. Eventually the redness and swelling can become permanent.
Symptoms of Acne rosacea
It may vary according to the severity of the case.
Facial flushing is the classic symptom of rosacea. Flushing is the result of increased blood flow through dilated facial blood vessels. During a flush, face can turn various shades of red depending on the amount of blood flowing through the skin. A sufferer may experience a fire-red face during intense flushes, a mildly-red face during moderate flushes, or a barely noticeable pinkish-hue during mild flushes; it may be transient or long-standing.
Facial redness is caused by hundreds of tiny dilated blood vessels near the surface of the facial skin
Facial Telangiectasia; tiny broken blood vessels which are permanently fixed in the dilated state and take appearance of
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