Acne in young people: What is new!
By Henry Osazuwa
How common is acne?
Acne vulgaris is distinctively recognizable and the commonest skin disease affecting adolescents with almost 90% having the facial rash at one time or the other. The human hair is anchored inside pillars underneath the skin surface called follicles that contain special glands (sebaceous glands) that produce a unique substance called sebum through tiny ducts unto the skin surface where they aid temperature regulation. Females who present with varying acneiform lesions along the mandible and chin or "beard area" tend to have a type of acne that typically flares during certain portions of the menstrual cycle and responds to hormonal therapy.
What causes acne?
At the onset of puberty, the high levels of androgens; testosterone (dehydrotestosterone), androstenedione and progesterone stimulate an increase in the turn over of the cells lining the surface of the skin which blocks the passage for sebum from the sebaceous glands, leading accumulation, some chronic inflammation and subsequent infection with a bacteria named after the disorder, Propionibacterium acnes, a normal colony of the skin.
What are the factors that influence acne?
The usual suspects include chocolate, French fried and pizza, but scant hard evidence to support them. It has been suggested that diary milk product may play a vital role because of its close link with severity. The non-fat portion of milk contains hormones and bioactive molecules, such as androgens and progesterone.
Living in a rural setting protects against acne! The quality of meals may have a lower ability to raise blood sugar following a meal (low glycaemic index). A high glycaemic index meal is more prevalent in urban areas and stimulates the release of insulin necessary for transport of sugar into cells where they are metabolized. Insulin stimulates adrenal and gonadal androgen production with increased sebum production and possibly acne.
Hygiene and skin care are assumed by lay individuals to be closely linked to acne. This has promoted the tendency to wash excessively, but too much washing maybe harmful. Washing your face twice a day is all that is needed to ensure facial hygiene, while washing up to four times add only negligible benefits. The effect of sweating and exercise is still debatable. While the occurrence of acne stimulates stressful preoccupation with the rash, stress is thought to also promote the onset of acne by facilitating increased sebum production.
What is new about treatment?
Treatment is based on the type of skin lesion and the severity. Traditional treatment options include; oral antibiotic such as Doxycycline because of its excellent skin penetration, topical retinoid, and the use of hormones either alone or in combination. Hormone therapy include; Spironolactone, Flutemide, Cyproterene acetate and Combined oral contraceptive pills. They decreases free Testosterone and also increases Sex Hormone Bing Globulin which attaches to the testosterone preventing their action on tissues.
New classes of combined topical therapies are being tried, such as clindamycin-tretinoin and adapalene-benzoyl peroxide while a profile of effectiveness greater than traditional options. Another newly approved agent is Dapsone gel. Oral dapsone is a sulphonamide with antimicrobial and anti-inflammatory properties, and a topical formulation has been found to help particularly with inflammatory acne lesions
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