SYSTEMATIC INTERVENTION OF ACNE IN ADULTS
Acne vulgaris is an inflammatory disorder that causes non-inflammatory lesions mostly on the face and also can occur on the upper arms, neck and back within the sort of closed and open blackheads and inflammatory lesions within the sort of papules, pustules, and nodules. Acne vulgaris is triggered mostly in adolescence, due to hormonal imbalances. Acne results in significant morbidity that's related to residual scarring and psychological disturbances like, anxiety, depression and poor self-image, which results in a negative impact on quality of life.
Acne may be caused due to use of medicines like steroids, anticonvulsants, excess sunlight exposure, use of shoulder pads, headbands, backpacks, and underwire brassieres, endocrine disorders like PCOS and even pregnancy, genetic factors. Food with a high glycemic quantity like dairy products and junk food stimulates follicular epidermal hyper proliferation. Acne occurs by hypersensitivity of the sebaceous glands to androgens, which are aggravated by p. acnes and inflammation. Oil-based cosmetics and facial massage without patch test for suitability on skin also can cause acne. Severe anxiety, tension and anger may aggravate acne, probably by an imbalance in stress hormones.
As sebum secretion is increased during puberty under the influence of androgens it results in increased hyper proliferation of follicular epidermis, so there's retention of sebum. The Hyper proliferated follicles rupture and release pro-inflammatory chemicals stimulating inflammation. Pathogens induce inflammation and induce follicular epidermal proliferation. Four key pathogenic processes cause the formation of acne lesions: increased and altered sebum production under androgen control, alteration of follicular keratinization that results in comedones, sophisticated inflammatory mechanisms that involve both innate and purchased immunity and follicular colonization by Propionibacterium acnes.
The medical history and physical examination of the patient should be evaluated. Medications and vitamins use, social history including alcohol, tobacco and drug use, menstrual history and prior acne treatments must be evaluated. A complete evaluation of endocrine system should be conducted for hyperandrogenism.
Signs and symptoms of hyperandrogenism include acne, amenorrhea, hirsutism, seborrhea, androgenetic alopecia, infertility, oligo menorrhea and decreased breast size. Hirsutism is highly associated with increased serum levels of free testosterone.
Topical therapy include treating with retinoids, clindamycin, benzoyl peroxide, Beta hydroxy acids and dapsone in the form of ointments, creams, gels and lotions to treat acne, decreases the post inflammatory pigmentation acne.
Many treatment choices are available to treat woman patients with acne. Treatment options should be unique to the individual patient with considerations for the patient’s preferences, tolerability of the agent, and psychosocial factors. A comparatively limited number of options are available for the management of acne during pregnancy and lactation. However, the extent of evidence on the efficacy and safety of these therapies during pregnancy and lactation is low. Novel agents are to be developed to treat patients with AV.