Acne

Acne - or Acne Vulgaris - is a common skin condition, identifiable by areas of scaly red skin (seborrhea), blackheads and whiteheads (comedones), pinheads (papules), pimples and nodules (pustules), and possible scarring caused by one or all of the previously mentioned characteristics.

Acne occurs more often during adolescence, and can often continue into adulthood. Acne in adolescence is commonly caused by an increase in testosterone, something that happens in both genders.

Signs and Symptoms

Typically acne will present with the following features:

• scaly red skin (seborrhead)
• blackheads and whiteheads (comedones)
• pinheads (papules)
• pimples and nodules (pustules)
• scarring

Acne can present somewhat differently in people with dark skin.

Scarring due to acne is caused by inflammation within the dermis brought on by acne. The scarring happens when a wound caused by acne tries to heal itself, resulting in too much collagen in one location.

Physical scars are referred to as "Icepick" scars, because the scars often cause an indentation on the surface of the skin. Scarring caused by acne may include:

• Ice pick scars: These are the most common sign of acne scarring, and are characterised by deep pits in the surface of the skin.
• Box car scars: Angular scars that often display on the forehead and cheeks. These can be deep or shallow, and are similar to chickenpox scars.
• Rolling scars: Scars that have a tendency to give the skin a wavey appearance.
• Hypertrophic scars: Thickened scars. Also known as keloid scars (a scarcomposed of type III or type I collagen).

Diagnosis

Acne diagnosis is divided into scales based on the severity of the case, and there are multiple scales used for grading. The three most common grading techniques are:

• Leeds acne grading technique: Counts the number of lessions into inflammatory and non-inflammatory types. The higher the count for each, the higher the number on the scale (ranging from 0-10.0).
• Cook's acne grading scale: Using photographs, the scale grades based on the severity, ranging from 0 for the least severe, to 8 for the most severe.
• Pillsbury scale: Simple classification based on severity, ranging from 1 for the least severe, to 4 for the most severe.

Treatment

There are a number of treatments available for acne that will help alleviate most or all of the symptoms. Medication includes:

• Benzoyl Peroxide: a first-line treatment for mild acne vulgaris. It works against the P Acnes bacterium, and normally causes dryness of the skin, slight redness and infrequent peeling (if side effects occur). During summer, sunscreen should be used as Benzoyl Peroxide increases sensitivity to sunlight.
• Antispetics: sometimes combined with Benzoyl Peroxide due to the antibacterial nature of certain antispetics.
• Antibiotics: reserved only for the most severe cases of acne, due to the the increasing resistance of P Acnes to antibiotics worldwide. These can either be applied topically or taken orally.
• Topical and oral retinoids: Vitamin A has been shown to have a positive effect on the resolution of acne of 4-6 month periods when taken topically or orally.
• Anti-inflammatories: have been shown to aid in treatment of acne through their anti-inflammatory properties.

In more severe cases of acne alternative treatments include Dermabrasion (removal of the surface of the skin by abrasion), Phototherapy (exposure to voilet, red and blue light can decrease the number of lessions by 60-70%), Laser treament (burn away follical sacs, sebaceous glands and to induce oxygen formation in bacteria).

Surgery may be attempted in people with cystic acne in order to drain boils through surgical lancing.