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Acne

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					Acne
Acne, eruptive skin disease. It is primarily a disorder of the sebaceous follicles of the skin and appears most often on the face,
neck, and back. The natural secretion, or sebum, of the follicles accumulates and mixes with dust and dirt. The follicles and
surrounding tissue become inflamed and blackheads appear. If the follicle opening completely closes, the accumulated sebum is
degraded by bacteria and forms a cyst.


Acne vulgaris, the most common form, is usually associated with adolescence but may also occur in adults. A severe form of the
disorder is known as acne conglobata. Other forms of acne are also observed, such as the chloracne caused by chlorinated
compounds. In acne rosacea, the capillaries in the cheeks, forehead, and nose are swollen with blood and the oil glands in the skin
become infected.


Acne in adolescence results primarily from hormonal changes taking place in the body; the hormones stimulate sebum
production. Outbreaks cannot be prevented by a controlled diet and are not a sign of uncleanliness. Good hygiene should be
observed, however, to prevent more serious infections. Severe acne may be treated by antibiotics, benzoyl peroxide, or vitamin A
derivatives. Severe acne in adults may be a sign of an underlying endocrine disorder.



CAUSES OF ACNE
     1. Sebaceous Gland
Sebaceous Gland, tiny oil-producing gland that is commonly found in human skin, except in the palms of the hands and the soles
of the feet. Sebaceous glands resemble small sacks with narrow outlet canals, or ducts. The ducts of some sebaceous glands open
directly onto the surface of the skin, but normally the ducts connect beneath the skin’s surface with the cavities, or follicles, that
surround individual strands of hair. Sebaceous glands are therefore most numerous where hair grows thickest. As a general rule,
sebaceous glands are larger and more active in men than in women.


The oily fluid produced by sebaceous glands is called sebum. Sebum helps retain body heat and prevent excessive evaporation of
perspiration. Its secretion on the surface of the skin keeps hair and skin both soft and supple.


Sebaceous glands may malfunction and overproduce sebum, a condition known as seborrhea. Individuals with seborrhea have
oily faces and greasy scalps, and are likely to develop seborrheic dermatitis, a scaly and itchy inflammation of the skin that
produces dandruff as well as rashes on the scalp, chest, and back. Seborrhea may develop into acne, a condition commonly
affecting adolescents and young adults. In acne, bacteria break down sebum into fatty acids. As the bacteria continue to work, the
fatty acids seep out, forming whiteheads and other eruptions on the surface of the skin.


Sometimes sebum becomes clogged in the opening of a sebaceous gland and forms a blackhead. Although blackheads look as if
they result from dirt beneath the skin, their color is actually produced by the combination of sebum and oxygen. Another
condition caused by the blockage of a sebaceous gland is the sebaceous cyst, a large flesh-colored lump beneath the surface of the
skin. Although a sebaceous cyst poses no threat to general health, it may be surgically removed for cosmetic reasons.
     2. Puberty
Puberty, period in the human life span during which the organs of sexual reproduction mature. This maturation is evidenced in
females by the onset of menstruation, in males by the production of semen, and in both by the enlargement of the external
genitalia. Rapid growth marks a range of physiological changes. Various secondary sexual characteristics also appear for the first
time during puberty; in males, production of body hair increases markedly, particularly in the pubic, axillary, and facial regions,
and the voice usually changes and becomes deeper in tone; in females, hair also appears in the pubic and axillary regions, and the
breasts become enlarged. Accelerated development of the sweat glands in both sexes may trigger acne.


Puberty usually occurs in males between the ages of 13 and 16, and in females between the ages of 11 and 14. Among the
pathological conditions related to puberty are amenorrhea and pubertas praecox. The former is characterized by an absence or
cessation of menstrual flow not caused by pregnancy. The latter is the premature appearance in the male or female of the typical
physiological characteristics of puberty and is caused by disturbances of secretion in the anterior pituitary, in the adrenals, or in
the gonads. See Adolescence.



TREATMENT
     1. Erythromycin
Erythromycin, antibiotic drug used to treat a wide variety of bacterial infections. These infections include respiratory tract
infections such as pneumonia, urinary tract infections, ear and skin infections, gonorrhea, syphilis, rheumatic fever, whooping
cough, and diphtheria. The drug is also used in a form applied directly to the skin to treat acne. It works by interfering with the
formation of essential proteins in the invading bacteria, preventing their multiplication and growth.


Erythromycin is available by prescription in capsules, tablets, ointment, gel, and various liquids. Depending on the site of the
infection, the drug is taken orally or applied directly to the infected area. Dosages range from 250 to 1000 mg taken every six
hours. Children may take most forms of this drug, with dosages determined by body weight. Some forms of this drug should be
taken on an empty stomach (one hour before or two hours after a meal). Erythromycin’s effectiveness is usually apparent after
three to five days. However, the entire prescribed course of treatment should be completed to avoid recurrence of infection.


Patients with liver disease should not take this drug. It should be used with caution by patients with a history of allergies,
impaired kidney function, or abnormal heart rhythm. It is generally safe for use during pregnancy (except in the form known as
erythromycin estolate); however, breast-feeding mothers should be aware that this drug appears in breast milk.


Possible side effects include abdominal pain, nausea, vomiting, loss of appetite, or diarrhea. Also seen are skin rash, hives, eye
irritation, yellowing of the eyes or skin, dizziness, rapid heartbeat, or temporary hearing loss.


Erythromycin can react adversely with a variety of drugs. These include other antibiotics (including penicillin), blood-thinners,
carbamazepine, digoxin, lovastatin, phenytoin, and theophylline. Erythromycin should never be combined with astemizole.


Brand Names: Erythrocin,Ilosone, Emgel,Benzamycin,Theramycin Z,Erygel,Erymax,Pediazole
     2. Tetracycline
Tetracycline, antibiotic drug used to treat various bacterial infections, including urinary tract infections, Rocky Mountain spotted
fever, trachoma (a chronic eye infection), and gonorrhea. Tetracycline is also sometimes used to treat early stages of Lyme
disease, acne, gum disease, and certain gastrointestinal ulcers. It works by interfering with the invading bacteria’s ability to form
essential proteins, thereby halting their growth.


Tetracycline is available by prescription in capsule form, taken orally, and in a reconstituted powder solution, applied topically.
Typical capsule dosages range from 1 to 2 g per day, taken in one to four doses, with a recommended maximum of 4 g per day.
Unless this drug causes stomach upset, it should be taken on an empty stomach (one hour before or two hours after a meal) with a
full glass of water. It should not be combined with milk or other dairy products. Tetracycline usually relieves symptoms after 48
hours of treatment, but it should be taken for the prescribed length of time to avoid recurrence of infection.


Patients with severe liver disease or pregnant or breast-feeding women should not take this drug. Patients with impaired liver or
kidney function or with systemic lupus erythematosus should use tetracycline with caution.


Possible side effects include diarrhea, nausea, vomiting, skin rash, itching, light sensitivity, facial swelling, headache, blurred
vision, chest pain, sore throat, difficulty swallowing, or in infants, a bulging soft spot on the head. Children may develop
discolored teeth with long-term use.


Tetracycline may interact adversely with antacids and other common gastrointestinal medications, oral contraceptives, blood
thinners, lithium, penicillin, isotretinoin, cholestyramine, and sucralfate.


Brand Names:Achromycin V, Topicycline.



     3. Doxycycline
Doxycycline, antibiotic drug used to treat various types of bacterial infections including urinary tract infections, traveler’s
diarrhea, Rocky Mountain spotted fever, trachoma (a chronic eye infection), and syphilis. It is also sometimes used to treat early
Lyme disease and to prevent the spread of malaria. Doxycycline belongs to a group of antibiotics known as tetracyclines. It
works by interfering with the invading bacteria’s ability to form essential proteins, thereby halting their growth.


This drug is available by prescription in capsules, tablets, and liquid forms, which are taken orally, although one form of liquid is
made for injection. Typical dosages range from 100 to 200 mg per day, taken in one or two doses, with a recommended
maximum dose of 300 mg a day. Unless this drug causes stomach upset, it should be taken on an empty stomach (one hour before
or two hours after a meal) with a full glass of water. Doxycycline usually relieves symptoms after 48 hours of treatment, but it
should be taken for the entire prescribed length of time to avoid recurrence of infection.


Patients with liver disease and pregnant or breast-feeding women should not use this drug. It may be taken by children over the
age of eight at a dosage based on body weight. Possible side effects include diarrhea, nausea, vomiting, skin rash, itching, light
sensitivity, headache, facial swelling, chest pain, difficulty swallowing, or bulging forehead (in infants). Children may develop
discolored teeth, especially with long-term use.
Doxycyline may interact adversely with antacids and other common gastrointestinal medications, birth control pills, barbiturates,
blood-thinners, penicillin, phenytoin, sodium bicarbonate, and carbamazepine.


Brand Names:Doryx, Vibramycin, Vibra-Tabs, Bio-Tab



     4. Cimetidine
Cimetidine, drug used in the treatment of stomach and intestinal ulcers. It is used to treat reflux disease, a condition in which
stomach acids back up into the esophagus causing heartburn, and to prevent upper abdominal bleeding. Cimetidine is also used to
treat chronic hives, acne, herpes infections (including shingles), excessive hair growth in women, and an overactive parathyroid
gland.


Cimetidine blocks the action of histamine, a chemical in the body that stimulates acid secretions in the stomach. When histamine
action is blocked, secretion of stomach acid decreases, allowing ulcers and other gastrointestinal ailments to heal.


This drug is available by prescription in tablet and liquid form, both taken orally, and in a liquid form that is injected. Depending
on the condition being treated, typical dosages range from 800 to 1200 mg per day. Cimetidine may be taken in a single dose at
bedtime or divided into two or four smaller doses, usually taken immediately after a meal. Relief of symptoms may take several
days. Recurrence of ulcers after cimetidine treatment ends may be slightly higher than with other forms of treatment.


Patients taking this drug should avoid alcohol, cigarette smoking, and excessive caffeine. Patients should refrain from taking
antacids within one to two hours of a cimetidine dose. This drug has not been proven safe for pregnant or nursing women or for
children under the age of 16. It should be used with caution by patients with impaired liver or kidney function. It should not be
stopped abruptly by patients taking it for peptic ulcer disease.


Breast development in men and headaches are the two most common side effects of this drug. Less common side effects are
diarrhea, dizziness, anemia, hair loss, impotence, joint or muscle pain, skin rash or inflammation, rapid or slow heartbeat, and
sleepiness. With prolonged use (one month or more), some patients experience anxiety, confusion, depression, or hallucinations.
These reactions are more likely to occur in elderly or severely ill patients, but they are temporary and subside several days after
drug treatment ends.


Cimetidine may interact adversely with a variety of drugs, including medications for diabetes, heart palpitations, and fungal
infections as well as blood pressure drugs (both beta blockers and calcium blockers), benzodiazepine tranquilizers (such as
diazepam), narcotic pain relievers, nicotine, and aspirin. Other drugs that may interact adversely include chlorpromazine,
cyclosporine, digoxin, metoclopramide, metronidazole, paroxetine, pentoxifylline, phenytoin, quinine, sucralfate, theophylline,
and warfarin.


Brand Name:Tagamet
     5. Tretinoin
Tretinoin, prescription drug used to treat moderate acne and sun-damaged skin. A naturally occurring derivative of vitamin A,
tretinoin works by interfering with the ability of skin cells to form pimples. It also speeds the growth of new skin cells, which
aids in healing acne and reduces sun-related conditions like fine wrinkling and rough, mottled skin.


Tretinoin is also the first in a new class of cancer drugs known as differentiating agents. It is taken in oral form as a
chemotherapeutic agent against acute promyelocytic leukemia (cancer of the blood-forming tissues). Taken orally, it has also
shown promise improving AIDS-related Kaposi’s sarcoma, a cancer that begins on the skin and spreads to the internal organs.


Tretinoin is available in a gel, cream, and solution. It is applied to the skin, usually once a day at bedtime. About 20 to 30 minutes
before application the skin should be cleansed with a mild soap and patted dry. Hands should be washed immediately after
application. Effectiveness is usually apparent after two to three weeks of treatment, although maximum improvement may take
several months.


Patients with sensitive skin or eczema (inflamed, crusty skin) should use this drug with caution. It should not come in contact
with the eyes, mouth, or mucous membranes of the nose. The gel form of this drug is flammable and should be kept away from
heat or open flames.


Possible side effects may include sun sensitivity, excessive redness or peeling of the skin, temporary worsening of acne,
darkening or lightening of skin color, or a sensation of heat or stinging when the drug is applied.


Tretinoin may interact adversely with other skin medications, especially those containing sulfur, salicylic acid, or resorcinol, as
well as with medicated soaps, astringents, and skin products containing alcohol, citrus scents, or spices.


Brand Names:Retin-A, Renoval, Vesanoid

				
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