ACNE STRATEGIES AND TREATMENT.

Acne is a common skin disorder that affects the pilosebaceous unit that consists of the hair follicle and the sebaceous gland. Acne usually starts in puberty due to increasing androgen levels which then activate the sebaceous gland, which then begins producing Sebum. As androgen levels continue to increase the sebum production will increase causing the sebaceous gland to become hypertrophic. Sebum is a powerful inflammatory agent that leads to acne and also causes problems in the maturation of keratinocytes. Increased sebum production and problems in the maturation of keratinocytes will lead to occlusion of pores and therefore lead to the production of whiteheads. When the trapped material in the pores gets oxidized whiteheads appears as blackheads. Due to the pores being clogged, the body’s immune system responds by causing inflammatory cystic lesions that involve the dermis and therefore lead to acne scars. Inflammation caused by increased sebum and P.acnes can lead to scarring and also postinflammatory hyperpigmentation. Over time the chronic inflammation can lead to various types of scars.


Some other factors that contribute to acne development are:

  1. Heredity
  2. Lifestyle: Heart showers or baths, Sauna’s, sweating from physical exercise or warm climates.
    Dietary factors: nonorganic dairy products from cows that have been given hormones, a diet with a high glycemic index, stimulants such as caffeine.
    In appropriate skin care products like moisturizers and oil-based makeup.
  3. Hormonal factors like polycystic ovarian syndrome and other conditions associated with excess androgens. In addition the hormonal changes before and during menstrual cycle monthly.
  4. Avoid manual extraction of acne lesions, attempting to squeeze her extract whiteheads or cysts can cause more inflammation and more aggravation of the acne flareup.
    How to prevent Acne? Acne is only preventable if addressed at the initial stages when whiteheads and blackheads appear but before the sebum induce inflammation has started.
    At this stage extraction with a comedone extractor should be done. Manual picking has to be avoided because it can push the sebum and the debris deeper and cause more inflammation. Using a good acne prevention program which consists of a cleanser, a scrub and is even reducing agent can help him urinate whiteheads and blackheads at an
    early stage.
    During early consultation for treatment of acne and detailed history and physical exam should be done. In addition to systemic hormonal abnormalities suspected detailed blood work should be obtained. Consult with endocrinologist might be warranted.
    Topical treatments for acne:
  1. Wash face twice daily with a cleanser specific for any skin.
  2. Mechanical exfoliation with a scrub once daily.
  3. Application of a sebum reducing astringent
  4. Disease specific agents such as benzoyl peroxide, antibiotics, dapsone, adapalene.
  5. Epidermal renewals: All patient’s reduced topical alphahydroxy acids.
  6. Barrier repair agents
  7. Tretinoin
  8. Skin protection: Sunscreen daily, nonoily makeup.
  9. Extraction of individual comedones
  10. Injection of active inflammatory nodules and cysts with intralesional steroids
  11. Initiation of one week course of oral systemic steroids if not contraindicated.

Systemic treatments for acne:
For a more serious case of acne and those that don’t respond to topical agents sometimes systemic treatment is required. If acne improvement after 1 Carrollton maturation cycle which is 6 weeks is minimal or no improvement is seen even though the patient is compliant with the topical regimen we may add antibiotics for one or 2 months ordered and isotretinoin.
We can start acne prevention strategies as early as 10 years of age by using the getting skin ready protocol. Using a gentle cleanser, a manual scrub once or twice a week. Avoiding moisturizers of all kinds. Teaching kits not to pick on acne. Dressing acne at the early stages. Stabilization of the skin.
AM:
Cleansing with a oily skin cleanser
Scrub
Sebum reducing astringent
Alpha-hydroxy acids for exfoliation
Acne specific topical agents such as benzoyl peroxide
Barrier repair and stabilizing agents antioxidants and anti-inflammatory agents
Never use moisturizers even the non-comedogenic variety or heavy foundation
PM
Cleansing with oily skin cleanser
Sebum reducing astringent.