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Magazine
Not just flawed skin
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Acne should not be dismissed as a normal part of growing up. It is important to handle teenagers carefully as the emotional scars are sometimes deeper and more permanent than the blemishes on the skin, says DR. SUSIE SAMUEL.
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ACNE is a common skin
complaint that brings
young adults in their
teens and twenties to
a dermatologist with
outbreaks of pimples
on the face, neck, back, chest, arms
and buttocks. Flawless skin suddenly
erupts with pimples as one
grows up. Though not a life threatening
condition, it can, if left untreated,
form ugly and permanent
scars, causing anguish to youngsters
especially when they are coping
with the physical and
psychological upheavals of puberty
and adolescence.
Studies have shown that acne is
carried by a gene and can be
passed on from one generation to
another. Acne, though generally
more severe in males, appears to be
more persistent in females who
may continue to experience periodic
premenstrual flares till menopause.
Acne appears around the onset
of puberty and runs a variable
course till adolescence is over.
Certain occupations and activities
seem to favour the formation
of comedones or acne. Restaurant
workers, factory and construction
site workers who spend long hours
in hot and humid conditions are
more prone to acne as are aerobic
enthusiasts who wear tight and occlusive
clothes in the gymnasium
while working out and training
with weights. Friction and sweat
make the acne worse. A few drugs
like barbiturates and lithium have
been known to cause acne. Cosmetics,
used injudiciously, can
contribute to the block in the duct
and aggravate pimples, especially,
if it is not removed completely and
carefully.
Acne is a disorder of the pilosebaceous
units. These are the skin's
oil or sebum producing sebaceous
glands, which are found in great
numbers on the face, chest, back,
upper arms and buttocks. The production
of sebum is influenced by
the male sex hormone, which is
found in high and fluctuating levels
in both sexes around puberty.
The sebum flows through a narrow
follicular canal or duct and
empties onto the surface of the skin
through a pore or opening. Normally
this flow is smooth and uninterrupted.
However if too much
sebum is produced or if the cells
that line the canal are shed too fast,
it accumulates in the canal trapping
oil, dirt and bacteria. This
causes a block in the canal which
eventually enlarges and finally ruptures,
spilling its contents into the
surrounding tissue to form pimples
causing inflammation
with pain, redness,
an increase in
temperature and swelling.
These pimples vary
according to the severity
of the acne and range from
whiteheads, blackheads,
pustules, nodules to cysts.
The treatment of acne aims
at reducing the severity of the
pimples and prevention of scarring.
As the intensity and severity
of acne varies from person to
person, treatment
schedules
have to be
customised.
One prescription
certainly does not fit all,
and borrowed diet restrictions are
not as effective as meticulous skin
and hair care in the treatment of
acne.
Cleansing routines should be
consistently followed twice a day to
include a mild soap, a gentle scrub
and a deep pore cleanser. Topical
medications are sold as gels, solutions,
lotions or creams. Creams
and lotions are moisturisers and
better for people with dry skin. Alcohol-
based gels and solutions dry
the skin and are better for people
with excessively oily skin. Gels are a
more comfortable option in hot
and humid conditions where
sweating is troublesome.
Topical benzoyl peroxide and antibiotics
such as erythromycin and
clindamycin destroy the bacteria in
the canal reducing the formation
and size of the pimples. Retino-A, a
vitamin A derivative used as a single
application at night, reduces the
size and activity of the sebaceous
glands while it helps to exfoliate
dead cells and unplug the pores.
Azaleic acid is a relatively new topical
cream used in treatment. It is
effective if there are pigmented
scars.
Oral medications include antibiotics,
such as the tetracyclines
and minocycline, which can be taken
for short periods. Hormone
therapy, in the form of the oral contraceptive
pill, is recommended for
women in a few select cases when
the benefit of treatment outweighs
the side effects that are sometimes
experienced.
The newer drugs in the market
include Roaccutane, a Vitamin A
derivative prescribed under medical
supervision. Roaccutane is a
terratogen and causes birth deformities
in children who are born to
mothers who have taken the drug
during pregnancy. It is generally
avoided in girls in the reproductive
years and should be administered
only with informed consent and
foolproof contraceptive cover.
Healing of acne is accompanied
with scarring. Picking at and
squeezing out pimples makes the
scarring worse. Scar revision in
acne includes intervention treatments
such as excision, chemical
peels, dermabrasion, laser therapy
and collagen implants. These are
best done in well-equipped centres
with trained and skilled professionals
who discuss the pros and cons of
each treatment modality with their
patients along with realistic estimates
for treatment and follow-up.
Many parents do not know that
acne can be treated and that early
treatment reduces the severity of
pimples and prevents unsightly
permanent scars. They often seek
medical treatment late, indifferently
or not at all.
However, like most skin conditions,
the results are not immediate
or dramatic and, often during treatment,
it gets worse before it gets
better. If parents and patients are
not aware of this, compliance is a
serious problem as they become
discouraged from persisting with
treatment schedules that may appear
tedious and expensive.
Default of treatment always sets
the clock back, wastes precious
time and causes fresh crop of acne
with more unsightly scars. Tragically,
these scars are cosmetic topographs
that are carried around with
acute embarrassment throughout
life, every career opportunity and
social challenge, rendering young
individuals dysfunctional as their
confidence, body image and selfesteem
continue to plummet
further.
Adolescent acne should not be
dismissed as a normal part of growing
up. Sensitive handling of teenagers
at this point is crucial as the
emotional scars of acne are sometimes
deeper and more permanent
than the blemishes on the skin.
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