Written By: Abeer Hamami. RPH. CPHQ

What is acne?
Acne is a common, but non-contagious skin disorder characterized by clogged pores and pimples. While not a life threatening condition, acne can be upsetting and disfiguring. When severe, acne can lead to serious and permanent scarring.

What are the types of acne?

Acne Vulgaris - is the most common form of acne usually experienced around puberty, typically of the face and shoulders/chest.Acne Rosacea - a red rash predominantly on the face.Acne Keloidalis Nuchae - a rash caused by shaving.Acne Conglobata - clusters of chronic absesses or boils that may be as large as a baseball and can last for years.Acne Cosmetica - acne caused by cosmetics.Acne Fulminans - an extreme form of acne Conglobata.Acne Medicamentosa - acne caused by starting or stopping a medicine.Chloracne - an acne rash caused by exposure to chlorinated hydrocarbons. such as dioxins or Polychlorinated Biphenyls (PCBs).

Where and how does it appear?
Acne typically appears on your face, neck, chest, back and shoulders, which are the areas of your skin with the largest number of functional oil glands. Acne appears in several types of pimples, and is classified in 2 categories:

Non-Inflammatory Acne(Obstructive Acne)

Open Comedones (Black heads) result when a pore is only partially blocked, allowing some of the trapped sebum (oil), bacteria, and dead skin cells to slowly drain to the surface

Closed Comedones (White heads) result when a pore is completely blocked, trapping sebum (oil), bacteria, and dead skin cells, causing a white appearance on the surface.

Inflammatory Acne (in order of lesion formation):

Papules are inflamed, red, tender bumps with no head.
Pustules are similar to whiteheads, but are inflamed, and appear as a red circle with a white or yellow center.
Nodules are large, hard bumps under the skin's surface.
Cycts appear similar to nodules, but are pus-filled, and have been described as having a diameter of 5mm or more across.
Scars result when squeezing an acne cyst, and in turn causing a deeper infection and more painful inflammation.

Typically, individuals exhibit a combination of both types.

What causes acne?
Excessive secretion of oils from the sebaceous glands combines with naturally occurring dead skin cells to block the hair follicles. There also appears to be in some instances a faulty keratinization process in the skin leading to abnormal shedding of skin lining the pores. Oil secretions build up beneath the blocked pore, providing a perfect environment for the skinbacteria Propionibacterium acnes to multiply uncontrolled. In response, the skin inflames, producing the visible lesion.

Who could get acne?
Both boys and girls get acne, but it may be worse in boys because they have more skin oils. More than four out of five people between the ages of 12 and 24 develop acne at least once, but it's not uncommon for acne to occur in people in their 30s, and even older.

What are the risk factors for acne?
Hormonal changes in your body can provoke or aggravate acne. Such changes are common in:

Teenagers, both boys and girls.Females, two to seven days before their periods.Pregnant women.People using certain medications, including steroids.

Other risk factors include:

Exposing your skin directly to greasy or oily substances, or to certain cosmetics.Having a family history of acne. If your parents had acne, you may be likely to develop it too.Friction or pressure on your skin caused by items such as telephones, cell phones, helmets, tight collars and backpacks.

What could worsen acne?
Several factors could make acne worse as:

Oil-based makeup, suntan oil, hair gels and sprays.In girls: menstruation.Squeezing or picking at blemishes.Hard scrubbing of the skin.Emotional factors, such as stress and anxiety.Environmental factors, such as humidity or exposure to dirt or oil in the air causes the skin to become irritated (Individuals who work in fast food restaurants and those exposed to motor oil regularly ).Some medicines such as Phenytoin, Isoniazid, Phenobarbital, Lithium, Quinine, Rifampin, and Steroids.

What could you do to prevent or control acne?

Wash problem areas with a gentle cleanser: establishing a twice-a-day skin-cleansing routine using warm water and facial soap without. moisturizers is one preventive measure that can be recommended.Try over-the-counter acne lotion to dry excess oil and promote peeling.Avoid irritants such as oily cosmetics, sunscreens. Use products labeled "water-based" or "noncomedogenic".Watch what touches your face: keep hair, hands, and objects as telephones away off your face.Don't pick or squeeze blemishes.Eat a healthy balanced diet, food usually do not make acne worse, although some people might notice their acne is aggravated by eating some kind of food like choclate or nuts.

Males with acne who use a safety razor should soften the beard with soap and warm water. Shave as lightly and as seldom as possible and always use a sharp blade. Stroke in the direction of hair growth and go over each area only once.

In general avoiding or lessening the exposure to factors that may worsen acne or cause flare-ups is recommended.

What nonprescription products are available for acne treatment?
A wide variety of topical nonprescription (over-the-counter OTC) products are available for treating acne, and are mainly indicated for mild type. These products contain active ingredients such as Benzoyl Peroxide, Salicylic Acid, or Sulfur and may be single-entity or combination products. They are available in a variety of dosage forms, such as gels, lotions, creams, cleansers, masks, and soaps.

Benzoyl Peroxide is the most effective nonprescription product as it acts as an exfoliant and has an antibacterial effect. It is used twice daily.

Salicylic acid and Sulfur are mainly exfoliants and are usually effective for mild acne. Salicylic acid products are used mainly as cleansers and then rinsed off. Sulfur-containing products usually are used 1 to 3 times daily.

In some people, OTC acne medications may cause side effects such as skin irritation, burning or redness. Tell your doctor if you have side effects that are severe or that don't go away over time.

Important: When applying acne treatment, use on whole area do not spot it, and be aware that it may take 6-8 weeks of treatment before you notice a significant improvement.

What prescription products are available for acne treatment?
Several products could be prescribed by your doctor such as:

Antibiotics, such as Clindamycin, Doxycyclin, Minocyclin, Erythromycin. They can be taken by mouth, or used on the skin in a lotion, cream or gel.Topical Retinoids such as Tretinoin (brand names: Retin-A, Avita, Altinac cream), Adapalene (brand name: Differin), and Tazarotene (brand name: Tazorac). They are usually rubbed onto the skin once a day. Be sure not to get them near your eyes, mouth and the area under your nose. If you use a Retinoid, you must avoid the sun or use a strong sunscreen because this medicine increases your risk of getting a very bad sunburn. women who are pregnant or may become pregnant should not use Tazarotene because it can cause birth defects.Oral Retiniod (Isotretinoin) marketed as Accutane or other trade names may be used to treat severe cystic acne that doesn't get better with other treatments. It is taken once a day by mouth for 15 to 20 weeks. In women, Isotretinoin can cause very serious side effects such as birth defects and miscarriages. It should never be taken during pregnancy or even 1 month before pregnancy. Young ladies must use 2 types of birth control or not have sex while they take Isotretinoin, as well as 1 month before they start and 1 month after they stop taking it. There is a possibility that other serious side effects may occur, so people taking Isotretinoin should be closely monitored by their doctor.Contraceptives or Hormone Therapy. For women, a standard combined oral contraceptive pill (containing an oestrogen and a progestogen) can improve acne symptoms. But in some women, it can also make symptoms worse. Also the anti- testosterone Cyproterone is particularly effective at reducing androgenic hormone levels,and though be an effective treatment for acne in such cases.Cortisone injection: If a pimple is large and/or does not seem to be affected by other treatments, a dermatologist may administer an injection of Cortisone directly into it, which will usually reduce redness and inflammation almost immediately.

What about the use of herbs and herbal masks?

OTC products labeled “herbal,” "organic" or "natural" are marketed as acne treatments but their effectiveness has rarely been tested in clinical trials. The value of such treatments is generally unknown.

What is the duration of treatment?
On average, 6 to 8 weeks are needed to see initial results. Once acne significantly improves or clears, continued treatment is needed to keep acne from re-appearing. If acne does not improve in 6 to 8 weeks, treatment may need to be adjusted as not every acne treatment clears every case of acne.

What physical procedures could be used in acne treatment?
Several physical procedures are used usually by dermatologists to treat acne. Trying these at home can lead to infection, worsening of the acne and scarring. Among these procedures are:

Chemical Peels using glycolic acid or other chemical agents.Comedo Extraction: dermatologists use a sterile pen-sized device to extract the whiteheads and blackheads.Drainage and Surgical Extraction: this is usually used for large cysts that do not respond to medication. Drainage and extraction, which is also called “Acne Surgery,” reduces the pain associated with these cysts and decreases the likelihood of scarring.Phototherapy (Laser and Light Treatments)
Several laser and light treatments are available to treat acne. Some of these laser and light treatments target only one factor that causes acne—P. acnes.( Propionibacterium acnes) For many patients, this is not a comprehensive treatment for resolving their acne. A dermatologist can determine if laser or light treatment is appropriate for a patient.

References:

http://www.skincarephysicians.com/acnenet/acne.html
http://www.mayoclinic.com/health/acne/DS00169/DSECTION=1
http://www.acne.org/faq.html
http://www.fpnotebook.com/DER2.htm
http://www.medicinenet.com/acne/article.
htmhttp://en.wikipedia.org/wiki/Acne_vulgarisCompendium of Nonprescription products/Seventh edition-2000/Canadian Pharmacists Association.