It is estimated that around 20% of teenagers suffer from pimples(acne)and pimple scars during adolescence. People are obsessed with personal looks and go to any length to seek pimple remedy as looks are everything in this modern world.
Nobody can deny the fact that a beautiful,clear face creates a favorable first impression that opens many doors of opportunities. Having a clear and beautiful face has been the pursuit of women and for a long time associated with women.All women have the urge to have beautiful looks.A face full of pimples is the dread of every woman especially teenagers as they are very particular about how they look.Of late even men have started to take interest in their appearance though they are supposed to be different.
However,the changing times have made Men too to take more interest in their personal appearance and are no longer content to play the old roles.The distinction between the sexes has started to blur.Men no longer ignore pimples and are eager to seek pimple remedy at the earliest.
Outside the family,Teenagers' lives are limited to friends and are very much sensitive to criticism especially about appearances.Pimples infection hurts them the most due to ugly pores that almost disfigure the face.They are hurt when friends make fun of pimple scarred face and friends can be very cruel at times.This in turn affects them psychologically and they suffer from anxiety and depression.
The teen years are a trying time for any person. Although the worries and cares of adulthood are still far into the future, the teen is not exactly a happy and relaxed person. The carelessness and ignorance of childhood makes room for rebellion and questions about one’s values and place in the world. Looking for their own road through life teens feel insecure and, often enough, misunderstood. Unfortunately, if the search for a place under the sun is not enough, teenagers also have to deal with other problems, such as pimples. This unsightly condition is the bane of many teenagers because of the effects it has at psychological level.
It doesn’t take a lot to foster a negative self image in a teenager. Most of them are at least somewhat insecure about their outward appearance because of various real or imaginary blemishes. But a real condition that causes true discomfort and mars a young face is something else altogether. The fragile self image and self respect of teenagers are hard pressed to cope with the pressure exerted by the opinions of others and the comparisons with various role-models that teenagers find for themselves. In extreme cases, the negative self image turns into self hatred and the disfiguring condition is seen as a cruel instrument of self punishment for failing to rise up to some standard or other.
What are pimples and how they are formed?
Pimples infection is a non life threatening skin condition affecting our face,upper neck and sometimes chest and back too.
We have oil secreting glands called sebaceous glands under our hair follicles which produce a oily substance called sebum that is meant to keep the skin healthy.When these glands produce more oil than necessary,the skin pores get clogged and get infected by bacteria and the follicles are inflamed causing pimples.
The production of sebum is found to be directly proportional to the production of testosterone and hormonal fluctuations in women during pregnancy,menstrual cycle and menopause. It is found that those who have a family history of pimples are more prone to it. Pimple infection is a non-life threatening skin condition but leaves tell tale signs behind in the form of scars which may take time to disappear.
Pimple infection may affect any age group but generally affects adolescents.
Pimples can occur in mild form causing blackheads and whiteheads to appear.In severe case of pimple infection,pus filled cysts are formed around the inflamed follicles which may cause pain.The main concern is that it may leave behind ugly scars which might cause embarrassment about appearance and may affect the self confidence of the patient.
There are many remedies for pimples especially for big pores and there are lots of products to choose from.How to choose a product among so many? What are the criteria to look for before purchasing a pimple remedy product?
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‘Acne Vulgaris’ popularly known as acne has other names too which are pimples,blemishes and zits.It is estimated that 30% of teenagers suffer severe acne warranting medical intervention.It is the single most common skin disease affecting mostly teenagers but it can affect anybody in any age group.It is a skin disorder which affects girls two to three years earlier than boys but there is no gender bias for this disorder and it affects almost every teenager in one form or the other.
Fortunately,majority of acne cases are mild in nature and responds to medication and vanish after some time.But for some,acne is severe with wave after wave of lesions which are disfiguring and causes anxiety and stress which aggravate the situation further.Acne scars and blemishes can have a devastating effect on the individual’s life causing depression and low self esteem there by lowering the quality of life.Acne sufferers are more prone to suicidal impulses due to stress and depression.
There are oil secreting glands called sebaceous glands situated under hair root follicles of the skin that produce a thick wax like oil to keep the skin healthy.This oil is called sebum.Sometimes these glands produce more oil than necessary due to hormone fluctuations in the body and also due to other factors.This excess production of thick wax like oil blocks the hair pores and creates a perfect breeding ground for bacteria called ‘propionibacterium acnes’ or ‘P.acnes’ for short.There are about four important factors that contribute to the development of acne.
1.Production of excess sebum by the sebaceous glands.
2.Blockage to the outflow of sebum at the mouth of pilosebaceous duct or hair root canal.
3.Inflammation of follicles due to the blockage.
4.Infection and proliferation of bacteria ‘P.acne’ in the trapped sebum and hair root canal.
Acne is the resulting condition of many interacting processes.Acne sufferers have a higher rate of sebum production than non-sufferers.The sebaceous glands are stimulated to produce more sebum by the increased circulation of hormone androgen,the production of which is high during puberty.Because of this increased sebum production,the micro organism population residing and thriving in the sebum(their main source of food)explodes.
These organisms are
1)bacteria called propionibacterium acnes,
2)micrococci also known as staphylococcus and
3) pityrosporum ovale which are yeast like micro-organisms.
This population explosion of these microorganisms causes infection.
During the onset of puberty, there is sudden upsurge of hormone levels for both boys and girls which in turn triggers more sebum production leading to blockage of pilosebaceous duct or hair root canal.Now the bacteria ‘P.acnes’ thrives and proliferates in the blocked sebum causing inflammation and subsequent lesion.The severity of acne varies from person to person according to their immune system response to the bacteria ‘P.acnes’.The early lesions are whiteheads and blackheads which are also called open or closed comedones.
Blackheads are medically known as open comedones.These are follicles with a wider opening than whiteheads.Blackheads are blocks or plugs (that usually appear on nose or forehead but can occur anywhere)which can be removed easily by using a blackhead strip which acts like a adhesive tape.This tape sticks to the body part and when removed after about ten minutes draws out the blackheads.This is the mild form of acne which is treatable and self limiting.This means it vanishes on it’s own.But severe cases of blackheads need medication.
Whiteheads are called closed comedones which are sebum filled follicles, having a very small opening at the skin surface. Though acne can occur in any hair bearing skin area,certain areas are more prone to acne formation such as nose,cheeks,lower jaws,forehead and chin.These acne prone skin areas have larger oil producing sebaceous glands.For those with severe acne,it can occur in other areas too such as thighs,buttocks,chest,back and sometimes even in upper arms.
There are some variants of acne which are acne inversa,drug acne,chemical acne or oil acne,chloracne,tropical acne, and infantile acne and excoriated acne.
Acne inversa is more prevalent than previously thought and is often misdiagnosed.It is characterized by appearance of lesions in scalp,neck,mammary folds,genitals,buttocks and anal region.The features of this type of acne is that patients are affected for years and sometimes even decades and withstood the onslaught of medication without any improvement.There is the discharge of foul smelling pus from the inflamed lesions which is very disconcerting. There are also other variants of this disease which make diagnosis difficult.The outcome of this type of acne is devastating leading to depression and other psychological problems.Genetic predisposition may be one of the factors for this disorder.
Drug acne occurs when drugs containing androgen stimulating agents are given to patients.This happens because androgen triggers excess sebum production which leads to acne formation.Drugs containing steroids too can cause acne.Anti-epileptic and anti-tuberculous drugs are known to cause acne eruptions or aggravate existing acne.
Chemical acne or oil acne can happen to industrial workers coming into contact with lubricating and cutting oils and other chemicals containing hydrocarbons.These acne like eruptions occur at the site of contact.Even cosmetics that contain certain mineral oils such as cocoa butter can cause acne at the site of application.The application of ointments for skin diseases containing tar can cause acne at the site of application.
Chloracne occurs to those who come into contact with substances containing dioxin and chlorinated hydrocarbons.This type of acne is very disfiguring and is characterized by appearance of whiteheads and inflamed cysts which may persist for a prolonged period and can be caused by a mere transient contact with the substance.Epidemics of this type of acne have occurred after factory accidents, caused by widespread spill of these substances and people coming into contact with these substances.Even months after the accident,the acne persists causing blemishes.
Tropical acne affects Caucasians in hot humid climates such as those obtaining in far east.This type of acne appears mostly in trunk and does not respond to medication.The only solution is avoiding the climate by moving to a more suitable moderate climate.
Infantile acne is rare which affects infants in the age group of three to twelve months.Infants affected with this type of acne are more prone to severe acne during or after puberty.Excoriated acne happens to those who pick or squeeze their acne spots.The resulting lesions and papules are more inflamed than the normal acne spots.The manual interference in fact aggravates the problems hence it is advisable not to pick or squeeze acne spots.
There are short term and long term goals for treating acne.The purpose of short term treatment should be to alleviate the symptoms and to heal the lesions.The long term treatment should aim at limiting the disease,scar removal and enhancing the quality of life.The treatment differs from person to person according physiology and severity of acne.The severity is categorized as mild acne,moderate acne and severe acne.Though many treatment options are available,the right treatment combination therapy suitable to the patient has to be figured out by trial and error method.The treatment in most cases are prolonged.
The first step should be to prepare the patient mentally for the treatment by counseling.Acne patients generally are a depressed lot hence sympathetic care and support should be given to change their mindset.
The treatment of acne consists of four parts aimed at
1.Administration of anti microbial medication to reduce the number of bacteria in the hair follicles
2.Removal of the blockage in the hair root canal.
3.Medication to reduce the rate of sebum production which is the original cause.
4.Reduction of acne inflammation by suitable medication.
There are two types of treatments namely topical and systemic.Topical treatment deals with application of medication on the skin surface of the affected area and systemic treatment means oral medication.
Topical medications used are as follows.
1.Preparations containing benzoyl peroxide.
2.Antiseptics and keratolytics.
3.Topical vitamin A preparations such as tretinonin
4.Preparations containing azaleic acid such as skinoren.
5.Topical antibiotics such as tetracycline,erythromycin and clindamycin.
6.Topical retinoids such as tazarotene.
7.Topical comedolytic which acts against comedones such as tretinoin,adapalene and isotretinoin.
The side effects of these topical retinoids are scaling of the skin surface and also the skin color of skin sensitive fair skinned people changes to pink.
For the removal of blackheads,abrasive preparations such as polyethylene beads or aluminum oxide.These substances clear blackheads by their abrasive action.
Systemic medications are as follows.
1.Preparations containing antibiotics such as tetracycline,minocycline,doxycycline and erythromycin.
2.Hormone therapy medication such as Dianette.
3.Sebum suppressing medications such as isotretinoin,spironolactone,cyproterone and Ethinylestranol.
The antibiotic tetracyclines has been the mainstay of treatment of moderate and severe acne for many years now.Slightly a higher dosage is given initially and when there is encouraging response,the dosage is reduced marginally.Tetracyclines improves the condition when taken regularly for four to eight weeks.It has to be taken for another three months or more(depending on the severity of acne)to see further improvement.
The side effects of tetracyclines are not usually serious such as occasional diarrhea and stomach discomfort.Tetracyclines must not be given to pregnant women and infants as it may cause bone deformities to the fetus.
Erythromycin is equally effective as tetracyclines and the dosage is similar to tetracyclines.It has minor side effects such as nausea.
For patients who are allergic to tetracyclines there are other antimicrobials and antibiotics such as clindamycin,sulphonamides and quinolines.The side effects of these can be of serious nature though.
Isotretinoin(13-cis-retinoic acid) is prescribed for those with severe acne.This drug suppresses production of sebum by shrinking sebaceous glands.It also has anti-inflammatory properties.The dosage usually is 0.5-1.0mg/kg body weight for a period of four months.More than 80% of the patients recover after a course for four months.For some people it may take two courses for the acne to respond.
The side effects of this drug is often severe.This drug should not be given to pregnant females as it may affect the fetus adversely causing malformation and other abnormalities.Other side effects include drying and cracking of lips and also increased blood lipid levels.This drug also causes bone problems such as osteoporosis.
Anti-androgen drugs such as Dianette,reduce sebum production by controlling androgen quantity in the blood.This drug inhibits the production of androgens in the pituitary gland, there by suppressing sebum production and consequently causing acne reduction.This drug suppresses ovulation and behaves like a oral contraceptive.If taken regularly for six to eight week,this drug improves acne condition.
The side effects of this drug are that it has feminizing properties due to which it is unsuitable for men.It has other side effects too like those caused by oral contraceptives.
Apart from topical and systemic therapies there is also another therapy called experimental therapy involving photodynamic therapy and laser treatment therapy to reduce acne scarring.
Treatment of mild acne is done with 5-10 percent benzoyl peroxide or tretinoin.If this treatment does not show improvement even after three months, systemic treatment should be added using tetracycline or erythromycin.Preparations containing vitamin A are effective in case of closed comedones or white heads.
The treatment for moderate acne is done using topical benzoyl peroxide and tetracycline or erythromycin 1g/day for three months.If there is no response,increase the dosage slightly to get better response.For women who seek acne therapy during pregnancy,erythromycin should be prescribed instead of tetracycline as it may affect the fetus.For women whose acne persists in spite of repeated topical and systemic treatments,hormonal therapy may be considered.
Severe acne control is possible in almost all cases by using isotretinoin which is a retinoid.This drug has a specific effect on sebaceous glands resulting in reduced sebum production.This reduction in sebum production persists up to twelve months even after stopping usage of this drug.This drug has severe side effects especially on pregnant women affecting the fetus causing deformities.Other side effects though not proven,include severe teenage depression leading to suicides in teenagers using this drug for acne.It is important to educate the patients on these side effects before prescribing.
Pimples are a fact of life and it is easy now to treat it.If you understand pimples it is easy to fight them.
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