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Acne

What do you know about Acne?
For some people, acne represents nothing more than the key to the door into adulthood – almost a rite of passage as the body changes. As the most common disease in the world, it is often taken for granted that spots, blackheads and greasy skin will stake their temporary claim on the faces of almost everyone in the world.
However, for approximately 15% of people, these spots will persist, or be widespread and scarring. With surprisingly poor, inadequate information available to teenagers about acne management, many do not even realise the pharmacy assistant and pharmacist are able to provide help.
How much do you really know about acne and its causes? Do you know that there is no proven link with diet and acne? Did you realise that not everyone grows out of having acne, with 5% of women and 1% of men in their 40’s still suffering from a ‘teenage’ problem?

What causes Acne:
There has been extensive research into this disease and dermatologists blame four main factors in the skin.

• Firstly, the body seems to become extremely sensitive to the male hormones (the androgens) in the body.
• Men and women have male hormones, but because men have higher levels, this is why they are often more affected.
• Secondly these male hormones do not have to be in high doses to get the oil producing glands (sebaceous glands) over worked, which in turn makes them pump out more oil.
• Thirdly in those affected by acne, the dead skin cells that sit near the top surface of the skin start to slow down their rate of shedding and clog up the pores where the oil normally escapes from.
• The combination of these two will result in the skin forming a tiny blockage, the starting point for all types of acne.
• Lastly this blockage is a wonderful environment for the acne bacteria that normally lives on the skin, to start to multiply, which in turn, leads to a chain reaction leading to infection and inflammation. This is what is commonly known as the spot. But, if the blockage doesn’t become infected, then it will remain as a solid plug – or the blackhead, as we know it.

Diet and Acne:
Big studies performed in USA looked at diet in relation to severity of acne. They found that high dairy – talking gallons of milk, yogurt and lots of cheese – and high sugar were associated with more severe acne. This is because these dietary excesses induced the production of a hormone called insulin like growth factor which has male hormone like effects and can exacerbate acne. In most people with a normal diet, food plays little part in acne. Oil production in the skin is controlled by male hormone and even high fat diets have no effect.
A recent study in USA has shown that skimmed milk is the worst for acne as manufacturers add a lot of whey to improve the flavour and this can worsen acne – full fat milk is better!
In some sufferers, avoidance of dairy or gluten can help. This may be because those individual have a low grade sensitivity to lactose or gluten – not enough to cause stomach upsets but enough to stress the body which can lead to stimulation of the adrenal glands as part of the stress response and more male hormone produced by the adrenals.

Red marks left after acne:
When you develop a spot, there is a lot of inflammation in the skin and some of the chemicals produced during the inflammation can cause abnormal growth of blood vessels at the site. Even when the spot goes, you can be left with a red mark, which looks as though you still have a spot. The rule of thumb is that if you cannot feel the spot, it’s not there.
These red marks will fade with time as the body does not like extra blood vessels, but this can take some time. Sunshine can help as this stimulates remodelling of the extra blood vessels. The only treatment that can help is pulsed dye laser, which destroys the extra blood vessels but will leave bruising that can last up to 2 weeks.

How long will acne last for?
Acne is always self limiting which means that it will eventually stop, but there is no way of predicting in any individual, how long it will last. The old supposition that acne would last 5 years or so is totally out of date and a recent study in USA showed that 15% of women and 7.5% of men still had acne at 50 years of age. Acne seems to stop when the body stops responding the the immunological stimulus that is inducing acne.
The most important thing is to treat it effectively and prevent long term scarring of the skin and psyche. Most treatments are suppressive and need to be used until the body turns its inflammatory reaction off which may be years. Good effective treatment can reduce the time that acne lasts. There are few treatments that will ‘cure’ acne. Even Roaccutane, which is the strongest drug we have for acne has a 50% relapse rate.

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