Acne is a general term for pimples and deeper pustules that are clogged pores. If severe enough acne can leave permanent scars.
Acne is an inflammatory skin disorder of the skin’s sebaceous glands and hair follicles that affects about 80% of people between the ages of 12 and 24. During puberty high levels of hormones are produced in both girls and boys. This leads to the production of large quantities of sebum. Sebum is an irritant that can clog the pores and form a pimple which may become infected and form a pustule. Hormones don’t go away after adolescence. Many women still get premenstrual acne from of the release of progesterone after ovulation.
Acne is a disease that affects the skin’s oil glands. The small holes in your skin (pores) connect to the oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows. Most pimples are found on the face, neck, back, chest, and shoulders. Acne is not a serious health threat but it can cause scars.
Causes of Acne
The exact cause of acne is unknown, several related factors are:
§ Hormonal activity supposed to be responsible, such as menstrual cycles and puberty.
§ Increase in hormones called androgens (male sex hormones), which causes sebaceous glands to enlarge and make more sebum.
§ Hormonal changes related to pregnancy can also cause acne.
§ Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder.
§ Accumulation of dead skin cell.
§ Bacteria in the pores, to which body becomes allergic.
§ Skin irritation or scratching of any sort will active the inflammation.
§ Starting or stopping birth control pills.
§ Heredity (if your parents had acne, you might get it too).
§ Some types of medicine.
§ Greasy makeup.
In some patients, contributing factors may be:
Pressure: In some patients, pressure from helmets, chinstraps, collars, and the like can aggravate acne.
Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids bodybuilders or athletes take.) Most cases of acne, however, are not drug-related.
Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.
Pathophysiology of Acne
§ Excessive secretion of oils from the sebaceous glands accompanies the plugging of the pores with naturally occurring dead skin cells (corneocytes) blocking hair follicles.
§ The accumulation of these corneocytes in the duct appears to be due to a failure of the normal keratinization process in the skin which usually leads to shedding of skin cells lining the pores.
§ Oil secretions are said to build up beneath the blocked pore, providing a perfect environment for the skin bacteria Propionibacterium acnes and the lipophilic (oil/lipid-loving) yeast Malassezia to multiply uncontrollably.
§ Under the microscope, however there is no evidence of pooled trapped sebum. Indeed the oil perolates through the plugged duct onto the surface.
§ In response to the bacterial and yeast populations, the skin inflames, producing the vision lesion.
§ The face, chest, back, shoulders and upper arms are especially affected.
Acne is a group of skin rashes with different causes named as:-
It is most commonly experienced around puberty, typically of the face and shoulders / chest.
A red rash predominantly on the face.
Acne keloidalis nuchae (pseudofolliculitis nuchae)
A rash caused by shaving.
Acne conglobata (Hidradenitis suppurativa)
Chronic abscesses or boils of sweat gland and hair follicle; in the underarms, groin, buttocks and under the breasts in women.
Acne caused by use of cosmetics.
An extreme form of acne conglobata.
Acne cause by starting or stopping medicine.
A rash seen on the cheeks, chin, and forehead of infants.
Acne caused by exposure to chlorinated hydrocarbons such as dioxins or PCBs.
Acne vulgaris is an inflammatory disease of the skin, which is caused by changes in the pilosebaceous units.
It is the most common form of acne. Large number of teenagers suffers from this, during the period of puberty. In most of the cases it tends to disappear or atleast decreases after one reaches early twenties. There is no fix prediction how long time it will take to disappear entirely,
Signs and Symptoms of Acne
Acne typically appears on face, neck, chest, back, shoulders and the areas of skin with the largest number of functional oil glands. People with acne frequently have a variety of lesions, some of which are shown in the diagrams below. The basic acne lesion, called the comedo, is simply an enlarged and plugged hair follicle. Acne can take the following forms;
Whiteheads: These are created when the openings of hair follicles become clogged and blocked with oil secretions and dead skin.
If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produceswhite bump called a whitehead.
Blackheads: These are similar to whiteheads, but are open to the skin surface and darken.
A comedo that reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the skin’s surface. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.
Other troublesome acne lesions can develop, including the following:
§ Papules – inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
§ Macule – A macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well defined border.
A macule may persist for days to weeks before disappearing. When a number of macules are present at one time they can contribute to the “inflamed face” appearance of acne. It shows the “red face” appearance.
§ Pustules (pimples) – These are raised; reddish spots that signal inflammation or infection in the hair follicles. Papules topped by white or yellow pus-filled lesions that may be red at the base
§ Nodules – large, painful, solid lesions that are lodged deep within the skin
§ Cysts – These are thick lumps beneath the surface of the skin, which are formed by the buildup of secretions deep within hair follicles. Deep, painful, pus-filled lesions that can cause scarring.
After resolution of acne lesions their may be prominent unsightly scars
Acne rosacea is a skin disorder leading to redness and pimples on the nose, forehead, cheekbones, and chin. The inflamed pimples and redness of rosacea can look a great deal like acne, but blackheads are almost never present. Fair-skinned individuals and people who flush easily seem to be more susceptible to this condition.
Rosacea becomes progressively worse in many of those affected. The real cause of rosacea is now thought to be a tendency to flush and blush in a person with sun damage. Sun damages the supporting fibers of the small blood vessels just under the surface of the skin, allowing the vessels to stretch out (become permanently dilated). The damaged blood vessels leak fluid when flushing occurs, resulting in blotchy red areas. Swelling occurs, but is not usually so prominent to be very visible. The first sign most people see are small red pimples and pustules (pus-filled whiteheads). The redness can come and go and may be tender, inflamed and sensitive to the touch. Later, the skin tissue can swell and thicken. Eventually the redness and swelling can become permanent.
Symptoms of Acne rosacea
It may vary according to the severity of the case.
Facial flushing is the classic symptom of rosacea. Flushing is the result of increased blood flow through dilated facial blood vessels. During a flush, face can turn various shades of red depending on the amount of blood flowing through the skin. A sufferer may experience a fire-red face during intense flushes, a mildly-red face during moderate flushes, or a barely noticeable pinkish-hue during mild flushes; it may be transient or long-standing.
Facial redness is caused by hundreds of tiny dilated blood vessels near the surface of the facial skin
Facial Telangiectasia; tiny broken blood vessels which are permanently fixed in the dilated state and take appearance of fine red lines coursing through the surface of the facial skin.
Facial Skin Hyper-Reactivity: These blood vessels dilate very easily to topical triggers and physical insults
Uneven skin texture, caused by dilated blood vessels,
Papules on the face
Facial Burning Sensations
Rhinophyma is a form of rosacea that is characterized by chronic redness, inflammation, and increased tissue growth of the nose.
What causes Acne Rosacea?
It is believe that rosacea is a disorder where the blood vessels become damaged when repeatedly dilated by stimuli.
Triggers that cause episodes of flushing and blushing.
Exposure to temperature extremes can cause the face to become flushed
Heat from sunlight,
Moving to a warm or hot environment from a cold environment
Some foods and drinks that can trig the condition include alcohol, foods high in histamine and spicy food.
Acne keloidalis nuchae
It refers to the occurrence of keloidlike papules and plaques on the occipital scalp and the posterior part of the neck, almost exclusively in African American men. Initially, patients usually develop a chronic folliculitis and perifolliculitis of the occipital part of the scalp and the posterior part of the neck, which heal with keloidlike lesions, sometimes with discharging sinuses. The lesions are often painful and cosmetica.lly disfiguring
Causes are still speculative; it is supposed to be caused by-
§ Injury produced by short haircuts, where hairline is shaved with a razor and curved hair follicles may be precipitating factors
§ Constant irritation from shirt collars
§ Chronic low-grade bacterial infections
§ An autoimmune process (AKN usually responds to systemic steroid therapy.)
§ Use of antiepileptic drugs
§ An increased number of mast cells in the occipital region
Sign and Symptoms
§ Large lesions are often painful.
§ Older lesions with abscesses and sinuses may emit an odorous discharge.
§ Hats, shirts, jackets, and sweaters may irritate the involved area, thereby causing patients to alter their preferred style of dress.
§ Even if large lesions are asymptomatic, they are often a cause of great cosmetic concern.
§ Acne starts after puberty as firm, dome-shaped, follicular papules that are 2-4 mm in diameter.
§ The papules develop on the nape of the neck and/or on the occipital part of the scalp.
§ Pustules may be present in the same areas.
§ Comedones are not present (in contradistinction to acne).
§ More papules may appear and enlarge as the disease progresses.
§ Some papules coalesce to form keloid like plaques, which are usually arranged in a band like distribution at or below the posterior part of the hairline.
§ Hair is usually lost in large lesions.
§ Scarring alopecia and subcutaneous abscesses with draining sinuses may also be present.
It is an uncommon and unusually severe form of acne characterized by burrowing and interconnecting abscesses and irregular scars (both keloidal and atrophic), often producing pronounced disfigurement. It is an uncommon disease.
The primary cause of it remains unknown.
Changes in reactivity to Propionibacterium acnes may play an important role in the etiology of the disease.
Exposure to halogenated aromatic hydrocarbons (eg, dioxins) or ingestion of halogens (eg, thyroid medication, hypnotic agents) may trigger AC in an individual who is predisposed.
Other factors that can provoke AC include androgens (eg, androgen-producing tumors) and anabolic steroids.