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Acne Vulgaris

DEFINITION

Acne vulgaris, commonly known as pimples or blemishes, is an unsightly skin condition which greatly affects self-esteem. Ance is characterized by the presence of open and closed comedones (blackheads and whiteheads, respectively). More severe acne includes erythema (reddening) and nodules (bigger collections of inflammation and, sometimes, pus under the skin). In normal skin, hair grows out of pores called follicles. The human body produces sebum (an oily substance) from glands at the bottom of the follicles which helps lubricate the hairs. Acne is caused by blockages of the hair follicles with oil and skin cells. There is also some involvement of a bacteria in the follicles called Propionibacterium acnes. Acne can occur all over the body but is most common in the areas of the body with the highest amounts of sebaceous glands: the face, back and upper chest. Acne typically worsens near puberty due to increases in androgens (a type of hormone) and affects most teenagers. For most people, the amount of acne will decrease with age. However, acne is a problem that can persist throughout life. Though no genetic link is known, acne seems to run in families. Acne is worsened by stress, poor hygiene, and hormonal changes such as those that happen with menstrual cycles in women or anabolic steroid use. Though people commonly believe that fatty foods and chocolate make acne worse, no evidence exists that dietary choices have an effect on the severity of acne. Acne can have effects on both physical appearance and self-esteem. Acne can have long-term effects on a person’s appearance, including scarring and hyperpigmentation (darkened discoloration of the skin).

SYMPTOMS
Blemishes anywhere on the body, pustules, whiteheads, blackheads, reddening around blemishes, nodules, cysts

DIAGNOSIS
Diagnosis of acne vulgaris is made by physical examination by a doctor. There are no special laboratory tests to diagnose acne.

TREATMENT
Treatments for acne vulgaris tend to work in several different ways: by affecting the shedding of skin cells and keeping pores clear, killing the bacteria living in the pores, decreasing inflammation in the skin, and stabilizing hormonal changes. Most experts agree that good hygiene and skin washing with mild cleansers is the first step to improving acne. It is also important not to pick or squeeze your blemishes to prevent long-term scarring. Over the counter options to improve acne include topical treatments like those containing benzoyl peroxide. Antibiotics can be prescribed both in topical cream and oral pill form. For women, hormonal contraceptive (birth control) will often decrease acne severity. When the previous options do not work or are not indicated, retinoids can be used. Retinoids are available both in topical form and by pill. Patients taking oral retinoids need closer monitoring and regular office visits. Phototherapy and microdermabrasion are available options if other treatments do not work. Many of these treatments can be prescribed by your primary care doctor. When initial treatments do not work, treatment of acne should be managed by a dermatologist. Some treatment options are also available for scars related to acne including treatment by laser, dermabrasion, microdermabrasion, or collagen fillers. If you have any questions about treatment options, you should speak with your doctor.

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