Acne of a 14 year old boy during puberty.Different types of Acne Vulgaris: A: Cystic acne on the face, B: Subsiding tropical acne of trunk, C: Extensive acne on chest and shoulders.Cotton pads soaked in salicylic acid solution can be used to exfoliate the skin
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Acne

Acne is an inflammatory disease of the skin, caused by changes in the pilosebaceous units (skin structures consisting of a hair follicle and its associated sebaceous gland). Acne lesions are commonly referred to as pimples or zits. more...

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The condition is common in puberty as a result of an abnormal response to normal levels of the male hormone testosterone. The response for most people diminishes over time and acne thus tends to disappear, or at least decrease, after one reaches their early twenties. There is, however, no way to predict how long it will take for it to disappear entirely, and some individuals will continue to suffer from acne decades later, into their thirties and forties and even beyond. Acne affects a large percentage of humans at some stage in life.

The term acne comes from a corruption of the Greek άκμή (acme in the sense of a skin eruption) in the writings of Aëtius Amidenus.

Symptoms

The most common form of acne is known as "acne vulgaris", meaning "common acne." Excessive secretion of oils from the glands combines with naturally occurring dead skin cells to block the hair follicles. Oil secretions build up beneath the blocked pore, providing a perfect environment for the skin bacteria Propionibacterium acnes to multiply uncontrolled. In response, the skin inflames, producing the visible lesion. The face, chest, back, shoulders and upper arms are especially affected.

The typical acne lesions are: comedones, papules, pustules, nodules and inflammatory cysts. These are the more inflamed form of pus-filled or reddish bumps, even boil-like tender swellings. Non-inflamed 'sebaceous cysts', more properly called epidermoid cysts, occur either in association with acne or alone but are not a constant feature. After resolution of acne lesions, prominent unsightly scars may remain.

Aside from scarring, its main effects are psychological, such as reduced self-esteem and depression. Acne usually appears during adolescence, when people already tend to be most socially insecure.

Causes of acne

Exactly why some people get acne and some do not is not fully known. It is known to be partly hereditary. Several factors are known to be linked to acne:

  • Hormonal activity, such as menstrual cycles
  • Stress, through increased output of hormones from the adrenal (stress) glands
  • Hyperactive sebaceous glands, secondary to the three hormone sources above
  • Accumulation of dead skin cells
  • Bacteria in the pores, to which the body becomes 'allergic'
  • Skin irritation or scratching of any sort will activate inflammation
  • Use of anabolic steroids
  • Any medication containing halogens (iodides, chlorides, bromides), lithium, barbiturates, or androgens
  • Exposure to high levels of chlorine compounds, particularly chlorinated dioxins, can cause severe, long-lasting acne, known as Chloracne

Traditionally, attention has focused mostly on hormone-driven over-production of sebum as the main contributing factor of acne. More recently, more attention has been given to narrowing of the follicle channel as a second main contributing factor. Abnormal shedding of the cells lining the follicle, abnormal cell binding ("hyperkeratinization") within the follicle, and water retention in the skin (swelling the skin and so pressing the follicles shut) have all been put forward as mechanisms involved.

Read more at Wikipedia.org

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Acne Care and Treatments
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The efficacy and safety of adapalene gel 0.3% in the treatment of acne vulgaris: a randomized, multicenter, investigator-blinded, controlled comparison
From Journal of Drugs in Dermatology, 11/1/05

The Efficacy and Safety of Adapalene Gel 0.3% in the Treatment of Acne Vulgaris: A Randomized, Multicenter, Investigator-Blinded, Controlled Comparison Study Versus Adapalene Gel 0.1% and Vehicle

Pariser DM, et al. Cutis. 2005;76:145-151.

Summary

The authors present a multicenter, randomized, double-blind clinical trial to assess the efficacy of adapalene 0.3% gel in comparison to both adapalene 0.1% gel and vehicle. Two hundred fourteen patients with moderate to moderately severe acne vulgaris of the face were enrolled in the study. Inclusion criteria included a minimum of 20 noninflammatory and 20 inflammatory lesions. Patients were randomized into the 3 treatment groups in a 1:1:1 ratio. Study medication was applied once daily for 12 weeks. Assessment occurred at weeks 1, 2, 4, 8, and 12. Each assessment included lesion counts and a global severity score using the Leeds Revised Acne Grading System. The same clinician performed all assessments for a given patient. Adverse events were recorded at each visit. At 5 of the 11 centers in this study, laboratory evaluation was undertaken, including plasma adapalene levels, complete blood cell counts, urinalysis, and serum chemistries. Of the 214 patients enrolled, 85% completed the study. Analysis was conducted using the intent-to-treat population, Patients in the adapalene 0.3% gel treatment arm had statistically significant reductions in inflammatory, noninflammatory, and total lesion counts compared to both the adapalene 0.1% gel and the vehicle groups. In addition, there was a statistically significant difference in the mean reduction of global severity scores for adapalene 0.3% gel compared to the 0.1% formulation and the vehicle. No serious advents events were noted. Across all groups, reporting of mild to moderate adverse events was similar. The most commonly reported adverse event was dry skin. In addition, erythema occurred more often in the adapalene 0.3% treated group compared with the adapalene 0.1% treated group. No significant changes in laboratory tests were noted. Adapalene was not detected in the plasma at any quantifiable level.

Comment

This was a well-designed, randomized, double-blind, controlled trial adequately powered to detect statistically significant differences in the efficacy of adapalene 0.3% gel in comparison to both adapalene 0.1% gel and vehicle in the treatment of moderate to moderately severe acne vulgaris. Results indicate the superior efficacy of the new adapalene formulation of increased concentration compared to the older formulation and vehicle. In addition to statistically significant decreases in lesion counts at the study's end, adapalene 0.3% gel was found to produce a statistically significant reduction in both total and noninflammatory lesion counts at week 1 compared to both adapalene 0.1% gel and vehicle. Although the data was generated during the study, the authors did not provide results of an analysis of adapalene 0.1% gel compared to vehicle. As adapalene 0.3% gel appears more efficacious than the older formulation, it would be interesting to evaluate its efficacy compared to topical tazarotene and tretinoin formulations.

COPYRIGHT 2005 Journal of Drugs in Dermatology, Inc.
COPYRIGHT 2005 Gale Group

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