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Acne
Acne typically affects
teenagers, occurring during a time of dramatic hormonal
shifts and rapid growth. The blackheads, whiteheads, pimples,
and boil-like lesions that appear on the face, back, chest,
and shoulders are a source of embarrassment and may lead to
permanent scarring.
Rising hormone levels during
puberty cause the sebaceous glands to enlarge and produce
more oil. No one knows why this process causes acne in some
people but not in others. However, certain factors are known
to contribute to the development of acne. They include oral
contraceptives; certain medications, such as steroids, some
hormones, iodides, bromides, and lithium; exposure to heavy
oils, greases, or tars; trauma or irritation from tight
clothing; cosmetics; and emotional stress.
Acne results when small kernels
of sebum (oil), skin cells, and bacteria fill up hair
follicles, causing blackheads and whiteheads to appear. The
sebum ruptures the walls of the follicles, forming pimples
and boil-like eruptions in nearby tissue. If the sebum is
further altered by bacteria, it may cause even more
irritation to the surrounding skin.
Acne can be treated with a
variety of prescription gels, creams, and ointments. Among
them are the antibacterial agent benzoyl peroxide,
antibiotics such as A/T/S and Cleocin T, tretinoin (Retin-A),
adapalene (Differin), and azelaic acid (Azelex). For patients
with moderate to severe acne, the doctor often adds to the
skin medication an oral antibiotic such as tetracycline,
minocycline, doxycycline, or erythromycin.
Because excess oil production
in young women is often linked to high levels of the hormone
androgen, for this type of patient the doctor may prescribe
one of several drugs that alter hormone levels. The options
include Ortho Tri-Cyclen (a low-dose birth control pill),
low-dose steroid drugs such as prednisone or dexamethasone,
or an antiandrogen drug such as spironolactone (Aldactone).
The oral drug isotretinoin (Accutane) also inhibits the
secretion of sebum, but has severe side effects and must be
used cautiously.
Other acne remedies include
injecting cortisone directly into the lesions and exposure to
ultraviolet light. Proper cleansing techniques also are often
part of the therapeutic plan.
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