Acne Acne is an inflammatory disease of the skin, caused by changes in the pilosebaseous units (skin structures consisting of a hair follicle and its associated sebaceous gland). The most common form of acne is known as "acne vulgaris", which means common acne. Excessive secretion of oils from the glands combine with naturally occurring dead skin cells to block the hair follicles. Oil secretions build up beneath the blocked pore, providing a perfect environment for the skin bacteria Propionibacterium acnes to multiply uncontrolled. In response, the skin inflames, producing the visible lesion. The face, chest, back is especially affected. The typical lesions of acne are: small whitish or skin-colored bumps (whiteheads) or blackish elevations (blackheads). More inflamed rashes take the form of pus-filled, or reddish bumps, even boil-like tender swellings. After these lesions are cured, prominent unsightly scars may remain. Picture of Acne on the face The condition is common in puberty as a result of an abnormal response to normal levels of the male hormone testosterone. The response for most people diminishes over time and acne thus tends to disappear after one turns 30. There is, however, no way to predict how long it will take for it to disappear entirely, and some individuals may suffer from acne all their life. Acne affects a large percentage of humans at some stage in life. Aside from scarring, its main effects are psychological, such as reduced self-esteem and depression. For this reason acne should be treated if severe. Causes for acne Exactly why some people get acne and some do not is not fully known. Several factors are linked with acne: · Stress · Heredity · Hormonal activity · Hyperactive sebaceous glands · Accumulation of dead skin cells · Bacteria in the pores · Skin irritation or scratching of any sort · Anabolic steroids · Birth control pills · Exposure to high levels of chlorine compounds. (Chloracne) · Traditionally, attentin has focused mostly on over-production of sebum as the main contributing factor of acne. Formation of Acne Nowadays, more attention is being given to narrowing of the follicle channel. Abnormal shedding of the cells lining the follicle and water retention in the skin (swelling the skin and so pressing the follicles shut) have all been put forward as mechanisms involved, but there does not appear to be much conclusive medical research on the subject. Acne misconceptions Since the medical knowledge about acne is still relatively small, many misconceptions and rumours about what causes acne exist: Diet - Chocolate, chips, sugar, milk and seafood among others have not been shown to affect acne However, there is no scientific evidence that this is the case. Available treatments There are a myriad of products sold for the treatment of acne, many of them without any scientifically proven effects. However, a combination of treatments can greatly reduce the amount and severity of acne in many cases. There are four types of treatments that have been proven effective: 1. Killing the bacteria that are harbored in the blocked follicles. This is done either by the intake of antibiotics like tetracyclines, or by treating the affected areas externally with bactericidal substances like benzoyl peroxide or erythromycin. However, reducing the bacteria will not, in itself, do anything to reduce the oil secretion and abnormal cell behaviour that is the initial cause of the blocked follicles. Therefore, acne may reappear after the end of treatment 2. Reducing the secretion of oils from the glands. This is done by daily oral intake of Vitamin A derivates like isotretinoin over a period of a few months. Isotretinoin has been shown to be very effective in treating severe acne for good. However, the treatment requires close medical examination by a dermatologist since the drug has many known side effects. The most common side effects are dry skin and nosebleed. It can also permanently damage the liver. Because of this, the drug is typically used given a last resort after milder treatments have proven insufficient. 3. Normalizing the follicle cell lifecycle. A group of medications for this are topical retinoids such as Tretinoin, Adapalene and Tazarotene. They are related to Vitamin A, but they are administered as topicals and have much milder side effects. They can give significant irritation of the skin. 4. Exfoliating the skin. This can be done either mechanically, using an abrasive cloth or a liquid scrub, or chemically. Common chemical exfoliating agents include salicylic acid and glycolic acid, which encourage the peeling of the top layer of skin to prevent a build-up of dead skin cells which combine with skin oil to block pores. It also helps to unblock already clogged pores. Note that the phrase "peeling" is not meant in the visible sense of shedding, but rather as the destruction of the top layer of skin cells at the microscopic level. Moisturizers and anti-acne topicals containing chemical exfoliating agents are commonly available over-the-counter. Popping a pimple or any physical acne treatment should not be attempted by anyone but a qualified dermatologist. Pimple popping irritates skin, can spread the infection deeper into the skin and can cause permanent scarring. Future treatments · Lasers have been in use for some time to reduce the scars left behind by acne, but research is now being done on lasers for prevention of acne formation. · As of 2004, this is still mostly at the stage of medical research rather than established treatment. · Because acne appears to have a significant hereditary link, there is some expectation that cheap whole-genome DNA sequencing may help isolate the body mechanisms involved in acne more precisely, possibly leading to a more satisfactory treatment However, as of 2004 DNA sequencing is not yet cheap and all this may still be decades off. It is also possible that gene therapy could be used to alter the skin's DNA. Acne scars Severe acne often leaves small scars where the skin gets a "volcanic" shape. Acne scars are very hard (and expensive) to treat and it is unusual for the scars to be successfully removed. In those cases, scar treatment may be appropriate. The most commonly used forms of scar treatments are: · Dermabrasion. · Microdermabrasion · Laser resurfacing. · Punch excision. · Chemical peels · Subcision.