Acne Vulgaris

What is Acne Vulgaris?

Acne Vulgaris is a skin disease caused by changes in the pilosebaceous units(the hair follicles and sebaceous gland).It commonly occurs during

adolescents affecting more than 85% of teenagers and frequently continuing to adulthood.

DESCRIPTION OF ACNE

In adolescence there is an increase in male sex hormones with people of all genders during puberty.Face and upper neck are most commonly

affected,but the chest, back, shoulder may have acne as well. Typical acne lesions are comedones, inflammatory papules, pustules and nodules.

Large nodules are called nodulocystic lesions which are seen in severe inflammatory acne. Acne vulgaris results from blockage of follicles. Hyper

keratinisation and formation of a plug of keratin and sebum are the earliest changes. Enlargement of sebaceous glands and an increase in sebum

production occurs with increase in androgen production. The microcomedones may enlarge to form an open comedone (black heads) or a closed

comedone (white heads). Closed comedones are direct result of skin pores becoming clogged with sebum and dead skin cells. In these conditions

the naturally occurring large commensal bacteria ( propionibacterium acnis) can cause inflammation leading to inflammatory lesions.

CAUSES OF ACNE

1)Family/Genetic history-Acne tends to run in family.
2)Hormonal activity-Such as menstrual cycle in puberty. During puberty androgen activity increases.
3)Inflammation, Skin irritation or scratching of any kind will activate the inflammation.
4)Stress-Some believe that increased output of hormones from adrenal glands during stress periods may activate acne formation.
5)Hyperactive sebaceous glands.
6)Accumulation of dead skin cells that block the pores.
7)Bacteria in pores.
8)Use of anabolic steroids.
9)use of certain medications containing lithium, barbiturates, androgen, amphetamines.
10)Diet-Acne is inflammed by dietary factors. People consuming high amount of chocolates may increase the chances of developing acne.
11)Carbohydrates-Recent studies have shown that low glycemic food that rapidly digest carbohydrates like soft drinks, sweets, white bread

produces an overload in blood glucose, that stimulates the secretion of insulin which in turn triggers release of IGF-1. It has direct effects on

pilosebaceous units and has shown to stimulate hyperkeratosis and epidermal hyperplasia.These events facilitates acne formation.
12)Vitamin A and E-Acne vulgaris patients have lower value of vitamin A and E in the blood.
Causes Of Adult Acne
The main cause of adult acne is sebum, which is an oil produced in your sebaceous glands. Sebum clogs your pores and causes them to swell,

e.g. a whitehead or blackhead. Some other causes are cosmetics, different anti-aging creams, and lack of sleep.

TREATMENT

1) TOPICAL BECTERICIDALS– bactericidal products containing benzoyl peroxide is used in mild to moderate cases of acne vulgaris. The gel or cream is applied daily into the pores on affected lesions. Bar soaps or face washes containing benzoyl peroxide- varying in strength (2-10%)may be used. It has a keratocytic effect and it prevents new lesions by killing propionibacterium acnis) bacterium. Keratolytic means dissolves the keratin plugging the pores. It may cause dryness, local irritation or redness.Use of low-concentration (2.5%) benzoyl peroxide preparations, combined with suitable moisturisers to help avoid overdrying the skin. Mild bleaching effect.

Other antibacterials-triclosan, or chlorhexidine gluconate(they are milder with less side effects and effect is also low).

2) ORAL ANTIBIOTICS –Erythromycin group of tetracyclin antibiotics, trimithoprim. It has been found that submaximal dosage of minocycline is quite effective. It also have anti-inflammatory effect.

3) TOPICAL ANTIBIOTICS -which can be applied externally are erythromycin, clindamycin, stievamycin, or tetracycline.They will kill bacteria blocked in follicles.

4) HORMONAL TREATMENT -In females acne can be improved by hormonal treatment. Common combined oestrogen/progestogen methods of hormonal contraception has shown the effect.

5) TOPICAL RETINOIDS -These group of medications normalise the follicle cell life cycle. They include tretinoin , adapalene , and tazarotene.

Retinoids appear to influence the cells creation and death. These help prevent hyper-keratinisation of cells that create blockage.

6) ORAL RETINOIDS- daily oral intake of vit A derivative over a period of 4-6 months can cause long term resolution or reduction of acne. It works

by reducing the secretion of oil from glands and studies suggest that it affects other acne related factors as well.

7) Physiotherapy treatment of acne vulgaris

GOALS
1)To obtain desquamation of skin.
2)Increase vascularity.
3)Reduce number of micro-organism.
4)Improve general health and hygiene.

(a)Ultraviolet radiation (UVR)-First the skin is washed with soap water and then gently dried with clean towel then irradiated by UVR. E 1 dose is given 2-3 times a week

for about 3-4 weeks. This is given to improve the condition of the skin and this is repeated. E2 and E 3 doses are given for healing purpose. This

will open the block causing the infected material to discharge rather than retain it in the skin.

The technique of UVR varies with the area being heated. The therapist must ensure that during screening there should not be any possibility of

overlap dosage.

(b)LASER-He-Ne laser with wavelength 632.8nm to burn away the follicle sac from which the hair grows. It burns away the sebaceous gland which

produce oil. Also it induce formation of oxygen which kills the bacteria which cause acne vulgaris. LASER can be used for scar marks Keloids.

ADULT ACNE CARE
The adult acne care is different than the treatment of teenage acne. Finding an effective treatment is basically a trial-and-error process and will

take some time.

PRESCRIPTION MEDICATION – Topical antibiotics like clindamycin fight acne bacteria at the source, the skin. Tetracycline, an oral antibiotic

attacks acne from the inside out by balancing hormones.

CLEANSER – For adults, it is important to find a cleanser that is gentle and void of scrubbing beads and exfoliators because they irritate “older”

skin. The most gentle cleansers are aquanil and cetaphil for Adult Acne Care.

LASER TREATMENT – For a more high-tech solution, laser or intense light treatments can target and kill acne-causing bacteria. This type of Adult

Acne Care is expensive, however, and could have the potential to be dangerous.

SKIN CARE REGIMEN – Acne treatment systems generally consist of a cleanser, treatment, and moisturizer. These regimens are strict, but often

have positive outcomes that are easy to achieve if you properly use the product.

Author: Nitesh Patel - Physiotherapist

Physiotherapist in Samarpan Physiotherapy Clinic Ahmedabad Bapunagar Amaraiwadi Vastral Mobile Physiotherapy Clinic Dr. Nitesh Patel ( Physiotherapist ) : Mo No : 09898607803