Acne:
What is Acne?
Acne vulgaris typically affects those areas of the body that have the greatest number of sebaceous glands, including the face, neck, chest, upper back, and upper arms. In addition to the typical lesions of acne vulgaris (e.g. blackheads, whiteheads, and inflammatory lesions), scarring and hyperpigmentation can occur. Hyperpigmentation is most common in patients with darker complexions. Acne vulgaris is distinguished from acne rosacea by the presence of comedones and the absence of telangiectasias.

Pathogenesis of Acne:
Pilosebaceous follicles: Acne vulgaris is a disease of pilosebaceous follicles. Four factors are involved:

    • Retention hyperkeratosis.
    • Increased sebum production.
    • Propionibacterium acnes within the follicle.
    • Inflammation.

External factors: Cosmetics may contribute to the development of acne. Oils, greases, or dyes in hair products and cosmetic creams can exacerbate the skin lesions, while water-based products are less comedogenic.
Diet: A potential role for diet in acne is controversial. Even though some people feel that their acne is aggravated by certain foods, such as chocolate, cola, peanuts and some fatty foods, there is no scientific evidence that suggests the influence of food in causing the acne. Anyway avoid the kind of food which seems to worsen your acne and maintain a balanced diet for your overall health. 
Stress: Patients and medical providers commonly believe that psychological stress can exacerbate acne. A prospective cohort study in 94 secondary school students compared acne severity and sebum production at times of high stress (midterm examinations) and low stress (summer holidays). Sebum production did not appear to be related to stress, but acne severity, as assessed by an examiner blinded to the hypothesis of the study, did appear to be associated with stress, particularly in boys.

Classification systems for acne:
Type 1: Mainly comedones with an occasional small inflamed papule or pustule; no scarring present.
Type 2: Comedones and more numerous papules and pustules (mainly facial); mild scarring.
Type 3: Numerous comedones, papules, and pustules, spreading to the back, chest, and shoulders, with an occasional cyst or nodule; moderate scarring.
Type 4: Numerous large cysts on the face, neck, and upper trunk; severe scarring.
However, these categories are not rigid. As an example, a patient with mainly comedones and papules but notable scarring may be considered to have severe acne.

Type 1 acneType 2 acneType 3 acne

Type 4 acne

Multiple painful nodules are present on the back (panel A) in spite of aggressive topical and oral interventions. (Similar lesions appear on the patient's chest and face). Panel B shows the response after treatment with isotretinoin.

When does acne occur?
Usually, acne begins at puberty due to the hormone changes and stops by the early 20s. In some cases, acne may persist into adulthood. Such types of acne include severe forms that affect the body as well as the face (these types affect males more than females). There is also a type of acne associated with the menstrual cycle in women.
In other cases, acne may not present itself until adulthood, which affects more females than males. The reasons for this are:

  1. Some women get acne when they discontinue anti baby pills that are comedogenic (can set up conditions that cause comedones to form).
  2. As females get older, the pattern of changes in hormones may itself change, disposing sebaceous glands to develop acne.
  3. Ovarian cysts and pregnancy may also cause hormonal changes that lead to acne.
  4. An acne-like rash can be due to another cause such as make-up or lotions, or even oral medication. It is important to help your dermatologist by providing an updated history of what you are using on your skin or taking internally.

Proper care is necessary:
No matter what special treatments your dermatologist may use, you must maintain a proper skin care!
Acne has nothing to do with not washing your face. The best is to use mild cleanser and warm water daily. Washing too often or too vigorously makes acne worse.
Use as little cosmetics as possible .Heavy foundation makeup should be avoided. Most acne patients should select powder blushes and eye shadow over cream products because they are less irritating and non-comedogenic. Choose oil-free, water-based moisturizers. An oil-free foundation is good for cover up. Shield your face when applying sprays and gels on your hair.
Many people use all kinds of products, including alcohol-based cleansers, and scrub vigorously; this will only lead to further irritation of the skin and worsen the acne.
However, acne is actually caused by a variety of biologic factors that are beyond the control of washing. For that reason, you should follow appropriate acne treatments for your acne. 

Acne treatment:
Your dermatologist will decide which treatments are best for you.
Before starting any medication, even topical medications, inform your dermatologist or pharmacist if you are pregnant, nursing or if you are trying to get pregnant.

Everyone's acne must be treated individually! If you have not gotten good results from the acne products you have tried, consider seeing a dermatologist .The time for improvement depends upon the product being used, but in almost cases it is more a matter of weeks or months and not of days! Most dermatologists would recommend the use of daily medication or combination for 4 to 8 weeks before they would change the treatment. It is very important for patients to be aware of this time frame so they do not get discouraged and discontinue their medications!  
The acne control is an ongoing process. All acne treatments work by breakouts prevention. Existing blemishes must heal on their own.

Treatment of type 1 acne

Treatment of type 2 acne

Treatment of type 3 acne

Treatment of type 4 acne

Permanence and frequency of treatment:

  • Using your medication more frequently than prescribed doesn't speed up the clearing of your acne!
    Using topical medications more often than prescribed may actually induce more redness and irritation of the skin which can delay clearing time.
  • Don’t stop your medication suddenly because your face is clear! Follow your dermatologist's instructions. If your dermatologist ceases the treatment, then stop taking your medication.
  • Do NOT pop, squeeze or pick at acne!
    This can worsen the acne by spreading the inflammation.

Acne treatment with Domina Pharmaceuticals:
A Sign of Trust             

Azelaic Acid 20%

Azelec (Cream)                          

Tretinoin 0.025, 0.05,
or 0.1%

Retinoid (Cream, Gel, Solution)

Benzoyl Peroxide Base
2.5,5,or10%

Ben-oxide (Gel, Lotion)       

Isotretinoin 0.05%

Iso Retinoid (Gel)

Clindamycin Base 10mg/ml (as phosphate)

Dalamycin (Solution)

Erythromycin 4%

Erythro-gel (Gel)

Erythromycin 2, or 4%

Erythro Sol (Solution)

Metronidazole 0.8%

Metrozol (Gel)

 

 
 
 

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