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Treating acne
breakouts require thorough understanding of its pathogenesis etiological
factors and manifestations. Acne is common among teenagers, yet
it could affect people over 20. Although acne is most prevalent
among teenaged males, most can expect spontaneous treatment by age
25. Adult females may continue to experience acne into the adult
years, sometimes beyond the age of 40. Problem skin ( skin implicated
with acne ) characterizes by clogged enlarged pores, excess production
of sebum and fatty inclusions , abnormal bacterial function and
production of inflammation in acne lesions.
Role of different
factors in development of acne
Acne is a multifactorial
disease. Genetic,
racial, hormonal, dietary and envrionmental factors have been implicated
in its development, while it is clear that its psychological implications may be severe.
Although the role of heredity in acne has not been clearly denied,
there is a great tendency toward more serious involvement if one
or both parents had severe acne during their youth.
Hormonal factors
and acne : Hormones, androgen, are obviously among the causes. Sebaceous glands ( part of sebaceous follicles
) are extremely sensitive to androgenic stimulation, and their enlargement
usually precedes other obvious signs of puberty even before any
sign of acne. They are under endocrine control and so it is not
surprising that sebum production varies with age and sex. Increase
in sebum production is associated with increase in free fatty acids
rather than an increase in essential fatty acids. Males have a signficantly
greater sebum production than females. The sebum production continues
to increase after puberty, reaching a peak in both sexes between
30 and 40 years, and thereafter there is a gradual decline. It is
evident that the sebaceous gland is an androgen target organ and
any measure pharmacologically to control androgens is a logical
approach to treatment of acne.
Emotional factors
and acne : As with any disease whose course is prolonged and
capricious, the importance of psychological factors in treament
of breakouts has been repeatedly stressed and should be seriously
taken into account when using topical treatments. There seems to
be no doubt that stressful situations such as final examinations
regularly causes acne exacerbations in patients. This is probably the
result of increased glucocorticoid secretion by the adrenal glands
that seem to potentiate the effect of androgens.
Environmental factors and acne
: Environmental
factors also play a major role in determining the severity and extent
of acne and affect topical treatments. In most cases the manifestations
are worse in winter and improves during the summer, suggesting a
salutary effect of sunlight. However, in some cases exposure to
sunlight worsens the disease. The constant friction caused by protective
devices such as a helmet, shoulder pads or pillows will make its
management futile.
How acne develepos in the skin, acne pathogenesis
Acne
is a complex, multifactorial disease whose pathogenesis proceeds
according to the following scenario: Because of the influence of
androgens, the sebaceous gland enlarges and quantity of sebum excretion
increases. Some studies suggest hyperkeratosis preceeds activation of propionobacterium acne and cytokine activation. Follicular hyperkeratosis and increase in sebum secretion are both involved in comedone formation.
Lipases, proteases and hyaluronidases derived from resident bacteria within the pilosebaceous
apparatus hydrolyze triglycerides produced by the sebaceous gland
into glycerol and free fatty acids. These irritating substances
cause hyperkeratination of the follicular wall, leading to obstruction
and subsequent rupture. This, in turn, leads to a variable degree
of inflammation resulting in the formation of pustules, papules,
nodules, and cysts. The severity of the process is presumably determined
by as yet unidentified genetic factors.
Accumulation of lipid peroxide and free radicals is seen with progression of acne vulgaris. This observation substantiates role of anti oxidants in prevention of comedogensis and treatment of acne.
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