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What is Acne?

Teenagers’ most prevalent issue is definitely acne. Doctors name it Acne Vulgaris medically.

Acne is pilosebaceous unit persistent inflammation. Extremely common, the disorder usually begins following puberty and has been documented to impact over 90% of teenagers.  

Usually most acute in the late teenage years, it can linger into the thirties and forty-years especially for women. 

Usually occurring between the ages of 12 and 20,vulgaris is Usually resolving by age 20–25, it starts about 10–13 years of age and lasts 5–10 years.

Reasons of Acne:

Propionibacterium acnes invading the pilosebaceous glands.

Acne severity is related to sebum excretion rate; this rises at puberty. 

Although the hormonal effects may also reflect end-organ sensitivity, most patients have normal hormone profiles so both androgens and progestogens increase sebum excretion and lower it.

Although monozygotic twins show great concordance and it is possible that genetic variables are significant in certain families, candidate genes have not been validated.

There may be a good family history.

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Symptoms :

Emotional effects:

Although allagens can lower self-esteem, it is especially crucial to find out how they influence teenagers.

Whether acne is objectively severe or not, the repercussions can be disastrous and cause shame, school avoidance, and lifelong affects on the capacity to build friendships, attract partners, and acquire and maintain work.

Usually affecting the face, acne sometimes affects the trunk.  Skin greasiness could be visible (seborrhea).

The hallmark is the comedone: open comedones—blackheads—are dilated keratin-filled follicles that show up as black papules from the keratin debris; closed comedones—whiteheads—usually show no visible follicular opening and are brought on by the accumulation of sebum and keratin deeper in the pilosebaceous ducts.

From comedones, inflammatory papules, nodules, and cysts develop. Scarring can be keloidal and accompany deep-seated or superficial acne.

There are several distinct clinical variants:

Conglobata:

Acne  Usually with considerable scarring, they are typified by comedones, nodules, abscesses, sinuses, and cysts.

Usually affecting adult males, it is infrequent and most often occurs on the trunk and upper limbs. 

It may be related to scalp folliculitis and pilonidal sinus as well as hidradenitis suppurativa, a chronic, inflammatory disease of the apocrine glands mostly affecting the axillae and groins.

With an elevated neutrophil count and plasma viscosity, fulminans—an uncommon but severe condition linked with fever, arthralgias, and systemic inflammation—show their presence. 

Usually present on the trunk in teenage men, one can experience costochondritis.

Acne Excoriée:

Describes self-inflicted excoriations brought on by obsessive plucking of pre-existing or imagined blemishes.  Usually, it affects teenage girls, and underlying psychiatric issues are rather common.

Greasy cosmetics or occupational contact with oils, tars, or chlorinated aromatic hydrocarbons might aggravate comedone.

Patients utilizing systemic or topical corticosteroids, oral contraceptives, anticonvulsants, lithium, or antineoplastic drugs—such as the epidermal growth factor receptor (EGFR) inhibitor—may have primarily pustular acne.

Most acne sufferers have no underlying endocrine condition.  But a common sign of polycystic ovarian syndrome is acne, which should be questioned if it is moderate to severe and linked with hirsutism and monthly abnormalities. 

Virilization should also inspire suspicion of an androgen-secreting tumor.

Clinically, acne is the diagnosis used. Still, certain related aspects are worth looking at.

Commonly occurring acne vulgaris does not call for investigations. Investigated should be secondary reasons and suspected underlying endocrine illness or virilisation:

Level of oestrogen

  • Testers of testosterone
  • Globulins related to sex hormones
  • Total capacity for iron binding

FSH/LH degrees

Usually, mild illness is controlled with topical treatment.  Should comedones prevail, then topical benzoyl peroxide or retinoids should be administered. 

Treatment should start at low concentrations for a brief period, then be raised as tolerated.  Mild acne could potentially benefit from azelaic acid. 

Mild-inflammatory acne sufferers should respond to topical antibiotics, such as clindamycin or erythromycin, which can be combined with other treatments.

For mild inflammatory acne, a systemic tetracycline—such as oxytetracycline or lymecycline—should be administered at appropriate dosage for three to six months in the first instance.  Should the case fail to respond, choices include trimethoprim or erythromycin.

In women, oestrogen-containing oral contraceptives or a combination of estrogen and anti-androgens (such as cyproterone acetate) may offer extra benefit.

If patients fail to satisfactorily respond to six months of therapy using this combination of systemic and topical techniques, they should be referred for consideration of isotretinoin (13-cis-retinoic acid).

For mild to severe acne not responding sufficiently to conventional treatments, isotretinoin has transformed treatment. 

Its multifactorial method of action includes P. acnes colonization and a reduction in sebum excretion by over 90%. Follicular hypercornification is another.

Usually, a course runs for four months.  Though clinical improvement is usually longer-lasting, sebum excretion normally returns to baseline over the course of a year when treatment is stopped.

Although a second or third round of isotretinoin may be needed, many people may not need more treatment. 

In patients who relapse following a higher-dose regimen, a low-dose continuous or intermittent-dose regimen may be taken into consideration for a longer duration.

For severe acne, a combination with systemic steroids could be needed temporarily to reduce the risk of disease flare early in the course of therapy.

Given the side-effect

Profile of isotretinoin, thorough screening and monitoring are necessary.

Inflamed acne nodules or cysts, which can also be incised and drained under local anesthesia, may call for intralesional triamcinolone acetonide injections.

Good, active acne therapy can help prevent scarring.  Intralesional steroid and/or silicone dressings may be suitable for keloid scars. 

For scarring, one also considers carbon dioxide laser, microdermabrasion, chemical peeling, or localized excision. Sometimes patients with inflammatory acne who are unable to undergo traditional therapy—such as isotretinoin—have UVB phototherapy, or PDT.

No compelling data exists to justify a causal relationship between diet and acne. 

Myths/Facts:

Myth: Acne comes and goes; it is not an illness to cause concern.

Fact: Depending on the degree, acne is a condition treatable with medication.

Myth: You will have scars always once you develop acne.

Fact: Scarring from acne changes with time.