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Dr. Andrew Rynne

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Pimples

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Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of hair follicles and their accompanying sebaceous gland. It most often affects adolescents. Hormones likely play a role in the development of acne, making the condition most common in teenagers.

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.


Symptoms

Acne can take the following forms:


Comedones appear as whiteheads and blackhead are created when the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria


Papules are small raised bumps that signal inflammation or infection in the hair follicles. Papules may be red and tender


Pustules are similar to papules; pustules are red, tender bumps with white pus at their tips


Nodules are large, solid, painful lumps beneath the surface of the skin


Cysts are painful, pus-filled lumps beneath the surface of the skin. These boil-like infections can cause scars


Causes

Three factors contribute to the formation of acne:

  • Overproduction of oil (sebum)
  • Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
  • Buildup of bacteria- Propionibacterium acnes

 

Acne occurs when the hair follicles become plugged with oil and dead skin cells. When the body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicle and form together as a soft plug.


Risk factors

  • Hormonal changes in your body can provoke or aggravate acne
  • Teenagers, both in boys and girls
  • Women and girls, two to seven days before their periods
  • Pregnant women

 

Other factors

  • People using certain medications, including steroids
  • Direct skin exposure to greasy or oily substances, or to certain cosmetics
  • A family history of acne — if your parents had acne, you're likely to develop it too
  • Friction or pressure on your skin caused by items such as telephones or cell phones, helmets, tight collars and backpacks


Classification of Acne Severity

  • Mild is < 20 comedones, or < 15 inflammatory lesions, or < 30 total lesions
  • Moderate is 20 to 100 comedones, or 15 to 50 inflammatory lesions, or 30 to 125 total lesions
  • Severe is > 5 cysts, or total comedones count > 100, or total inflammatory lesion count > 50, or > 125 total lesions

 

How to prevent acne

  • Wash acne-prone areas only twice a day. Washing removes excess oil and dead skin cells. But too much washing can irritate the skin. Wash areas daily with a gentle cleanser and use oil-free, water-based skin-care products
  • Shower after exercising or doing strenuous work. Oil and sweat on your skin can trap dirt and bacteria
  • Avoid heavy foundation makeup and remove makeup before going to bed
  • Picking or squeezing can cause infection or scarring. Most acne will clear up without this kind of intervention

 

Treatment

  • Comedones: Topical Tretinoin
  • Mild inflammatory acne: Topical antibiotics, benzoyl peroxide
  • Moderate acne: Oral antibiotics
  • Severe acne: Oral isotretinoin
  • Cystic acne: Intralesional Triamcinolone

 

 

Mild inflammatory acne: should be treated with topical benzoyl peroxide, topical antibiotics (eg, erythromycin, clindamycin) alone or combinations will hlep.Topical retinoid are often used concomitantly

 

Severe acne: Oral isotretinoin is the best treatment for patients with moderate acne in whom antibiotics are unsuccessful and for those with severe inflammatory acne


Oral contraceptives, including a combination of norgestimate and ethinyl estradiol have been shown to improve acne in women. However, oral contraceptives may cause other side effects that you'll want to discuss with your doctor


Laser- and light-based therapies: Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. Light therapy targets the bacterium that causes acne inflammation.

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