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Expert Speak

Acne

Dr. Vidya

Did you think that Acne was a teenage worry? It is that and more… Dr Vidya Ram Pradeep, Dermatologist, discusses the problem and offers tips on managing it.


What is Acne?

A Chronic disorder of the pilosebaceous apparatus which results in greasiness and a polymorphic eruption on the face and torso.

What Causes Acne?

Other than warts, acne is the commonest reason for a dermatological consultation. It results from an over activity of the sebaceous gland and a blockage in its duct. The gland is under is control of Androgens.

How does Acne Manifest?

The physical signs of acne include greasiness, comdones, milia, red papules and postules, Sometimes it occurs in association with nodules, cysts, scarring, keloids and post inflammatory hyper pigmentation.

Acne occurs primarily on the face and trunk.

Different types of Acne

There are various clinical forms of acne. Here is a description of some of them.


Acne vulgaris

This is the common variety of acne. It is one of the first manifestations of adolescence and, as such, is now commencing much earlier. Today it is quite usual to see comedones and milia in a 10-year-old. The disorder reaches maximum activity at 16-18 years and then subsides, but often does not disappear until the early or mid-twenties.

Post-adolescent female’s acne

This is remarkably common in women in their twenties and thirties who invariably state that they were not troubled by acne in adolescence. The condition usually clears by the middle or late thirties, but not always. It has a characteristic predilection for the muzzle area of the chin and jaw and results in painful and deep nodules, especially pre -menstrually. Most patients have low levels of the sex hormone-binding globulin and the consequent rise in free-circulating levels is responsible for the acne. Some patients have features of the polycystic ovary syndrome. Some women relate occurrences to either stopping, starting or changing their oral contraceptive, while others have never taken a pill.

Infantile acne (milk spots)

The newborn display endocrine behaviour that is not unlike that of puberty. Spots therefore are quite common in early infancy and may be due to transplacental stimulation of the sebaceous glands by adrenal androgens rather than due to transfer of maternal androgens via breast milk. The acne occurs predominantly on the cheeks and clears after a few months.

Nodulocystic acne

This is an exceedingly unpleasant form of acne. It differs from acne vulgaris in the degree of physical signs, in its chronicity and, until recently, its relative resistance to standard therapy. The condition, which usually begins in adolescence, occurs in both sexes, but probably more frequently in males. The lesions which distinguish it from acne vulgaris are the deep and painful papules and nodules that occur and the resulting disfiguring scarring, sometimes with keloid formation. The condition does not remit after adolescence, but frequently persists into early middle age. The face, chest and back may be involved in isolation or together, it is quite startling to examine a patients whose face appears quite normal, only to find severe disease on the back or chest. The buttocks may also be involved.

Rules for control of Acne

Acne lesions are made worse by the patients squeezing or tampering with pimples.

Rule one – Do not pick or squeeze your skin.

Rule two - Clean your face thoroughly but gently.

Rule three - Avoid potentially acne causing foods such as nuts, cheese, oily greasy foods, cola drinks and chocolates. Sea food containing iodine may cause skin trouble. Do not eat food that from experience you know make you worse.

Rule four – Do not apply any greasy ointments to your face.

Rule five – Shampoo your head as often as necessary to eliminate the grease.

Rule six – Try to control constipation. The best way to do this is by a diet of fresh fruits and vegetables. Another aid is drinking plenty of water.

Rule seven – Emotional factors may influence acne. So rule seven is, try not to get two worried about things that will pass or have passed successfully for thousands of your fellow travellers.

In summary, much can be done to relieve your acne. Try the seven basic rules and get competent professional advice.

Cosmetological Procedures for Acne

Chemical Peel

Chemical peeling is basically an accelerated form of exfoliation induced by the use of a chemical cauterant or escharotic agent. Very light peeling agents induce a faster sloughing of the cells in the statum cornium.

Classification of peel depth

Superficial – Medium and Deep.

Common peeling agents

  • Retinoic acid
  • Trichloroacetic acid
  • Alpha hydroxy acid.
  • Phenol.

Alpha hydroxy acids is a group of organic acids that have recently become popular they are derived from fruits and are called “fruity acids”.

After a peel patient may notice-

  1. Improvement in skin texture within 2-3 weeks.
  2. Reduction of pore size 3-6 weeks.
  3. Improvement in pigmentation 6-12 weeks.
  4. Improvement in scars/wrinkles 8-24 weeks.

Frequently performed techniques for treating acne scars are:

Dermbrasion

The surgeon freezes the patient’s skin and then sands or “abrades” the skin with a rotary instrument. A new layer of skin replaces the abraded skin during healing, resulting in a smoother skin surface.

Excision and Punch Replacement Graft

A depressed acne scar is surgically removed, and a patch of skin from else where on the patient’s body is transplanted over it.

Collagen Injections

The dermatologic surgeon injects collagen, one of the building blocks of the skin under the scar. The collagen pumps up the scar issue, leaving a smoother surface.

Dr. Vidya Ram Pradeep M.D.

Dr. Vidya is a Dermatologist and has specialised in Cosmetology. She has trained in Cosmetology at North Carolina, U.S.A. She is currently a Consultant Dermatologist and Cosmetologist at the Skin and Cosmetology Clinic, Chennai, India.

Address:

Dr. Vidya Ram Pradeep M.D.
Skin and Cosmetology Clinic
#1, Baliah Avenue
Luz Church Road
Mylapore
Chennai - 600 004
India
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