Women Health

There is the question that there are many acne cream medications with several types and brands on the shelves. So, which is the most effective to battle my acne proplem? What else can be done to reduce my persistent acne?
Acne vulgaris (better know as acne) is not just a problem for teenagers. Although is has been estimated to effect over half of all adolencents, it can affect adults up to age 40. It is not unusual for women in their mid to late 20s to develop acne – especially in the days before their menstrual periods.
What is acne?
Acne is a comman skin disense characterised both by non-inflammatory papules, pustules, nodule and cysts. Acne lesions are commonly referred to as pimples, blemishes, spots or zits.
Acne effects skin with dense areas of sebaceous follicles (or pilosebaceous units), mainly on the face and upper neck as well as chest, back and shoulders.
There are different types of acne including :
• Newborn acne – about 20% of newborns develop mild acne, usually with only whiteheads
• Infantile acne – blackheads and pimples may develop in babies between six and 16 months, such children are more likely to develop severe acne during their teen years.
• Acne Vulgaris – the most common type of acne
• Acne conglobata (cystic acne) – a rare but severe form of acne vulgaris with disfigurement, effecting mainly young men.
• Acne Fulminans – an ulcerative acne with sudden onset, fever and abscesses leading to haemorrhagic necrosis an extreme form of acne conglobatta that accurs is teen boys.
Do not confuse acne with rosacea (sometimes ‘erroneously’ called acne rosacea), which is a chronic inflammatory disorder with readness and pimples on the nose, cheeks, chin and forehead.
Sign and symptoms
When a pilosebaceous unit become obstructed with a plug of sebum and keratin (of dead skin cells), a microcomedo is formed and may break through the skin surface to form a closed comedone. This whitish lesion of 1-3 mm in diameter is also called “whitehead”
If the comedone gets dilated at the skin surface and accumulates melanin pigmen or becomes oxidised – the oil changes from white to black – it is then called an open comedone or ‘blackhead’ (a pinhead-sized dark spot).
Blackheads are therefore not dirt due to failure to wash the skin sufficienly, and do not reflect poor hygiene.
Sometimes, the comedone gets infected by normal skin bacteria, Propionibacterium acnes, and cause inflammation within the follicle. This results in superficial inflammatory lesion such as pustule (containing pus) or deeper inflammation in a papule (pimple). Deeper still and larger lesion is a nodule or cyst – which accurs when rupture of inflamed follicle releases free fatty acids, bacteria and keratin into surrounding tissues. Papules and pustules are about 2 – 5 mm in diameter.
Other symptoms may include pain or tenderness, if the lesions are infected as in cystic acne.

Classification of acne severity
Severity Definition
Mild, < 20 comedones, or < 15 inflammatory lesions, or < 30 total lesions
Moderate 20 to 100 comedones, or 15 to 50 inflammatory lesions, or 30 to 125 total lesions
Severe 5 cysts <, or total comedones count > 100, or total inflammatory lesion count > 50, or >125 total lesons

Treatments
Most acne sufferers resort, at least initially, to self-treatment and in the case of mild acne. Most will respond well to OTC treatments. For moderate to severe acne cases, you should consult your doctor or pharmacist for treatment options.
The severity and grading of acne will determine the types of treatment, which can be of either single agent or combination therapy.
? Comedones – Tropical retinoids (e.g. tretinoin andalalene and tazarotene), azelaic acid
? Mild inflammatory acne – Tropical antibiotics (e.g. erythromycin, clindamycin), benzoyl peroxide or both.
? Moderate acne – Oralantibiotics (e.g. microcycline, doxycline, tetracycline, erythromycin)
? Severe acne or moderate acne unresponsive to antibiotics – Oral isotretinoin
? Cystic acne – Intralesional triamcinolone
Benzoyl peroxide can be considered as first – line OTC treatment for acne. It has a kerotolytic action and antibacterial properties.
For acne with endocrine disorders, anti-androgen (anti – malehormone) such as spironolactone – which has some anti androgen effects – and cyproterone acetate have been used.

When to seek professional help
See you doctor if :
? It is acne in baby or infant
? Your acne gets worse or does’t improve with self-treatment within eight weeks
? Your pimples become large and hard or filled with pus (moderate to severe or cystic acne)
? Your acne began after starting a new medication (drug induced acne)
? You develop acne after being exposed to chemicals, oils or other substances (chemical include acne), or
? If there is a strong family history of acne, or you are emotionally affected or scarred by acne.

Other Practical Points
The three basic points of focus are to (1) unclog pores, (2) kill bacteria, and (3) minimise sebum – and to include these points in a good basic skin regimen
For effective removal of comedones, you can apply hot compresses or steam to pustules and cysts, and to get facials. Never pick or squeeze pimples, if necessary use a comedone (pimple) expressor or extractor correctly.
Skin washes and soaps containing antiseptic agents such as chlorhexidine and tea tree oil, are useful to degrease the skin as well as to reduce the skin flora (bacteria). Wash the effected areas gently once or twice daily.
Sunlight (ultraviolet rays) can be helpful in some cases of acne due to its peeling effect and drying (or degreasing) of oil on the skin. Also, use a light skin moisturiser and oil free or water based make up.
Treating acne requires patience and preverance. Most treatments take two to three months to start working, and a period of up to six months may be required for maximum benefit. Patients must give each regimen or drug enough time to work before giving up on it and moving on to other treatments, unless there are severe side effects.

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