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Acne: The ultimate guide

Acne - Pimples - Zits

What is Acne?

Acne is a common skin condition commonly referred to as acne vulgaris that causes pimples and zits and other changes on the face and upper body.  It is the most common skin disease in the United States of America, and it affects 80% of the population at some point in their lives.

Common acne is a collection of comedones, papules, pustules, nodes and / or cysts as a result of obstruction and inflammation of the pilosebaceous complex (hair follicles and adjacent sebaceous gland). Acne forms on the face and upper body. Most often seen in adolescents. Diagnosis is made by physical examination. Treatment depends on the severity and may include a number of medicines for external and systemic use, aimed at reducing the sebum production of sebaceous glands, the formation of comedones, inflammation and the number of bacteria, as well as normalizing keratinization.

Acne is caused by the interaction of hormones, sebum, and bacteria, resulting in inflammation of the hair follicles (the pores of the skin from which hair grow). Acne is characterized by many types of skin abnormalities (lesions). They vary in size and severity; some of them grow deeper into the skin than others:

  • blackheads (open comedones);
  • whiteheads (closed comedones);
  • acne (inflamed closed comedones);
  • hard bumps that rise above the level of the skin (papules);
  • Superficial bumps containing pus (pustules)
  • dense bumps containing pus in the depths of the skin (nodules);
  • large pockets containing pus (cyst with debris);
  • sometimes even larger, deep pockets containing pus (abscesses).

Complex debris containing cysts and abscesses are cavities filled with pus, but the abscesses are somewhat larger and deeper.

The sebaceous glands, which secrete an oily substance (sebum), are found in the dermis (the middle layer of the skin). These glands are associated with hair follicles. Sebum, along with dead skin cells, is excreted from the ducts of the sebaceous glands and hair follicles to the surface of the skin through the pores.

Acne occurs when a buildup of hardened sebum, dead skin cells, and bacteria clogs hair follicles, preventing sebum from escaping through the pores.

If the blockage is incomplete, blackheads (open comedones) form .

If the blockage is complete, whiteheads (closed comedones) form .

A pimple  is an inflamed whitehead . Blocked hair follicles filled with sebum promote overgrowth of the bacteria Cutibacterium acnes (formerly Propionibacterium acnes ), which normally live in hair follicles. These bacteria break down the sebum, resulting in substances that irritate the skin. The resulting inflammation results in bumps on the skin known as acne (acne). Deeper inflammation causes cysts and sometimes abscesses.

Summary of introduction:

  • Acne is caused by a buildup of dead skin cells, bacteria, and hardened sebum that clogs the hair follicles.
  • Bumps such as comedones, whiteheads, acne, cysts, and sometimes abscesses form on the skin (usually on the face, chest, shoulders, or back).
  • Doctors examine the skin to diagnose acne.
  • Common treatments include topical application of antibiotics and other drugs to the skin for mild acne, oral antibiotics for moderate acne, and oral isotretinoin for severe acne.

What causes acne and hormonal acne?

The most common triggering factor is

  • Puberty

During puberty, the rise of androgens (sex hormones) stimulates the production of the sebaceous glands and the hyperproliferation of keratinocytes.  Acne occurs mainly during puberty, when the sebaceous glands are stimulated by increased levels of hormones, especially androgens (such as testosterone ), resulting in excess sebum production. In people between the ages of 20 and 25, hormone levels tend to decrease so much that acne diminishes or disappears. However, in almost 40% of women, acne can occur between the ages of 40 and 50.

In addition, other conditions associated with hormonal changes can affect the appearance of acne:

  • Hormonal changes that occur during pregnancy or the menstrual cycle
  • Cosmetics, cleansers, lotions, and clothing that clog pores
  • High humidity and profuse sweating
  • polycystic ovary syndrome;
  • certain medications;
  • Tight fitting clothes;

In younger women, acne may occur and worsen during the menstrual cycle and may subside or worsen significantly during pregnancy. Polycystic ovary syndrome (PCOS) is a hormonal disorder that can interrupt your menstrual cycle and cause or worsen acne. Certain drugs, especially corticosteroids and anabolic steroids, can make acne worse. Certain cosmetics, detergents, and lotions can aggravate acne by clogging pores. Acne can be caused by clothing that is too tight or excessive moisture and sweating.

Identifying the factors that can lead to the sudden onset of acne is not an easy task, since the severity of the disease in most people varies, sometimes worsening and then decreasing. Acne is often worse in winter and gets better in summer, possibly due to sun exposure, which has anti-inflammatory effects. However, there is no connection between the appearance of acne and poor quality skin washing, masturbation and sexual activity. It remains unclear whether dairy products, especially low fat, and a diet rich in simple or processed carbohydrates and sugars (a high glycemic index diet ) contribute to acne .

 

Pathophysiology of Acne

Acne is formed as a result of the interaction of 4 main factors:

  • Excessive secretion of the sebaceous glands
  • Follicular blockage with sebum and keratinocytes
  • Colonization of the follicles of Propionibacterium acnes (anaerobic, which is part of the normal human microflora)
  • Release of multiple inflammatory mediators

No statistically significant connection has been found between exacerbations of acne and diet, inadequate washing of the face, masturbation and or intercourse. Some research suggests a possible link to dairy and high-carb diets so some clinicians will advise reducing low fat dairy and adherence to ketogenic diets or low glycemic diets. Acne can be reduced in the summer months due to the anti-inflammatory effects of sunlight and purported effects of vitamin D. The alleged association between acne and hyperinsulinism which has been reported warrants further research. Certain drugs and chemicals (eg, glucocorticosteroids, lithium, phenytoin, isoniazid) worsen acne or cause acneiform lesions.

Types of Acne

There are two different types of acne classified broadly.

 

Non-inflammatory: characterized by the presence of comedones

Inflammatory: characterized by papules, pustules, nodules and cysts

Non-inflammatory acne

Comedones are sebaceous plugs squeezed into follicles. They are called open or closed, depending on whether the follicle is enlarged or closed at the surface of the skin. Plugs are easily squeezed out of open comedones, but they are more difficult to remove from closed comedones. Closed comedones are lesions that precede inflammatory acne.

Inflammatory acne

Papules and pustules occur when P. acnes colonizes closed comedones, breaking down the secretion of the sebaceous gland into free fatty acids, which irritate the follicular epithelium and cause an inflammatory response from neutrophils and then lymphocytes, which further destroy the epithelium. The inflamed follicle ruptures into the dermis (sometimes the process is accelerated by physical manipulation or harsh cleaning), where the contents of comedones cause a further local inflammatory reaction with the formation of papules. If the inflammation is significant, then extensive purulent pustules are formed.

Nodules and cysts are other manifestations of inflammatory acne. Nodules are deeper lesions that may involve> 1 follicle, while cysts are large fluctuating nodules.

 

Acne can be further broken down into the following types

Boil or Furuncle

Boil or Furuncle

 

 

 

 

 

 

 

The boil looks like a lump with pus inside. A boil is an acute infection of the hair follicle, most commonly caused by Staphylococcus aureus. The source of a staphylococcal infection is usually in the nose or perineum and is believed to be spread by dirty hands. Boils are most commonly found on the thighs, buttocks, neck, back, groin, and armpits. Furunculosis often tends to recur over and over again and can even spread to family members.

 

Miliums (closed comedones)

Miliums (closed comedones)

 

 

 

 

Miliums are most commonly referred to as closed comedones, whiteheads, or millet.These Closed comedones are quite common. A closed comedone is a flesh-colored or white bump on the skin that protrudes slightly above the surface of the skin. It can be hardly noticeable, it is felt only as some unevenness, if you run your hand over the skin. Generally there is no associated Inflammation or pain observed. A thin layer of skin coats pores clogged with dead cells, debris, and sebaceous secretions, creating white, round blackheads on the skin’s surface.

Milium (white eel) is a dense superficial cyst of the sebaceous gland. looking like a small white grain. These are painless, non-inflamed, whitish nodules, measure about 0.5-3 mm in size, containing thick sebum and keratin. They are usually observed on the so-called T-zones of the face, as well as on the cheeks, eyelids, less often on the trunk and genitals.

It is imperative not to squeeze out the milia as this can cause tissue infection and or scarring.

Acne (open comedones)

Acne (open comedones)

Clogged pores and excess sebum production cause acne breakouts. Blackheads are not covered by the skin, they remain open and exposed to air, which causes their dark appearance.

Most often, the skin has black spots in the pores – these are open comedones. They arise as a result of blockage of the mouth of the sebaceous glands with sebum, cosmetics, dust, etc. Open comedones are localized, usually in those areas where a significant number of sebaceous glands are located, as a rule, this is the forehead area, chin and wings of the nose. Single comedones are usually treated with proper skin care. However, with porous skin, the formation of numerous comedones is possible, and not only on the face, but also on other areas of the skin – on the back, shoulders, etc. This situation requires special measures including cleansing the skin gently.

Pustules

Pustules

Pustules “Pustula” are small balls, at the very top of which there is a white spot (purulent head). Painful redness – inflammation – is usually observed around the pustule. The pustules can be very painful. This damage to the epidermis occurs not only on the face, but also on different areas of the body. In principle, these rashes are not dangerous, but treatment is required, since the abscesses are of an infectious nature. Antiseptic treatments, and in more severe cases, antibiotic treatment is considered.

 

Cystic acne

Cystic acne

 

 

 

 

 

 

 

 

This is one of the most severe types of acne, it is considered the most uncomfortable and painful, since the formation of cysts occurs deep below the surface of the skin, in the deep layers of the epidermis. When squeezed out, the pus spreads under the skin and causes widespread inflammation.

Cystic acne usually occurs as a result of hormonal changes, which is why it is most common in adolescents, although it can affect the faces of people of all ages.

 

Acne fulminance

Acne fulminance

 

 

 

This is a rare form of severe cystic acne that is characterized by inflamed nodules and plaques with open ulcers.

Papules (nodules)

Papules (nodules)

Like cystic acne, papules are another severe form of acne that requires the help of a dermatologist. Papules look like tight knots or balls on the skin. They are always accompanied by suppuration and swelling of the surrounding skin.

Papules are dense, sharply defined pimples with a diameter of 1 – 3 mm, somewhat towering above the dermis. They do not have a purulent head. Papules are usually formed from closed comedones. If the papule has formed from an open comedone, a dark plug, an enlarged mouth of the hair follicle, is visible. They can be both inflammatory and non-inflammatory. If inflammation occurs, scars may remain, so papules must be treated without fail. It should be said that papules can be a symptom of some serious diseases, for example, chickenpox, measles, syphilis, smallpox, anthrax, lichen planus. Therefore, if numerous rashes appear, there is an urgent need to consult a doctor!

Acne Mechanica

Mechanical acne

This type of acne occurs as a result of heat and friction, such as from wearing sports equipment or wet workout clothes, which causes increased irritation and excess skin abrasions, which leads to acne. Mechanical acne is sometimes called sports acne because it is most common in athletes.

Nodules and cysts

In more serious cases, there are deep subcutaneous lumps – nodes and cysts. Nodules are deep subcutaneous seals with a diameter of more than 5 mm, red or bluish-purple in color, painful to palpation. After their healing, scars (of various types – atrophic, hypertrophic, keloid) may remain. Cysts are nodules that have degenerated due to inflammatory processes, usually very painful, and have a reddish-cyanotic color.

Purulent capsules

If there is an inflammatory process in deep tissues for a long time and the resulting infiltrate is not removed, a dense volumetric capsule may form, inside which pus or sebum is contained. Experts call this formation a cyst.

Scars and pigmentation

Also, with acne, scars (the consequences of healed rashes), as well as various spot sizes on the skin (post-inflammatory pigmentation), can be observed.

 

Fungal Acne – What is it?

Pityrosporum folliculitis — Pityrosporum or Malassezia folliculitis is a fungal acne like disorder that can present as fine pustules, often itchy and occurring on the face. It tends to be unresponsive to traditional acne therapies and worsens with humidity and heat.  A dermatologist can diagnose this form of “Acne” with A KOH examination will reveal copious budding yeast and pseudohyphae under microscopy.

Treatments of fungal acne:

Defense soap is an antifungal soap meant for the gym but because of its ingredients including tolnaftate (1%) and other ingredients but free of Parabens, Sulfates, and Dyes it is a great addition to your routine and treatment of skin fungal issues.

Zinc is also advocated for dandruff and for its antifungal effects.  Because of this zinc shampoo with 2% Zinc pyrithione can be a good addition.

Nizoral is another good shampoo with broad effects on skin and scalp fundus because of its containing 1% ketokonazole which is a broad antifungal.

Another shampoo is the home health Everclean anti dandruff shampoo with salicylic acid which may also have antifungal effects

               

 

Back Acne

 

 

The typical distribution of acne vulgaris correlates with areas of the body with hormonally responsive sebaceous glands including the face, neck, chest, upper back, and upper arms.

A severe form of back acne is called Acne conglobata which is a severe form of nodular acne that most often occurs in young men. Skin involvement is often in the back, chest, and buttocks but can also be seen on the face or other sites. Large, draining lesions; sinus tracts; and severe scarring can occur. Sinus tracts manifest straight lines like lesions and form when nodules merge.  

However, back acne can be of any of the aforementioned types of acne.

Back Acne treatment / How to get rid of back acne / How to clear back acne

Although the treatment of both mild facial and mild truncal acne can be approached similarly, application of topical treatments to the back can be challenging. Often, for mild truncal papulopustular acne vulgaris, benzoyl peroxide wash with or without a topical antibiotic a practical initial approach, provided the patient can apply the medication to the affected area relatively easily (eg, shoulders, chest, upper back). Pharmacy-provided medication applicators designed to aid with application of medications or emollients to the back are sometimes helpful for topical treatment.

  • The main recommendations for caring for back acne is absence of scrubs (any products containing abrasive particles), brushes, washcloths when taking a bath (rubbing and scrubbing of the back is detrimental).
  • Consider getting a specific towel for your back and change it often. 
  • Use topical treatments for inflammation (which are also recommended for the face): they work well and help to get rid of acne on the back and minimize their reappearance.
  • Don’t pop pimples! Scarring is a common occurrence resulting from attempted popping.
  • You can use a tonic for the back with drying and antibacterial properties.
  • Look for pH  neutral soaps and shower gels or facial cleansers for problem skin 

The main etiology of back acne is similar to that of acne on other parts of the body including the face: the pores are clogged with sebum, which leads to the growth of bacteria. Well, or you are too nervous, and the body reacts to stress in this way. But you need to treat acne on the back a little differently.  As mentioned previously, evaluate your body wash and make sure it does not contain comedogenic ingredients.  With long hair avoid allowing shampoo to run down your back when you wash your hair.  There are many tools and accessories available for treating back acne and acne in general and we will review some below.

Types of Acne by distribution

Face Acne – Causes

Acne Vulgaris – The most common form of acne on the face is Acne vulgaris.   Acne vulgaris also referred to plainly as acne/pimples/zits are the most common skin disorder affecting adolescents and young adults. Inflamed pustules occur most commonly on the face and, less frequently, on the back and chest

Acneiform eruptions — Acneiform eruptions can occur as a result of exposure to drugs/medications, cosmetics containing comedogenic ingredients, chemicals (Including cutting oils, coal tar, chlorinated hydrocarbons), or environmental factors (eg, elevated temperatures, ionizing radiations).

Acne keloidalis nuchae — Acne keloidalis nuchae is a condition involving chronic inflammation and scarring of the hair follicles of the posterior neck that is seen more frequently in dark-skinned patients. Follicular papules, pustules, and hypertrophic scars may result. The clinical manifestations, diagnosis, and treatment of acne keloidalis nuchae are discussed in detail separately.

Rosacea — Rosacea is a common chronic disorder that may present with pustular eruptions, particularly in moderate and severe cases . Pustular rosacea is found frequently on the central face and neck and, occasionally, in atypical locations, such as the retroauricular area or scalp. Look for telangiectasia, erythema, papules, nodules, thickening of the soft tissue, and sebaceous prominence of the central face. Exacerbating factors for rosacea that have been anecdotally reported include alcohol, spicy food, hot beverages, temperature extremes, and psychologic stress.

Perioral dermatitis — Perioral dermatitis (ie, periorificial dermatitis) presents as small papules, vesicles, and/or tiny pustules with erythema and scaling around the mouth, nose, or periorbital region . When in a perioral distribution, the eruption classically spares the skin immediately surrounding the vermilion border of the lips. A burning sensation or pruritus may be present

Bacterial folliculitis and impetigo — Bacterial folliculitis may occur anywhere on the body, including the face. It is in most cases caused by Staphylococcus aureus. Folliculitis is typically characterized by isolated pustules with a hair piercing the central aspect .

Gram-negative folliculitis may occur on the face as a sudden pustular flare of acne previously controlled by chronic oral antibiotics . It can be caused by Klebsiella, Enterobacter, and Proteus species.

Impetigo occurs most commonly on the face and can present with bullae, honey-colored crusts, erythema, edema, and exudate

Fungal folliculitis — Tinea barbae is a fungal infection of the beard region that can present with a significant pustular component . There is usually scaling and eventually a circular configuration. Early or mild cases may not have pustules and can have an appearance similar to tinea corporis. (See “Infectious folliculitis”, section on ‘Fungal folliculitis’.)

Herpes simplex — Herpes simplex eruptions can present as grouped pustules or vesicles on an erythematous base typically located on the vermilion border of the lips . They may present similarly in the genital or sacral areas, particularly with recurrent disease. Patients frequently have a history of a prodrome prior to the onset of lesions. Precipitating factors include fever, wind or sunburn, trauma, or stress. (See “Epidemiology, clinical manifestations, and diagnosis of herpes simplex virus type 1 infection”.)

Herpes zoster — Herpes zoster may present early on as isolated pustules or vesicles on the face in association with significant discomfort. Look for grouped pustules and/or vesicles on an erythematous base that occur in a dermatomal distribution . Whether zoster occurs on the face, trunk, or extremities, it is usually associated with symptoms of pain, aching, and burning.

Pityrosporum folliculitis — Pityrosporum or Malassezia folliculitis is a fungal acneiform disorder that can present as fine pustules, often pruritic, on the face . It tends to be unresponsive to traditional acne therapies and worsens with humidity and heat. A KOH examination will reveal copious budding yeast and pseudohyphae.

Body, chest, trunk and arms/legs Acne – Causes

Acne vulgaris — Patients with acne vulgaris often have pustules and/or inflamed papules on the back and upper chest. Acne vulgaris is discussed in detail separately.

Acneiform eruptions — Acneiform eruptions may be induced by exposure to drugs, cosmetics containing comedogenic ingredients, industrial chemicals (eg, cutting oils, coal tar, chlorinated hydrocarbons), or environmental factors (eg, elevated temperatures, ionizing radiations).

Keratosis pilaris — Keratosis pilaris, while often asymptomatic, may produce pruritic and pustular lesions of the lateral face, trunk, upper and lower arms, thighs, and buttocks. It is caused by the plugging of the follicle by keratin that has failed to exfoliate, leading to a sterile, papular or pustular eruption. Prepubertal children can have significant involvement of the lateral cheeks.

Miliaria — Miliaria is a transient skin disorder caused by accumulation of sweat beneath eccrine sweat ducts obstructed by keratin. Depending on the level of duct obstruction, miliaria is divided into miliaria crystallina, the most superficial form (; miliaria rubra ; and miliaria profunda . The clinical manifestations, diagnosis, and treatment of miliaria are discussed in detail elsewhere. (See “Miliaria”.)

Bacterial folliculitis — S. aureus folliculitis can involve the upper trunk, buttocks, and legs . Gram-negative folliculitis is often seen as a generalized, pustular eruption that ranges from mildly symptomatic to being associated with considerable pain and pruritus. Truncal involvement is typically seen in healthy patients after use of recreational hot tubs, with Pseudomonas aeruginosa identified as the pathogen on culture .

Dyshidrotic eczema — Hand and foot eczema typically presents with vesicles, bullae, erythema, scale, and intense itching . Isolated pustules also may occur but rarely are the predominant primary lesions. A KOH preparation is needed to rule out underlying fungal infection.

Palmoplantar pustulosis — Palmoplantar pustulosis (PPP) is a chronic, pustular skin disorder of unknown etiology that usually occurs in adults. PPP presents as recurrent crops of pustules on the palms and/or soles , sometimes associated with nail dystrophy and psoriasis-like skin lesions.

Hidradenitis suppurativa — Hidradenitis suppurativa occurs in areas of hormonally influenced apocrine sweat glands, including the axillae, mammary, and inguinal regions, frequently in patients who are obese . Pustules may be evident in early lesions. Follicular rupture and involvement of the apocrine gland occurs deeply, resulting over time in extensive scarring and sinus tract formation in many patients . Comedonal lesions are usually present as well and help to define the diagnosis, with chronic, recurrent disease as the norm.

Fungal infections

Pityrosporum folliculitis — Pityrosporum or Malassezia folliculitis is a fungal acneiform disorder that manifests with asymptomatic or pruritic, pustular lesions typically involving the trunk and upper arms, especially in patients with a history of exposure to an extremely humid environment . The lesions represent an overgrowth of normal yeast flora. Extensive lesions may require treatment with oral antifungal drugs. More limited involvement often responds to topical therapy (eg, ketoconazole, ciclopirox cream).

Candida infection — Candida infections tend to be associated with beefy red areas with scaling, predominantly in areas of moisture, such as the inframammary folds , neck folds, inguinal folds , and axillae . Satellite pustules may occur, particularly beyond the erythematous plaques . A KOH preparation of the roof of the pustule will demonstrate the characteristic organisms.

Dermatophyte infection — Dermatophyte (superficial fungal) infections, such as tinea pedis or corporis, typically occur with papules, plaques, and peripheral scale . Pustules may also be a key primary lesion when follicular units are involved, particularly on the legs, scalp, or forearms. A KOH preparation of the roof of the pustules will demonstrate hyphae

Scabies — Scabietic infestations can produce isolated papules, vesicles, and pustules that are intensely pruritic, particularly located in the interdigital web spaces, volar wrists, axillae, breasts, umbilical, and groin areas . Family members are often symptomatic. Scrapings from the base of isolated, nonexcoriated pustules, vesicles, or papules may reveal mites, eggs, or fecal material.

Fire ant bites — Fire ant bites are painful and may cause isolated or grouped pustules , especially in patients with a history of outdoor exposure. Significant erythema and edema can occur in patients who have a hypersensitivity reaction to the insect venom.

PUSTULES IN PATIENTS WITH FEVER OR OTHER SYSTEMIC SYMPTOMS

Eosinophilic folliculitis — Eosinophilic folliculitis is a pustular skin eruption predominantly located on the scalp, face, neck, and upper chest that occurs in immunosuppressed patients, particularly in those with advanced human immunodeficiency virus infection

Varicella — Varicella lesions may present with both vesicles and pustules in a generalized fashion. Look for lesions that occur in varying stages in febrile patients. Oral lesions also can occur . Secondary staphylococcal infection may result in a pustular eruption of not only a viral but also a bacterial origin.

Acute generalized exanthematous pustulosis — Acute generalized exanthematous pustulosis is a rare drug eruption most often caused by antibiotics . Patients experience the rapid onset of a widespread pustular eruption approximately 24 hours after ingesting the drug.

Disseminated gonococcemia — Disseminated gonococcemia can present with lesions that initially begin as papules and vesicles, ultimately causing no more than 10 pustules that occur along with a necrotic base. In addition to the rash, patients may have a fever, migratory polyarthritis, or tenosynovitis. A Gram stain obtained after unroofing the pustule reveals the causative organism.

Secondary syphilis — Rash is the most characteristic finding of secondary syphilis. The rash is classically a symmetric papular eruption involving the entire trunk and extremities including the palms and soles. Individual lesions are discrete red or reddish-brown and measure 0.5 to 2 cm in diameter . They are often scaly but may be smooth and rarely pustular.

Pustular psoriasis — Pustular psoriasis is typically localized to the palms and soles but may rarely occur in an acute, generalized form (von Zumbusch-type). Acute, generalized pustular psoriasis is characterized by the abrupt development of widespread, painful, erythematous patches that rapidly become studded with hundreds of pinhead-sized, sterile pustules . Systemic symptoms include fever, malaise, and arthralgias.

Pyoderma gangrenosum — Pyoderma gangrenosum is an inflammatory skin disease often associated with underlying systemic disorders such as inflammatory bowel disease, arthritis, and lymphoproliferative disorders. The eruption may begin as an isolated pustule or scattered lesions on the trunk or extremities. There is surrounding edema and purplish induration with rapid progression into a large ulcer, which heals ultimately with cribriform scars. The diagnosis is typically made after all infectious etiologies have been ruled out. Histologic examination is helpful but not diagnostic in characterizing this disease.

Sweet syndrome — Sweet syndrome (acute febrile neutrophilic dermatosis) is an uncommon inflammatory disorder characterized by the abrupt appearance of painful, edematous, and erythematous papules, plaques, or nodules on the skin, accompanied by fever and leukocytosis. In some patients, it can present with vesicular or bullous lesions. Sweet syndrome can be idiopathic or associated with infections, inflammatory bowel disease, medications, or malignancy.

Best products for acne

There are many products to choose from to help fight acne, pimples and zits.  We’ve gone through the best of the best that we could find here for you.  Benzoyl peroxide kills bacteria, thereby stopping or limiting inflammation and acne. But be cautious when using these products as this ingredient can stain your clothes and towels.

 

Benzoyl Peroxide cleansers

                   

 

 

 

Our favorite and the most rated and top rated product is Proactiv 3 Step Acne Treatment.  It contains a Benzoyl Peroxide Face Wash, Repairing Acne Spot Treatment for Face and Body, Exfoliating Toner with a 90 Day supply

 

How to get rid of pimples fast overnight

Hydrocolloid patches such as the wildly popular Mighty Patch.   They are known to flatten whiteheads in 6 hours by providing a barrier, trapping skin impurities and drawing out pus and fluid while blocking further bacterial growth.  These are generally made of medical grade hydrocolloid which is a natural fluid absorbing gel.   The mighty patch has zero parabens, phthalates, or toxic ingredients and is reportedly Safe for teens and pregnant women.

           

 

Palmer’s Skin Success Anti-Acne Medicated Complexion Bar

This soap is said to be gentle but also able to clean the surface bacteria from the skin that can clog pores and lead to acne breakouts and helps to control existing breakouts and remove excess shine.  Palmers is made with Sulfur to help control existing breakouts and promote smoother skin, plus Vitamin E to help improve the appearance of scars, stretch marks and imperfections

 

Grandpa’s Thylox Acne Treatment Soap with Sulfur

This 3% Sulfur soap is catching some great reviews and has become an amazon choice amongst those with acne.  It is made without phalates, sulfates, parabens, EDTA, Glutens, artificial fragrances or colorants.

 

Some physicians endorse treatments that target fungal infections to address possibility of fungal infections masquerading as acne vulgaris.   One particular fungi called Pityrosporum is known to cause folliculitis which is a common inflammatory skin disorder that can mimic acne vulgaris. Some patients with acne which appears to be resistant to common treatments presenting with pustules or papules may have acne and Pityrosporum folliculitis simultaneously. Because of this antifungals can be used in conjunction with regular acne medications

Does masturbation cause acne?

  • There is no connection between the appearance of acne and inadequate washing, masturbation and sexual activity.
  • There is no connection between the appearance of acne and inadequate washing, masturbation and sexual activity.

Pathophysiology of Acne

Acne is formed as a result of the interaction of 4 main factors:

  • Excessive secretion of the sebaceous glands
  • Follicular blockage with sebum and keratinocytes
  • Colonization of the follicles of Propionibacterium acnes (anaerobic, which is part of the normal human microflora)
  • Release of multiple inflammatory mediators

No statistically significant connection has been found between exacerbations of acne and diet, inadequate washing of the face, masturbation and or intercourse. Some research suggests a possible link to dairy and high-carb diets so some clinicians will advise reducing low fat dairy and adherence to ketogenic diets or low glycemic diets. Acne can be reduced in the summer months due to the anti-inflammatory effects of sunlight and purported effects of vitamin D. The alleged association between acne and hyperinsulinism which has been reported warrants further research. Certain drugs and chemicals (eg, glucocorticosteroids, lithium, phenytoin, isoniazid) worsen acne or cause acneiform lesions.

Types of Acne

There are two different types of acne classified broadly.

Non-inflammatory: characterized by the presence of comedones

Inflammatory: characterized by papules, pustules, nodules and cysts

Non-inflammatory acne

Comedones are sebaceous plugs squeezed into follicles. They are called open or closed, depending on whether the follicle is enlarged or closed at the surface of the skin. Plugs are easily squeezed out of open comedones, but they are more difficult to remove from closed comedones. Closed comedones are lesions that precede inflammatory acne.

Inflammatory acne

Papules and pustules occur when P. acnes colonizes closed comedones, breaking down the secretion of the sebaceous gland into free fatty acids, which irritate the follicular epithelium and cause an inflammatory response from neutrophils and then lymphocytes, which further destroy the epithelium. The inflamed follicle ruptures into the dermis (sometimes the process is accelerated by physical manipulation or harsh cleaning), where the contents of comedones cause a further local inflammatory reaction with the formation of papules. If the inflammation is significant, then extensive purulent pustules are formed.

Nodules and cysts are other manifestations of inflammatory acne. Nodules are deeper lesions that may involve> 1 follicle, while cysts are large fluctuating nodules.

Acne can be further broken down into the following types

Boil or Furuncle

The boil looks like a lump with pus inside. A boil is an acute infection of the hair follicle, most commonly caused by Staphylococcus aureus. The source of a staphylococcal infection is usually in the nose or perineum and is believed to be spread by dirty hands. Boils are most commonly found on the thighs, buttocks, neck, back, groin, and armpits. Furunculosis often tends to recur over and over again and can even spread to family members.

Miliums (closed comedones)

Miliums are most commonly referred to as closed comedones, whiteheads, or millet.These Closed comedones are quite common. A closed comedone is a flesh-colored or white bump on the skin that protrudes slightly above the surface of the skin. It can be hardly noticeable, it is felt only as some unevenness, if you run your hand over the skin. Generally there is no associated Inflammation or pain observed. A thin layer of skin coats pores clogged with dead cells, debris, and sebaceous secretions, creating white, round blackheads on the skin’s surface.

Milium (white eel) is a dense superficial cyst of the sebaceous gland. looking like a small white grain. These are painless, non-inflamed, whitish nodules, measure about 0.5-3 mm in size, containing thick sebum and keratin. They are usually observed on the so-called T-zones of the face, as well as on the cheeks, eyelids, less often on the trunk and genitals.

It is imperative not to squeeze out the milia as this can cause tissue infection and or scarring.

Acne (open comedones)

Clogged pores and excess sebum production cause acne breakouts. Blackheads are not covered by the skin, they remain open and exposed to air, which causes their dark appearance.

Most often, the skin has black spots in the pores – these are open comedones. They arise as a result of blockage of the mouth of the sebaceous glands with sebum, cosmetics, dust, etc. Open comedones are localized, usually in those areas where a significant number of sebaceous glands are located, as a rule, this is the forehead area, chin and wings of the nose. Single comedones are usually treated with proper skin care. However, with porous skin, the formation of numerous comedones is possible, and not only on the face, but also on other areas of the skin – on the back, shoulders, etc. This situation requires special measures including cleansing the skin gently.

Pustules

Pustules “Pustula” are small balls, at the very top of which there is a white spot (purulent head). Painful redness – inflammation – is usually observed around the pustule. The pustules can be very painful. This damage to the epidermis occurs not only on the face, but also on different areas of the body. In principle, these rashes are not dangerous, but treatment is required, since the abscesses are of an infectious nature. Antiseptic treatments, and in more severe cases, antibiotic treatment is considered.

Cystic acne

This is one of the most severe types of acne, it is considered the most uncomfortable and painful, since the formation of cysts occurs deep below the surface of the skin, in the deep layers of the epidermis. When squeezed out, the pus spreads under the skin and causes widespread inflammation.

Cystic acne usually occurs as a result of hormonal changes, which is why it is most common in adolescents, although it can affect the faces of people of all ages.

Acne fulminance

This is a rare form of severe cystic acne that is characterized by inflamed nodules and plaques with open ulcers.

Papules (nodules)

Like cystic acne, papules are another severe form of acne that requires the help of a dermatologist. Papules look like tight knots or balls on the skin. They are always accompanied by suppuration and swelling of the surrounding skin.

Papules are dense, sharply defined pimples with a diameter of 1 – 3 mm, somewhat towering above the dermis. They do not have a purulent head. Papules are usually formed from closed comedones. If the papule has formed from an open comedone, a dark plug, an enlarged mouth of the hair follicle, is visible. They can be both inflammatory and non-inflammatory. If inflammation occurs, scars may remain, so papules must be treated without fail. It should be said that papules can be a symptom of some serious diseases, for example, chickenpox, measles, syphilis, smallpox, anthrax, lichen planus. Therefore, if numerous rashes appear, there is an urgent need to consult a doctor!

Acne Mechanica

This type of acne occurs as a result of heat and friction, such as from wearing sports equipment or wet workout clothes, which causes increased irritation and excess skin abrasions, which leads to acne. Mechanical acne is sometimes called sports acne because it is most common in athletes.

Nodules and cysts

In more serious cases, there are deep subcutaneous lumps – nodes and cysts. Nodules are deep subcutaneous seals with a diameter of more than 5 mm, red or bluish-purple in color, painful to palpation. After their healing, scars (of various types – atrophic, hypertrophic, keloid) may remain. Cysts are nodules that have degenerated due to inflammatory processes, usually very painful, and have a reddish-cyanotic color.

Purulent capsules

If there is an inflammatory process in deep tissues for a long time and the resulting infiltrate is not removed, a dense volumetric capsule may form, inside which pus or sebum is contained. Experts call this formation a cyst.

Scars and pigmentation

Also, with acne, scars (the consequences of healed rashes), as well as various spot sizes on the skin (post-inflammatory pigmentation), can be observed.

Back Acne

The typical distribution of acne vulgaris correlates with areas of the body with hormonally responsive sebaceous glands including the face, neck, chest, upper back, and upper arms.

A severe form of back acne is called Acne conglobata which is a severe form of nodular acne that most often occurs in young men. Skin involvement is often in the back, chest, and buttocks but can also be seen on the face or other sites. Large, draining lesions; sinus tracts; and severe scarring can occur. Sinus tracts manifest straight lines like lesions and form when nodules merge.  

However, back acne can be of any of the aforementioned types of acne.

Back Acne treatment / How to get rid of back acne / How to clear back acne

Although the treatment of both mild facial and mild truncal acne can be approached similarly, application of topical treatments to the back can be challenging. Often, for mild truncal papulopustular acne vulgaris, benzoyl peroxide wash with or without a topical antibiotic a practical initial approach, provided the patient can apply the medication to the affected area relatively easily (eg, shoulders, chest, upper back). Pharmacy-provided medication applicators designed to aid with application of medications or emollients to the back are sometimes helpful for topical treatment.

  • The main recommendations for caring for back acne is absence of scrubs (any products containing abrasive particles), brushes, washcloths when taking a bath (rubbing and scrubbing of the back is detrimental).
  • Consider getting a specific towel for your back and change it often. 
  • Use topical treatments for inflammation (which are also recommended for the face): they work well and help to get rid of acne on the back and minimize their reappearance.
  • Don’t pop pimples! Scarring is a common occurrence resulting from attempted popping.
  • You can use a tonic for the back with drying and antibacterial properties.
  • Look for pH  neutral soaps and shower gels or facial cleansers for problem skin .

The main etiology of back acne is similar to that of acne on other parts of the body including the face: the pores are clogged with sebum, which leads to the growth of bacteria. Well, or you are too nervous, and the body reacts to stress in this way. But you need to treat acne on the back a little differently.  As mentioned previously, evaluate your body wash and make sure it does not contain comedogenic ingredients.  With long hair avoid allowing shampoo to run down your back when you wash your hair.  There are many tools and accessories available for treating back acne and acne in general and we will review some below.

Best products for acne

Try benzoyl peroxide foods

Almost all dermatologists have advised us to get cosmetics with this component. You can choose from both shower gel and soap. Benzoyl peroxide kills bacteria, thereby stopping inflammation and acne. But be careful, this ingredient can stain your clothes and towel. Therefore, you need to thoroughly wash off such cosmetics from the body.

Anti-dandruff shampoo with zinc is also good for you.

Dr. believes acne is caused by a fungus called Pityrosporum, which causes dandruff. Therefore, in order to get rid of this microorganism, you need to use special cosmetics with zinc for 10 days, and then wash with this product a couple of times a week.

Finally buy a massage brush

It is with this accessory, according to doctors, that you can perfectly cleanse the skin of sweat and keratinized scales, thereby preventing the growth of bacteria.

Make a back mask

According to dermatologists, for this you will need a benzoyl peroxide-based product. Apply the product on your back and let it sit for 5-10 minutes. This will kill bacteria and dry out pimples.

Try exfoliation

This product should only be used as a last resort. You can do the procedure both in the salon and at home (in this case, you will need the product itself and a sponge for applying cosmetics).

Start monitoring your diet

Eat foods with anti-inflammatory properties 

doctors recommend adding more fish, tomatoes, green vegetables and herbs to your diet to reduce the risk of acne.

Reduce the amount of sugar 

But dermatologists reminds that you need to limit the amount of simple carbohydrates. But omega-3 foods should be eaten more often: look for this element in avocados, salmon and walnuts.

Practice good hygiene

Change clothes, linens and towels frequently

Drs says dirty and sweaty fabrics are a favorite spot for bacteria. Therefore, do not be lazy and wash your clothes, towels and bed linen regularly.

Take a shower after active work

Frequent water treatments can help reduce the risk of acne. If you don’t wash away sweat and dirt, for example after exercise, says dermatologists, your pores will clog with sebum and become inflamed.

Carry sweat wipes with you:

Dr suggests that if you don’t have time to shower, you can use napkins. But only after that do not forget to wash if possible.

Maintain hygiene even in the gym

Wear a uniform made of sweat-wicking fabrics

Dr recommends choosing T-shirts and shorts made from these synthetic materials, as they cool the body and reduce sweat, unlike cotton models, which retain moisture.

Give up tight things

According to dermatologist, compression and slimming sportswear is too tight on the skin, leading to clogged pores and ingrown hairs. Therefore, it is better to choose the shape of a free or slightly fitted cut.

Get rid of whey protein

Products based on this component, according to doctors, can cause inflammation on the skin. It is best to replace these bars and powders with analogs from other types of protein.

Don’t take steroids

Skin specialists warns that these substances not only increase the level of aggression, but also provoke the appearance of scarred acne.

See a dermatologist

We recommend starting treatment with a visit to a specialist. they will explain to you what is the reason for the appearance of acne, as well as prescribe the necessary remedies: it can be medical creams, and antibiotics, and hormonal drugs. You may need to undergo peeling or laser therapy. The main thing is not to delay visiting a dermatologist, because a serious problem can be hidden behind a small inflammation.

Symptoms of different types of acne

In most cases, acne appears on the face and is also often present on the neck, shoulders, back, and upper chest. Anabolic steroid use tends to cause acne on the shoulders and upper back.

There are three degrees of severity of acne:

  • mild acne;
  • moderate acne;
  • severe acne.

However, even mild acne can be distressing, especially for adolescents, who perceive every pimple as a serious cosmetic problem.

People with mild acne develop only a small amount of non-inflamed acne or whiteheads, or a moderate amount of small pimples with mild irritation. In addition, pustules that resemble pimples with yellowish heads may occur. Acne appears as small, flesh-colored bumps with a black head. Whiteheads have a similar appearance, but without a black head. Acne is mildly uncomfortable and has a white head with mild redness around it.

Patients with moderate acne have more blackheads, whiteheads, pimples, and pustules.

Patients with severe acne either develop very large numbers of blackheads, whiteheads, pimples, and pustules, or develop a cystic (deep) form of acne. In cystic acne, patients develop cysts, which are large, painful, pus-filled red nodules that can drain under the skin to form large abscesses with discharge.

Mild acne usually does not scar. However, trying to pop or otherwise open up pimples increases the inflammation and the depth of the damage to the skin, increasing the likelihood of scarring. In severe acne, cysts and abscesses often rupture, and, as a rule, scars remain after they heal. Scars can be small in size, deep dimples (chipped scars), and there are also wider dimples of varying depth or large irregular dimples. Acne scars last a lifetime, and for some people they are a major cosmetic problem and a source of emotional stress. Scars may be dark.

Acne nodules (conglobata) are the most severe form of acne that leads to rough scars and other complications caused by abscesses. Severe acne can occur on the arms, abdomen, buttocks, and even the scalp.

Acne conglobata is the most severe form of acne vulgaris, most often affecting men. Patients have abscesses, draining sinuses, comedones with fistulas, as well as keloid and atrophic scars. The back and chest are affected. The upper limbs, abdomen, buttocks, and even the scalp can be affected.

Acne fulminant and facial pyoderma (rosacea fulminant) are two possibly related and rare types of severe acne that tend to come on suddenly.

Fulminant acne is an acute, febrile, ulcerating acne characterized by the sudden appearance of confluent abscesses and leading to hemorrhagic necrosis. Leukocytosis, pain and swelling in the joints may also occur.

Facial pyoderma (also called fulminant rosacea) occurs suddenly in the midface of young women. It can resemble fulminant acne. The rash consists of erythematous plaques and pustules that affect the chin, cheeks, and forehead. Papules and nodules may enlarge and merge with each other.

 

 

Clinical manifestations

Skin lesions and scars can be a source of significant emotional distress. Nodules and cysts can be painful. Often, rashes of different types and different stages of development exist simultaneously.

Comedones appear as white or black spots. White spots (closed comedones) – palpable formations of healthy skin color or whitish color, 1-3 mm in diameter; blackheads (open comedones) are similar to them, but have a dark center.

Papules and pustules are red eruptions, 2–5 mm in diameter. The papules are relatively deep. The pustules are more superficial.

The nodes are larger, deeper and denser than papules. Such rashes resemble inflamed epidermoid cysts , although they do not have the structure of a true cyst.

Cysts are festering nodes. Rarely, cysts form deep abscesses. Long-standing cystic acne can cause scarring, which manifests itself as shallow and deep depressions (ice pick scars), larger depressions, superficial depressions, or hypertrophic scarring or keloids .

 

Diagnostics

  • Assessment of associated factors (e.g. hormonal, mechanical or drug-related)
  • Determination of severity (mild, moderate, severe)
  • Psychological Impact Assessment

Acne vulgaris is diagnosed by clinical examination.

 

Differential diagnoses include rosacea (in which comedones are not observed), acne induced by glucocorticosteroids (in which comedones are absent, and pustules are usually at the same stage of development), perioral dermatitis (usually with a distinct perioral and periorbital distribution of rashes) and acneform drug eruptions Types of reactions to drugs and drugs that usually cause them ). In terms of severity, acne is mild, moderate, and severe, depending on the number and type of rashes. The standardized system is presented in the table Classification of acne by severity .

 

  • Skin examination

Doctors diagnose acne by examining the skin. They look for specific symptoms, such as blackheads or whiteheads, to establish that the person is suffering from acne and not another skin condition such as rosacea .

After confirming the diagnosis, doctors determine the severity of acne (that is, whether it is mild, moderate, or severe) depending on the number and nature of the lesions.

 

Outcomes

Acne of any severity usually spontaneously regresses around the age of 20-25, but in a small proportion of patients, usually women, acne may persist even at the age of 40; the choice of treatment may be limited due to pregnancy. Many adults occasionally develop isolated, mild acne rashes. Non-inflammatory and mildly inflammatory acne usually heals without scarring. Moderate to severe inflammatory acne heals, but scarring often remains. Scars cause more than just a cosmetic defect; Acne can cause serious emotional stress for adolescents who may have avoidant behaviors using acne as an excuse to avoid personal adjustment difficulties. In severe cases, supportive counseling may be indicated for patients and their parents. Acne can cause deep emotional stress in adolescents and lead them to social isolation. In some cases, psychological counseling may be required.

 

The severity of acne tends to naturally decrease by the age of 20–25, but some people, mostly women, may develop acne as late as age 40. Some adults have occasional mild acne lesions.

Mild acne usually resolves without scarring. Moderate to severe acne often leaves scars after resolution.

 

Treatment

  • Treat white and blackheads with tretinoin cream and / or benzoyl peroxide
  • Treat mild acne with tretinoin cream, sometimes with benzoyl peroxide or an antibiotic, or both
  • Oral antibiotics are given to treat moderate acne in combination with treatment for mild acne
  • For severe acne, oral isotretinoin is given
  • For the treatment of cystic acne, injectable corticosteroids such as triamcinolone

 

It is important for acne treatment to reduce the severity of disease, scarring, and emotional distress.

Treatment for acne depends on the severity of the condition. For mild acne, it is enough to use the simplest methods of treatment, which have the least number of side effects. More severe forms of acne require additional treatment, particularly if prior treatment has failed. The treatment plan must include education, support and the most effective treatment for the individual. Patients may need to see a specialist.

 

Acne treatments include a range of topical and systemic drugs to reduce sebaceous gland production, comedones, inflammation, bacteria and normalize keratinization. The choice of treatment is usually determined by the severity of the disease. For further reading on the topic you can refer to the American Academy of Dermatology guidelines of care for the management of acne vulgaris .

General medical care for acne is straightforward. The affected area should be gently washed with mild soap and water once or twice a day. Antibacterial or abrasive soaps, alcohol wipes, and frequent use of deep-cleansing scrubs are not beneficial and can further exacerbate skin irritation.

It is necessary to use water-based cosmetics, as cosmetics that are too oily and oils that have a high comedogenic score can worsen acne.

 

A hypoglycemic diet and moderate milk intake can be considered for treatment-resistant acne in adolescents.  Eat a healthy and balanced diet. If acne treatment in adolescents is not working, a diet low in simple and processed carbohydrates and sugars (a low glycemic index diet ) may be recommended , and limiting the intake of skim milk may be helpful (Studies have linked skim milk intake with acne).

 

Other treatments for acne may be helpful for individuals. For example, women with acne may be prescribed oral contraceptives. Such treatment must be carried out for more than 6 months to obtain positive results. Some women may also benefit from spironolactone (a drug that blocks the action of the hormone aldosterone). Various light source treatments have been effective in people who have had inflammation (with pimples or pustules).

Oral contraceptives are effective in treating inflammatory and non-inflammatory acne, and spironolactone (starting at 50 mg orally once a day, up to 100 mg orally once a day after several months as needed) is another antiandrogen sometimes used in women. Various types of light therapy, with and without the use of topical photosensitizers, are used effectively mainly for inflammatory acne.

 

Exfoliating agents such as sulfur, salicylic acid, glycolic acid, and resorcinol can be effective adjuncts to treatment, but are no longer widely used.

 

Alternative treatments and considerations

  1. Because of the friction induced acne, especially on the back, frequent change of bed and underwear, as well as the choice of clothes made from natural fabrics: cotton and its derivatives, can significantly help.
  2. 2. Comedogenic cosmetics. Acne and makeup are often intertwined. Look at your creams, lotions, sunscreens, and even shampoos.

 

  1. Try not to let the shampoo or conditioner run down your back while washing your hair – very often they have ingredients that are comedogenic and can clog the pores and cause inflammation. We recommend rinsing your hair with your head down while in the shower. 

 

  1. 4. Hot and humid climates are thought to be an external cause of acne. It is also reported that adolescents with existing acne can see exacerbations of long-standing acne in humid conditions.

 

  1. 5. Another non-obvious reason is the use of skin creams and massage oils oils which often contain comedogenic products, these items can also provoke the occurrence of inflammatory skin conditioner which predispose to acne. The oil must be thoroughly washed off or eliminated from use to limit risks of clogging pores. 

 

  1. A similar situation exists with sunscreens.   We recommend skin cleanser after using sunscreens 

 

 

Treatments for mild acne;

Medications used to treat mild acne are applied to the skin (topical medications). They either kill bacteria (antibiotics), or dry the skin, or help remove contents from the pores (comedolytics). Early treatments with over-the-counter creams containing salicylic acid, resorcinol, or sulfur can help by drying out acne and causing slight flaking of the skin.

The most common topical prescription drug for blackheads and whiteheads is tretinoin. Tretinoin is very effective, but it irritates the skin and increases its sensitivity to sunlight. For this reason, doctors prescribe this drug with some hesitation, not recommending it as the first treatment to be undertaken and recommend starting at very low doses, only gradually increasing the dosage. People who cannot tolerate tretinoin are prescribed adapalene, azelaic acid, and topical glycolic or salicylic acids.

If patients have skin inflammation (with pimples or pustules), they are given tretinoin, either in combination with benzoyl peroxide and/or a topical antibiotic. The two most commonly prescribed topical antibiotics are clindamycin and erythromycin. Minocycline foam and dapsone are other topical antibiotics that are commonly used to treat mild acne. Topical antibiotics should only be used if retinoids such as tretinoin or benzoyl peroxide are administered concurrently. Benzoyl peroxide is available with and without prescription. Glycolic acid can be used in place of or in addition to tretinoin, but is not often prescribed at the same time.

Blackheads and whiteheads can be removed by a doctor (blackhead extraction) using special tools called comedone extractors and sterile needles.  Mechanical extraction of comedones using a comedone extractor is performed for patients in the absence of other therapy. A comedone extraction can be done by a doctor, nurse, or doctor’s assistant. One end of the comedone extractor is like a blade that pierces a closed comedone. The other end creates pressure to extract the comedone.

 

Treatment for mild acne should be continued for 6 weeks or until the effect occurs. Supportive treatment may be required to maintain the effect.

 

Approaches to treatment of mild acne

 

Monotherapy is usually sufficient for comedogenic acne. The basis of therapy for comedones is external preparations of tritinoin daily, subject to tolerance. Adapalene in the form of a gel, tazarotene in the form of a cream or gel, azelaic acid in the form of a cream and glycolic or salicylic acid daily – an alternative for patients with intolerance to topical tretinoin preparations. Side effects include erythema, burning, tingling, and flaking. Adapalene and tazarotene are retinoids; like tretinoin, they are capable of causing some irritation and photosensitivity. Azelaic acid has comedolytic and antibacterial properties, the mechanism of manifestation of which is different, and can act synergistically with retinoids.

 

Combination therapy (eg, combining tretinoin with benzoyl peroxide and / or a topical antibiotic) should be used to treat mild papulopustular (inflammatory) acne. The topical antibiotic is usually erythromycin or clindamycin. Combinations of benzoyl peroxide with these antibiotics can slow the development of resistance. Glycolic acid can be used in place of or in addition to tretionine. Treatment has no serious side effects other than dryness and irritation (and rarely allergic reactions to benzoyl peroxide).

 

Oral antibiotics (eg, tetracycline, minocycline, doxycycline, erythromycin) may be used when widespread lesions make topical therapy impractical.

Treatment of moderate acne;

Moderate acne is usually treated with antibiotics taken by mouth (orally). Typical antibiotics include doxycycline, minocycline, tetracycline, and sarecycline. Other options are azithromycin, erythromycin, and trimethoprim / sulfamethoxazole. Patients often use topical treatments (similar to those for mild acne) in combination with oral antibiotics. It is possible that patients will need to take antibiotics for about 12 weeks to achieve maximum results.

Oral antibiotics are stopped as soon as possible, after which topical treatments are applied to maintain the achieved effect. Because there is a potential for acne to return after short-term treatment, therapy can last from several months to several years.

Women who take antibiotics for a long time may have vaginal yeast infections that may require treatment.

If oral antibiotics are not effective, women may be given oral contraceptives, spironolactone, or both.

 

Doxycycline and minocycline are the first choice; both can be taken with food. Tetracycline is also a good first choice, but it should not be taken with food, so it is less effective than doxycycline and minocycline. The dosage for doxycycline and minocycline is 50 to 100 mg orally, 2 times a day. Doxycycline may cause photosensitivity with prolonged use, minocycline may have more side effects, including drug-induced lupus erythematosus and hyperpigmentation. The dosage of tetracycline is 250 or 500 mg orally, 2 times a day, between meals. In order to reduce the development of antibiotic resistance after the desired result is achieved (usually 2 to 3 months), the dose is reduced to the minimum, which will keep acne under control. If topical therapy keeps acne under control, antibiotics may be discontinued.

Erythromycin and azithromycin are other drugs of choice, but they can cause gastrointestinal side effects, and resistance to these antibiotics develops more frequently. Some doctors also use trimethoprim / sulfamethoxazole, however, antimicrobial resistance may develop and this combination may cause rare adverse drug reactions.

Long-term use of antibiotics can cause gram-negative pustular folliculitis near the nose and in the central part of the face. This rare superinfection can be intractable and the best treatment is oral isotretinoin after stopping the oral antibiotic. Ampicillin is an alternative treatment for gram-negative folliculitis. In women, prolonged use of antibiotics can cause candidal vaginitis, if external and systemic therapy does not correct this problem, antibiotic therapy for acne should be discontinued.

If the patient is female and does not respond to oral antibiotics, oral antiandrogen testing (oral contraceptives and / or spironolactone) may be considered.

 

severe acne.

If antibiotics do not work for the most severe forms of acne, oral isotretinoin is most effective. Isotretinoin, which is similar to tretinoin, a topical drug, is the only drug that can treat acne. However, isotretinoin can have very serious side effects. Isotretinoin can harm a developing fetus, so women taking it should use at least two forms of contraception before, during, and after treatment to prevent pregnancy. In addition, other, less serious side effects are possible.

The duration of treatment is usually 16 to 20 weeks.

For patients with acne nodules, doctors prescribe antibiotics by mouth. If antibiotics fail, doctors give isotretinoin or oral corticosteroids.

For patients with fulminant acne, doctors prescribe corticosteroids and antibiotics by mouth.

 

Oral isotretinoin is the best treatment for moderate acne patients in whom antibiotics have failed and for those with severe inflammatory acne. The dose of isotretinoin is usually 1 mg / kg once a day for 16–20 weeks, but the dose may be increased to 2 mg / kg once a day. If side effects make it difficult to tolerate this dose, it can be reduced to 0.5 mg / kg once a day. After the end of acne therapy, the improvement may increase.

Most patients do not require a 2nd course of therapy; if necessary, taking the drug should be resumed only after 4 months, with the exception of severe cases in which the resumption of admission can be carried out earlier. Repeated treatment is often required if the initial dose was low (0.5 mg / kg). At this dose (which is very popular in Europe), fewer side effects develop, but long-term therapy is usually required. Cumulative dosing approved; a total dose of 120 to 150 mg / kg resulted in fewer relapses, and some experts suggest a high cumulative dose of 220 mg / kg.

Isotretinoin is almost always effective, but its use is limited by side effects, including dry conjunctiva and genital mucosa, chapped lips, arthralgia, depression, increased lipid levels, and the risk of birth defects if treated during pregnancy. Increased hydration following petrolatum application usually relieves dry mucous membranes and skin. Arthralgias (mainly of the large joints and lower back) develop in about 15% of patients. An increased risk of depression and suicide is often described, but the real likelihood is low. It is not yet clear whether the risk of developing or worsening inflammatory bowel disease (Crohn’s disease and ulcerative colitis) is increased.

Before starting treatment, it is necessary to conduct a complete blood count, determine the state of the liver, the level of triglycerides and cholesterol. Each patient should be reevaluated at week 4 and, if no abnormalities are noted, there is no need to repeat the tests until the end of treatment. The triglyceride content rarely rises to a level at which the drug should be discontinued. Liver function is rarely affected. Since isotretinoin is teratogenic, women of childbearing age are told to use 2 methods of contraception for 1 month before starting treatment, during treatment, and for at least 1 month after finishing treatment. Pregnancy tests should be performed before starting treatment and then monthly until 1 month after the end of therapy.

 

Cystic acne

To treat patients with large, inflamed nodules or abscesses, doctors sometimes prescribe corticosteroid injections into the affected area. In some cases, the doctor will open the nodule or abscess to drain it.

 

Intra lesional focal injections of 0.1 ml of triamcinolone acetonide in the form of a suspension of 2.5 mg / ml (the suspension should be diluted with 10 mg / ml) are indicated for patients with dense (cystic) acne who require rapid clinical improvement with a decrease in scarring. Localized atrophy may develop, but this usually disappears over time. Opening and drainage are very effective for isolated, very superficial lesions, but can lead to residual scarring.

 

Other types of acne

Facial pyoderma is an indication for the administration of oral corticosteroids and isotretinoin.

Fulminant acne is treated with oral corticosteroids and systemic antibiotics.

Acne conglobata is treated with oral isotretinoin if systemic antibiotics fail.

For acne caused by endocrine disorders (for example, polycystic ovary syndrome, virilizing adrenal tumors in women), antiandrogens are indicated. Spironolactone, which is somewhat antiandrogenic, is sometimes prescribed for acne at a dose of 50-100 mg orally once a day. Cyproterone acetate is used in Europe. When other methods of therapy have failed, estrogen / progesterone- containing contraceptives can be used ; therapy for ≥ 6 months is necessary to evaluate the effect.

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