Pimples

Other Names: Acne,Acne vulgaris, Zit or Spot

Definition;
Pimple is a kind of comedo and one of the many results of excess oil getting trapped in the pores. Some of the varieties are pustules or papules.It is an inflammatory skin condition that causes spots.Spots result from the build up of dead skin cells and grease that block the pores or hair follicles, typically on the face, upper arms, upper back and chest.

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It is not contagious and is nothing to do with not being clean.Hormonal changes, such as those related to puberty, menstruation and pregnancy, can contribute to acne.
Some medicines will also make it worse, including some contraceptive pills and steroids.

Pimples can be treated by various acne medications prescribed by a physician, or purchased at a pharmacy with a wide variety of treatments.

Acne occurs most commonly during adolescence, affecting an estimated 80–90% of teenagers in the Western world. Lower rates are reported in some rural societies.

It is 8th most common disease in the world. People may also be affected before and after puberty. Though it becomes less common in adulthood than in adolescence, nearly half of people in their twenties and thirties continue to have acne. About 4% continue to have difficulties into their forties.

Clasification:
Acne is commonly classified by severity as mild, moderate, or severe. This type of categorization can be an important factor in determining the appropriate treatment regimen. Mild acne is classically defined as open (blackheads) and closed comedones (whiteheads) limited to the face with occasional inflammatory lesions. Acne may be considered to be of moderate severity when a higher number of inflammatory papules and pustules occur on the face compared to mild cases of acne and acne lesions also occur on the trunk of the body. Lastly, severe acne is said to occur when nodules and cysts are the characteristic facial lesions and involvement of the trunk is extensive
Symptoms:
As the pores of the skin become blocked, blackheads develop and small, tender, red spots appear. These can turn into pimples or whiteheads filled with pus.Typical features of acne include seborrhea (increased oil secretion), microcomedones, comedones, papules, pustules, nodules (large papules), and possibly scarring. The appearance of acne varies with skin color. It may result in psychological and social problems.

Some of the large nodules were previously called cysts and the term nodulocystic has been used to describe severe cases of inflammatory acne.

Scars:
Acne scars are the result of inflammation within the dermal layer of skin brought on by acne and are estimated to affect 95% of people with acne vulgaris. The scar is created by an abnormal form of healing following this dermal inflammation. Scarring is most likely to occur with severe nodulocystic acne, but may occur with any form of acne vulgaris. Acne scars are classified based on whether the abnormal healing response following dermal inflammation leads to excess collagen deposition or collagen loss at the site of the acne lesion.

Atrophic acne scars are the most common type of acne scar and have lost collagen from this healing response.[19] Atrophic scars may be further classified as ice-pick scars, boxcar scars, and rolling scars. Ice pick scars are typically described as narrow (less than 2 mm across), deep scars that extend into the dermis.[19] Rolling scars are wider than ice pick scars (4–5 mm across) and have a wave-like pattern of depth in the skin. Boxcar scars are round or ovoid indented scars with sharp borders and vary in size from 1.5–4 mm across.

Hypertrophic scars are less common and are characterized by increased collagen content after the abnormal healing response. They are described as firm and raised from the skin. Hypertrophic scars remain within the original margins of the wound whereas keloid scars can form scar tissue outside of these borders. Keloid scars from acne usually occur in men and on the trunk of the body rather than the face.

Pigmentation:
Postinflammatory hyper pigmentation (PIH) is usually the result of nodular or cystic acne (the painful ‘bumps’ lying under the skin). They often leave behind an inflamed red mark after the original acne lesion has resolved. PIH occurs more often in people with darker skin color. Pigmented scar is a common but misleading term, as it suggests the color change is permanent. Often, PIH can be avoided by avoiding aggravation of the nodule or cyst. These scars can fade with time. However, untreated scars can last for months, years, or even be permanent if deeper layers of skin are affected. Daily use of SPF 15 or higher sunscreen can minimize pigmentation associated with acne.

Causes:
Inside the pore are sebaceous glands which produce sebum. When the outer layers of skin shed (as they do continuously), the dead skin cells left behind may become ‘glued’ together by the sebum. This causes the blockage in the pore, especially when the skin becomes thicker at puberty. The sebaceous glands produce more sebum which builds up behind the blockage, and this sebum harbours various bacteria including the species Propionibacterium acnes, causing infection and inflammation.

Genetic:
The predisposition for specific individuals to acne is likely explained in part by a genetic component, which has been supported by twin studies as well as studies that have looked at rates of acne among first degree relatives. The genetics of acne susceptibility is likely polygenic, as the disease does not follow classic Mendelian inheritance pattern. There are multiple candidates for genes which are possibly related to acne, including polymorphisms in TNF-alpha, IL-1 alpha, and CYP1A1 among others.

Hormonal:
Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in sex hormones called androgens cause the follicular glands to grow larger and make more sebum. A similar increase in androgens occurs during pregnancy, also leading to increased sebum production.[25]

Several hormones have been linked to acne including the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I) and growth hormone. Use of anabolic steroids may have a similar effect.

Acne that develops between the ages of 21 and 25 is uncommon. True acne vulgaris in adult women may be due to pregnancy or polycystic ovary syndrome.

Infectious:
Propionibacterium acnes (P. acnes) is the anaerobic bacterium species that is widely suspected to contribute to the development of acne, but its exact role in this process is not entirely clear. There are specific sub-strains of P. acnes associated with normal skin and others with moderate or severe inflammatory acne. It is unclear whether these undesirable strains evolve on-site or are acquired, or possibly both depending on the person. These strains either have the capability of changing, perpetuating, or adapting to, the abnormal cycle of inflammation, oil production, and inadequate sloughing of acne pores. One particularly virulent strain has been circulating in Europe for at least 87 years. Infection with the parasitic mite Demodex is associated with the development of acne. However, it is unclear if eradication of these mites improves acne.

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Lifestyle:
Cigarette smoking is known to increase the risk of developing acne. Additionally, acne severity worsens as the number of cigarettes a person smokes increases. The relationship between diet and acne is unclear as there is no high-quality evidence. However, a high glycemic load diet is associated with worsening acne. There is weak evidence of a positive association between the consumption of milk and a greater rate and severity of acne. Other associations such as chocolate and salt are not supported by the evidence. Chocolate does contain a varying amount of sugar that can lead to a high glycemic load and it can be made with or without milk. There may be a relationship between acne and insulin metabolism and one trial found a relationship between acne and obesity. Vitamin B12 may trigger acneiform eruptions, or exacerbate existing acne, when taken in doses exceeding the recommended daily intake.

Psychological:
While the connection between acne and stress has been debated, research indicates that increased acne severity is associated with high stress levels.

Acne excorie is a type of acne in which a person picks and scratches pimples due to stress.

Diagnosis:
There are multiple scales for grading the severity of acne vulgaris, three of these being:

*Leeds acne grading technique: Counts and categorizes lesions into inflammatory and non-inflammatory (ranges from 0–10.0).
*Cook’s acne grading scale: Uses photographs to grade severity from 0 to 8 (0 being the least severe and 8 being the most severe).
*Pillsbury scale: Simply classifies the severity of the acne from 1 (least severe) to 4 (most severe).

Differential diagnosis:
Similar conditions include rosacea, folliculitis, keratosis pilaris, perioral dermatitis, and angiofibromas among others. Age is one factor that may help a physician distinguish between these disorders. Skin disorders such as perioral dermatitis and keratosis pilaris can mimic acne but tend to occur more frequently in childhood whereas rosacea tends to occur more frequently in older adults. Facial redness triggered by heat or the consumption of alcohol or spicy food is suggestive of rosacea. The presence of comedones can also help health professionals differentiate acne from skin disorders that are similar in appearance

Treatment:
Many different treatments exist for acne including benzoyl peroxide, antibiotics, retinoids, antiseborrheic medications, anti-androgen medications, hormonal treatments, salicylic acid, alpha hydroxy acid, azelaic acid, nicotinamide, and keratolytic soaps. They are believed to work in at least four different ways, including the following: normalizing skin cell shedding and sebum production into the pore to prevent blockage, killing P. acnes, anti-inflammatory effects, and hormonal manipulation.

Commonly used medical treatments include topical therapies such as retinoids, antibiotics, and benzoyl peroxide and systemic therapies including oral retinoids, antibiotics, and hormonal agents. Procedures such as light therapy and laser therapy are not considered to be first-line treatments and typically have an adjunctive role due to their high cost and limited evidence of efficacy
Over-the-counter medications:
Common over-the-counter medications for pimples are benzoyl peroxide and/or salicylic acid and antibacterial agents such as triclosan. Both medications can be found in many creams and gels used to treat acne (acne vulgaris) through topical application. Both medications help skin slough off more easily, which helps to remove bacteria faster. Before applying them the patient needs to wash his or her face with warm water and dry. A cleanser may also be used for that purpose. Acne rosacea is not caused by bacterial infection. It is commonly treated with tretinoin. A regimen of keeping the affected skin area clean plus the regular application of these topical medications is usually enough to keep acne under control, if not at bay altogether. The most common product is a topical treatment of benzoyl peroxide, which has minimal risk apart from minor skin irritation that may present similar as a mild allergy. Recently nicotinamide, applied topically, has been shown to be more effective in treatment of pimples than antibiotics such as clindamycin. Nicotinamide (vitamin B3) is not an antibiotic and has no side-effects typically associated with antibiotics. It has the added advantage of reducing skin hyperpigmentation which results in pimple scars.

Prescription medication:
Severe acne usually indicates the necessity of prescription medication to treat the pimples. Prescription medications used to treat acne and pimples include isotretinoin, which is a retinoid. Historically, antibiotics such as tetracyclines and erythromycin were prescribed. While they were more effective than topical applications of benzoyl peroxide, the bacteria eventually grew resistant to the antibiotics and the treatments became less and less effective. Also, antibiotics had more side effects than topical applications, such as stomach cramps and severe discoloration of teeth. Common antibiotics prescribed by dermatologists include doxycycline and minocycline.  For more severe cases of acne dermatologists might recommend accutane, a retinoid that is the most potent of acne treatments. However, accutane can cause various side effects including vomiting, diarrhea, and birth defects (women).

Hygiene:
Practicing good hygiene, including regularly washing skin areas with neutral cleansers, can reduce the amount of dead skin cells and other external contaminants on the skin that can contribute to the development of pimples. However, it is not always possible to completely prevent pimples, even with good hygiene practices.

Alternative medicine:
Numerous natural products have been investigated for treating people with acne. Low-quality evidence suggests topical application of tea tree oil or bee venom may reduce the total number of skin lesions in those with acne. There is a lack of high-quality evidence for the use of acupuncture, medicine, and cupping therapy for acne.

Perfectly balanced hormones give a person a pimple-free face. One could try to correct internal hormonal levels by exercising aerobically (jog, swim, run, cycle) for 40 minutes a day, preferably in the fresh air. This needs to be balanced with 20 minutes of stretching and yoga with pranayama.

Prognosis:
Acne usually improves around the age of 20 but may persist into adulthood. Permanent physical scarring may occur. There is good evidence to support the idea that acne has a negative psychological impact and worsens mood, lowers self-esteem, and is associated with a higher risk of anxiety, depression, and suicidal thoughts.

Research:
In 2007, the first genome sequencing of a P. acnes bacteriophage (PA6) was reported. The authors proposed applying this research toward development of bacteriophage therapy as an acne treatment in order to overcome the problems associated with long-term antibiotic therapy, such as bacterial resistance.

A vaccine against inflammatory acne has been tested successfully in mice, but has not yet been proven to be effective in humans. Other workers have voiced concerns related to creating a vaccine designed to neutralize a stable community of normal skin bacteria that is known to protect the skin from colonization by more harmful microorganisms.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Acne_vulgaris#Management

Acne


https://en.wikipedia.org/wiki/Pimple
http://www.telegraphindia.com/1150810/jsp/knowhow/story_36267.jsp

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