Chapter 18 - Acne

Question 1

What is ance and how does it develop?

Answer 1

• Acne is a disease of the sebaceous hair follicle
• Sebum is trapped within the follicle unlike normal circumstances where sebum produced by sebaceous glands travels up the hair follicle and out onto the skin surface.
• Acne develops on areas of the skin where sebaceous glands are most numerous.

Question 2

What is the common/ordinary acne called?

Answer 2

Acne vulgaris

Question 3

What are the 4 basic factors for the development of acne?

Answer 3

(1) Hormones (androgens)
(2) Increased sebum production
(3) Changes inside the follicle
(4) Bacteria

Question 4

How does hormone aid the development of acne?

Answer 4

• Acne begins when the body starts to produce hormones (androgens) at about age 11 to 14 years
• Androgens cause sebaceous gland to enlarge
• Acne develops when sebaceous glands are over-stimulated by androgens
• Young women have acne flare-ups that coincides with hormonal changes associated with their menstrual cycle.

Question 5

How does increased sebum production aid the development of acne?

Answer 5

• Androgens stimulate sebaceous gland causing more sebum to be produced.
• Sebum accumulates in the follicle
• Sebum travels up the hair follicle and mixes with normal skin bacteria and dead skin cells
• Greater sebum production, greater the likelihood the follicle will get clogged.

Question 6

How does changes inside the follicle aid the development of acne?

Answer 6

• As androgen production increases, sebaceous glands enlarge
• Dead cells inside the follicle shed gradually and are expelled onto the surface.
• During puberty, these cells shed more rapidly and tend to stick together
• When the cells mix with sebum, they can clog the follicle

Question 7

How does bacteria aid the development of acne?

Answer 7

• Clogged follicle becomes a breeding ground for bacteria
• One type of bacteria specifically involved is Propionibacterium acnes or P. acnes (Normal resident on the skin which ingests the sebum)
• Follice gets clogged and sebum builds ups inside causing P. acnes to multiply rapidly

Question 8

How are acne lesions generally defined?

Answer 8

1) Size

2) Inflammatory/ non- inflammatory

Question 9

What are the 2 types of non-inflammatory lesions and what are the general difference between them?

Answer 9

(1) Open comedones (Blackheads)
- Contents of the follicle are firmly impacted inside
- Tightly compacted cells and sebum give the follicle its ‘black’ appearance
(2) Closed comedones (Whiteheads)
- White or skin-coloured, small bumps on or under the skin.

Question 10

What are the 3 types of inflammatory acne lesions?

Answer 10

(1) Papules
(2) Pustules
(3) Nodules
- Have a red colour, often making a ring around the pimple itself.
- Result when sebaceous materials from the comedo get into the surrounding tissue and cause an inflammatory reaction

Question 11

Describe the genetic connection of acne.

Answer 11

Similarities in acne among family members regarding the types of acne lesions, duration of acne, severity of acne

Question 12

How can cosmetics cause acne?

Answer 12

• May be caused by ingredients that clog pores. (known as comedogenic)
• Should look for non-comedogenic cosmetics and toiletries.

Question 13

Describe the susceptibility of the public to acne.

Answer 13

• Close to 100% of age 12-17 have at least an acne lesion
• Most are able to manage with over-the-top counter treatments.
• Usually occurs between age 11 to 14 and usually last 5 to 10 years. Normally disappears in early 20s
• Young men more likely to have more severe, longer lasting forms of acne
• Young women are more likely to have intermittent acne due to the hormonal changes associated with menstrual cycle and acne caused by cosmetics

Question 14

Describe the process and types of scars from acne.

Answer 14

• Scarring because acne is a skin disease and skin responds by repairing it
• Repair can produce a scar that looks like a pit in the skin.
• Red mark on skin called an erythematous macule will fade in 4-6 months after an acne outbreak (red macule not a scar)

Question 15

When should you seek professional advice for acne lesions?

Answer 15

• Tried OTC products but does not work.
• Acne interferes with enjoyment of life
• Acne scars in addition to acne lesions
• Acne lesion are large and painful

Question 16

How can acne be treated?

Answer 16

By preventing its development.

• Reduce P.acnes
• Unplug clogged pores
• Reduce sebum production

Question 17

What are the general guidelines for acne care?

Answer 17

• Do not pop, squeeze or pick at acne
• Gently wash your face twice a day with a gentle cleanser that has pH of around 5.5. (Vigorous washing and scrubbing can irritate your skin
• After washing use appropriate acne products
• Style hair so that it does not directly touch the forhead and face. (Keep items that directly touch the face and hair very clean)
• Acne products can increase the skin’s sensitivity to sunlight. Use protective clothing and sunscreens, and avoid tanning booths
• Reduce stress associated with over-work

Question 18

What are the 3 main functions in acne products and name examples of ingredients from each?

Answer 18

(1) Antibacterial - Benzoyl peroxide, sulfur, tea tree oil
(2) Exfoliating - Salicylic acid, glycolic acid, lactic acid
(3) Comedolytic - Benzoyl peroxide, tretinoin (drug)

Question 19

What is HPMC used for?

Answer 19

Viscosity controlling agent