ABOUT ACNE VULGARIS (Common acne)

By Acne vulgaris there are swallen, infected and inflamed lumps, in the skin, filled with sebum and pus, called pimples, spots, plukes and or zits.

But inflammation is not the basic process in this ailment The basic causes are poorly understood, and may be many. Hormonal changes during puberty where the levels of testosterone rizes is such a basic cause.

These changes cause changes in the the skin's pilosebaceous units, consisting of a hair follicle and its associated sebaceous gland.

The hair follickle now produces more of the fatty substance semen, and the semen may also change chemical composition.

This is at first seen just as greasy skin, and there may be some inflammation allready at this stage, because bacteria in he skin nourishes off the semen and produce waste substances that the skin reacts against.

The sebum then tends to harden at the outlet of the follicle because of reactions with the air, and form a prop in the outlet of the hair follickle, a so called comedone, also called blackspot or whitespot according to the colour of the comedone. Also the outlet of the hair follickle tend to narrow, because of increased cellular activity in the skin so that the comedone more easily forms.

Now the follicle begins to be filled with sebum, and makes a swallen lump with the comedone and the hair in the middle.

Bacteria and yest now begin to proliferate in the mass of sebum, and make a lot of wast products. Most abundant are Propionibacterium acnes and the lipophilic (oil/lipid-loving) yeast Malassezia.

These waste products tend to penetrate into the surrounding walls of the swallen follickle and furter into the skin. The bacteria themselves and these waste products now cause a big inflammation.

An inflammtion is actually the responce of the body to get rid of the irritating factors. It consists of such things as increased blood flow, increased tissue fluid. Production of anti-bodies and their reaction with foreign factors, the action of cells that go in to digest foreign objects, and the action of cells that tidy away bacterial waste and destroyed tissue elements.

Cells of the immune system will now penetrate into the stuffed mass in the swallen hair follickle, and this makes a lot of pus, the slump swells even more and gets red.

At this stage a fully formed pimple has been formed. Eventually the pimple ruptures and the content flows out. then the skin heals, but the healing may cause a scar.

A person can have skin areas and hair follickles with al the listed stages at the same time. The face, chest, back, shoulders and upper arms are especially affected by acne.

The acne of most affected individuals tend to dimmish  over time and acne thus tends to disappear, or at least decrease, after one reaches the 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[specify] 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. The vernacular term bacne or backne is often used to indicate acne found specifically on one's back.

Aside from scarring, the main long term effects of acne are psychological, such as reduced self-esteem and, according to at least one study, depression or suicide. Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and treatment is therefore advocated to lessen the overall impact to individuals.

Acne scars

Severe acne often leaves small scars where the skin gets a "volcanic" shape.

Acne scars generally fall into two categories: physical scars and pigmented scars. Physical acne scars are often referred to as "Icepick" scars. This is because the scars tend to cause an indentation in the skin's surface. Pigmented scars is a slightly misleading term, suggesting a change in the skin's pigmentation. This is not true. Pigmented scars are usually the result of nodular or cystic acne (the painful 'bumps' lying under the skin). They often leave behind an inflamed red mark. Often, the pigmentation scars can be avoided simply by avoiding aggravation of the nodule or cyst. When sufferers try to 'pop' cysts or nodules, pigmentation scarring becomes significantly worse, and may even bruise the affected area. Pigmentation scars often fade with time, and those who suffered from acne before, and have developed scars are generally relieved that the acne has gone, and emotional effects of acne scars tend to be less distressing.

Acne scars are unsightly, and it is for this reason they can be psychologically and emotionally distressing. However, there are a range of treatments available. If acne scars are causing severe psychological distress, social withdrawal and/or emotional ill-health, a physician should be contacted.

There are several types of acne scars: Ice pick scars are deep and that are the most common and a classic sign of acne scarring. Box scars are angular scars, resembling chicken pox scars, that usually occur on the temple and cheeks, and can be either superficial or deep. Rolling scars give the skin a wave-like appearance. Hypertrophic scars are thickened, or keloid scars, resulting from an exaggerated growth when acne lesions are healing.

Causes of acne

Several factors are known cause acne, either alone or in combination, or aggravate an allready formed acne.

-Family history
-Hormonal activity, such as menstrual cycles and puberty
-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.

Several hormones have been linked to acne: the male hormones testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I). In addition, acne-prone skin has been shown to be insulin resistant[citation needed].

It has also been suggested that there is a link between a diet high in refined sugars and other processed foods and acne. According to this hypothesis, the startling absence of acne in non-westernized societies could be explained by the low glycemic index of these cultures' diets. Others have cited possible genetic reasons for there being no acne in these populations, but similar populations shifting to these diets do develop acne.[citation needed] Note also that the populations studied consumed no milk or other dairy products.[7] Further research is necessary to establish whether a reduced consumption of high-glycemic foods (such as soft drinks, sweets, white bread) can significantly alleviate acne, though consumption of high-glycemic foods should in any case be kept to a minimum, for general health reasons.[8] Avoidance of 'junk food' with its high fat and sugar content is also recommended.[9] On the other hand there is no evidence that fat alone makes skin oilier or acne worse.

One study [specify] suggested that chocolate, french fries, potato chips and sugar, among others, affect acne. A high GI (glycemic index) diet that causes sharp rises in blood sugar worsens acne. [10] If this study's conclusions are verified then a low GI diet may help acne also, but a 2005 review of somewhat dated scientific literature cannot affirm either way.[11] A study in November 2006 in Australia gave a 50% reduction in 12 weeks in mild-moderate facial acne by introducing its subjects to a high protein, low GI diet

Development of acne vulgaris in later years is uncommon, although this is the age group for Rosacea which may have similar appearances. True acne vulgaris in adults may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Dermatologists are seeing more cases of menopause-associated acne as fewer women replace the natural anti-acne ovarian hormone estradiol whose production fails as women arrive at menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).

Traditional Chinese Medicine philosophy is based around the idea than illness is a form of imbalance, and acne is no exception. One idea is that the body of the patient contains a lot of "hot" energy, and may be due to diet (e.g. fried foods, chocolate, lychee, durian) or an imbalanced life style (this may be connected with hormone activity). The usual treatment is to assume a healthy life style, and that the patient should eat food that is "cold" by nature, such as some herbal teas, and certain fruits, e.g. melons.

(Some of this information is compiled from wikipedia.org)

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