ACNE Adult, Occupational, Medications, Contraceptives, and many others. Part 2

This blog follows "Healthy Skin from within" ACNE part 1

Acne's prevalence in our society after all, it is estimated that, at any given tie, 40-50 MILLION American's are affected by the symptoms of acne.  While adolescents and young adults are most affected -- a whopping 75-85% of them experience the condition -- for 3-12 % of the population, it persists into middle age.

It should come as no surprise, then, that acne is the most common skin ailment treated by physicians.  An inflammatory condition of the hair follicle, acne can result in pustules, pipples, and cysts on the skin, while persistent symptoms can lead to long-term scarring.  Beyond scars of the cosmetic variety, however, acne can also cause scarring of the emotional kind.  Sufferers often experience depression and anxiety, embarrassment, and social inhibition.  In fact, a recent survey of British teenagers found that 39% said acne stopped them from making friends.  It is, therefore, obvious that treatment of acne is not just important form aesthetic perspective -- it's often key to the overall well-being of the individual suffering its symptoms.

If you count yourself among the millions who suffer from acne, chances are you've been fighting the symptoms your entire life.  Acne is a chronic condition, meaning the disease is long lassting and has a propensity to recur after symptom-free periods.  These factors contribute to the challenge of finding the proper treatment protocol.  To that point, consumers on the quest for an acne "cure" spend billions annually on prescription and over-the-counter drugs.  Yet, despite the plethora of products developed to eliminate acne symptoms, few do so successfully.  Why?  Because most often, each of these products exist to address acne symptoms rather than its multiple causes.  Unless each factor that causes acne is successfully addressed, acne symptoms will recur again and again.

Acne Causes
For those who suffer from acne, the skin's natural rhythm of oil production and sloughing of dead skin cells is not in balance as it is for those with healthy skin.  Four principle factors have been identified as causing acne:

Abnormally stticky cells (Follicular Keratinization)
Acne sufferers tend to have excessively "sticky" skin cells.  Because of this, dead skin cells do not shed as they should and, instead, plug hair follicles (at the skin's surface, the folicle opening is called a "pore").  Attached to the hair follicles are sebaceous glands, which produce sebum, the skin's natural oil.  Given that hair follicles are the "tunnel" through which sebum travels to the surface of the skin, you can understand that a blocked hair follicle causes sebum to build up.

Excess sebum production
Many acne sufferers have overactive sebacious glands that produce far more sebum than is needed by the skin.  Sebaceous glands are prompted to produce oil by androgenic hormones such as testosterone and androsterone, which affiliated with the development of masculine characteristics but are present in both males and females.  When hormones change or surge, such as during adolescence, pregnancy, menstruation, or in times of stress, sebum production may increase.  In some individuals, however, excess sebum production is simply a hereditary factor.

Bacteria
Present on the skin of all adult humans i s Propionibacterium, or P. acnes, the bacteria that is responsible for acne. Because P. acnes live on fatty acids found in sebum, those individuals with excessive sebum production may also have higher than normal levels of acne bacteria on their skin.  When a hair follicle becomes blocked, the buildup of sebum and dead skin cells creates the ideal environment for P.acnes.  Therefore, the criteria begins to grow within the follicle itself, rather than on the surface of the skin.

Inflammation
The body's inflammation response occurs whenever tissue is damaged.  Characterized by redness, swelling, warmth, and pain, inflammation happens in acne when P.acnes are prevalent within hair follicles.

Yet inflammation, while a protective response of the body, also inflicts its own damage.  I explain it this way:  Damage to tissue is like a house fire raging out of control.  The inflammation response is like the fire department that quickly arrives to put out the flames.  Once the fire is out, the house may be standing, but the property has been trampled and the structure is in disarray.  In the case of acne, inflammation may address some damage to the microscopic site where bacteria once were, but in the process it can produce papules, pustules, nodules, cysts and the like.

While these four factors can individually contribute to the development of acne, most often they work together.  The typical scenario is this:

The presence of abnormally sticky cells coupled with the excessive production of sebum cause a hair follicle to plug.  The obstructed follicle, engorged with oil and dead skin cells, initially becomes a comedo.  At this point the follicle becomes the ideal habitat for bacteria.  As bacteria flourish within the hair follicle, they release proteins (enzymes) that attract white blood cells to the area, causing inflammation that results in pustule.  If the inflammation is not controlled, the condition worsens, resulting in more serious lesions.

Beyond the four main causes of acne, however, the condition may be integrated by repeated, localized friction and irritation, as in common in violinists; below normal levels of Vitamin A, which is why retinoids (a form of Vitamin A) are effective in the treatment of acne; certain occupational hazards; certain medications; and possibly, food allergies.

In the case of occupational acne, an individual is exposed to chemicals and other irritable substances that combine with dead skin cells to block the skin's pores, resulting in acne lesions.  While the incidence of occupational acne has dropped considerably in recent years, thanks to the strengthening of workplace health and safety legislations, it does still occur.  Forms include oil acne, which affects those who work with grease and/or petroleum  based cutting oils; coal-tar acne, which affects those who work with creosote and other coal tar oils; and chloracne, which affects those who work with halogenated aromatic compounds.

Jobs associated with occupational acne include, but are not limited to:

• Auto and diesel truck mechanics or assembly line workers
• Fast food workers
• Construction workers, roofers, and road pavers
• Waste handling workers
• Chemical manufacturers
• Wood preservation workers

To reduce the risk of occupational acne, workers should emphasize thorough protective measures and personal hygiene, including frequent hand and face washing and the daily use of clean workplace-appropriate clothing.

Medications
 As mentioned, several medications have been shown to trigger acne outbreaks or aggravate existing cases of acne.  A direct connection however, is often difficult to prove.  This is because the condition or disease that the medication is treating is often a source of stress for the individual.  Because stress can cause a surge in hormones, it is often associated with the onset of acne.  This leaves physicians uncertain if the medication itself is causing the acne symptoms.  Therefore, if you are taking a prescription and develop or see an increase in acne, do not stop taking the medication.  Rather, consult your physician to determine if an alternative treatment may be prescribed.  In cases where the prescribed medication is the only viable treatment solution it is often necessary to treat the acne instead of ceasing administration of medication.  Acne may be a psychological strain, but it is generally not dangerous and will not affect your physical well-being.

Potential acne-inducing medications include:

Contraceptives
 Contraceptives are occasionally prescribed to specifically control acne.  This is due to the capacity of these medications to affect the body's hormone balance, a factor with a direct link to the development of acne.

Oral contraceptives contain both estrogen and progestin hormones.  While the estrogen between contraceptive brands is fairly consistent, several types of progestin may be used, wich each creating a different effect.  Those that are most likely to cause acne contain low amounts of estrogen and a type of progestin that increases the androgen (male hormone) levels in women.  Even in this case, however, the only women to see the onset or increase of acne are those with a tendency toward androgenicity.

Anticonvulsants
Prescribed for the treatment of epilepsy, other types of seizures, bipolar disorder, and some forms of depression, contain anticonvulsants, such as Dilantin, list acne as a common side effect.  Lithium, which is also used to treat bipolar disorder and depression, may also contribute to acne breakouts.
(Note, essential oil companies and their eager consultants, will have homemade remedies for acne using essential oils.  Many oils have cautions NOT to be used if your epileptic or on certain medications, pregnant, etc.  Note these cautions before mixing your home made batch of acne treatment).

Corticossteroids
Often used to treat asthma and other chronic lung diseases, corticosteroids act as cortisol, a natural steroid produced by the body during ties of intense stress. As such, corticosteroids can stimulate sebum production, a factor involved in the development of acne.

Immunosuppressants
Used to suppress the immune system of patients awaiting organ transplantation, immunosuppressants, such as Immuran, may also suppress the body's natural ability to fight bacteria, including that which causes acne.

Steroids
Systemic steroids are synthetic versions of the body's natural steroid, cortisol, and are often prescribed to treat skin conditions.  These medications may stimulate sebum production, a factor involved in the development of acne.

Antabolic steroids, which are used and sometimes abused by athletes and body builders to increase muscle mass, increase the presence of androgenic hormones.  Again, androgenic hormones stimulate the sebaceous glands to produce sebum.  An excess of male hormones causes the excess production of sebum, one of the four main causes of acne.

Thyroid Medications
Used to treat individuals with low thyroid function, these medications have been shown to trigger acne.  Additionally, large amounts of iodine, another substance used to help regulate thyroid function, has also been shown to cause acne breakouts.

 Diet

While one's diet is not a direct facctor in the development o f acne, the ingredients in certain foods may cause allergic reactions in some individuals.  Among those reactions may be acne breakouts.  Foods with potential to cause such reactions include:

Beer
Among the main ingredients in beer is yeast.  For those with yeast allergies, beer is recognized by the body as a toxin and depending upon the severity of the allergy, consumption may cause acne to develop.  The severity of the outbreak is dependent upon the body's sensitivity to yeast.

MilkA 2005 study showed that those who drank three or more cups of milk a day were 22% more likely to experience severe acne compare with those who drank less than one serving each week.  The study showed an even stronger correlation between acne and the consumption of skim milk in particular.  The study's author suggested that hormones and bioactive molecules present in milk are responsible for exacerbating acne.

High Glycemic Levels
Recent studies have shown that the glycemic levels of foods play a role in the development or cessation of acne.  Foods with high glycemic levels, include white break, potatoes, and most processed foods, cause a large insulin response after ingestion.  This elevated level of insulin in the body triggers a "hormonal cascade" that leads to increased production of substances known to contribute to acne formation.  Conversely, low glycemic load diets contain more whole grains and vegetables have been shown to reduce the presence of acne.

Types of Acne Lesions

While most individuals consider any type of acne lesion to be a "pimple" , there are actually several categories that relate to the disease:  (Note the link below, with amazing information and photos)

Comedo

Characterized by a plugged and thereby, enlarged hair follicle, there are two types of comedones.  A closed comedo (also called a "whitehead") is a blockage deep below the skin pore.  Because it is deep, it leaves only a microscopic opening at the skin's surface, which air cannot penetrate because of the lack of oxygen, the dead skin cells and sebum present in the follicle do not oxidize, leaving them colorless and giving them their white appearance.  An open comedo (also called a "blackhead") is a blockage that is close to the skin's surface.  Because of its location, the pore is enlarged allowing oxygen to reach the blockage.  this oxidation coupled with the way the blockage reflects light gives the comedo a dark hue, causing it to appear brown or black. 

Papule

Caused by inflammation, papules are round, raised red bumps that do not have a fluid or pus-filled center.  They tend to be painful and, if squeezed, can become infected. 

Pustule

Also caused by inflammation, pustules appear similar to papules, with the addition of a white or yellow pus-filled center.  this is the type of lesion commonly called a "pimple".

Nodule
When inflammation is allowed to worsen, the blockage within the hair follicle coupled with a bacteria invasion can cause the follicle to rupture, resulting in nodules -- large, hard lumps below the skin's surface.  Modules are often painful and take weeks or even months to heal.  If not properly treated, nodules can recur repeatedly at the same site and have a high propensity for scarring.

Cysts
Siilar to a nodule, cysts are caused by severe inflammation after a rupture to the hair follicle wall and a bacterial invasion.  The difference is that cysts are larger and filled with pus.  Again, cysts ay recur at the same site if left untreated and have a tendency to leave scars  What's more, nodules and cysts can create channels between them, which makes severe acne all the more difficult to treat.

Types of Acne

To establish the proper course of treatment, skincare professionals must first determine the type of acne from which an individual  is suffering.  To do this, the professional thoroughly examines the skin to review the acne lesions that are present, along with the prevalence of each.  Among the acne types of classifications are:

Acne Vulgaris

This is the most common type of acne and is classified by the severity of the acne lesions:

Mild acne is characterized by the presence o f comedones, including either whiteheads or blackheads or both.

Moderate acne  is characterized by the presence of papules and pestules.  Whiteheads and blackheads may also be visible.

Severe acne is characterized by the presence of nodules and cysts

Severe acne has several forms These include;

Acne Conglobata

Occurring ost often in males, acne conglobata is characterized by a proliferation of coedones, pustules, and nodules.  The nodules may become interconnected through Channels, which causes extensive scarring.  Acne conflobata is often resistant to treatment.

Acne Fulminans

This type of acne develops quite suddenly and is characterized by extensive inflammation.  This inflammation isn't limited simply to acne lesions, however.  Rather it may cause pin in joints, swelling of the lymph nodes and fever.  Acne fulminans can be severe to the extent that hospitalization becomes necessary.

Gram Negative Folliculitis

Individuals who have acne culgaris and have been treated with antibiotics for an extensive period of time may develope gram negative folliculitus.  This type of acne is characterized by the presence of pustules, nodules and cysts.  In most cases, as soon as the antibiotic is discontinued, symptoms of gram negative folliculitus end.

Nodulocystic acne

Causing significant discomfort, nodulocystic acne is characterized by the presence of numerous pus-filled cysts most often on the face, neck, and back.  Nodulocystic acne has the potential to cause extensive and severe scarring. 

Watch for blog Part 3 "Myths Surrounding Acne"

And catch the previous blog  "Healthy Skin from within" ACNE part 1

This link takes you to the best listing of all possible skin conditions with photo's.
http://www.medicinenet.com/image-collection/acne_vulgaris_nodulocystic_picture/picture.htm