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Whitepaper_acne_june2014

Mild or comedonal acne consists of comedones material within, are open to the surface, and have a acne lesions during this time. With female menopause, (blackheads and whiteheads) only and is • Higher androgen levels cause the overproduction of black color due to melanin pigment in the cells that estrogen and progesterone levels decrease as the non-inflammatory. Inflammatory acne consists of both sebum, which can occur during direct elevation of were shed and decomposed. Closed comedones ovaries fail (stop hormone production). At this point, comedones and a substantial number of inflammatory androgens (during both male and female puberty) or (whiteheads) have a layer of epithelial cells that covers without the overriding effect of high estrogen and Dr. Charlene DeHaven M.D.
ESTIMATING SEVERITY OF DISEASE lesions (pustules and papules). Inflammatory lesions can relatively higher androgen levels compared to the pore and a tiny, microscopic opening to the skin progesterone levels, DHEA from the adrenals again Clinical Director, INNOVATIVE SKINCARE® Unfortunately, the severity of acne is often overlooked leave permanent scars. A mixture of both inflammatory estrogen levels (during the premenstrual period, surface, which is the pore of the pilosebaceous unit. becomes important. The DHEA, which is androgenic or minimized by physicians. Conversely, severity is often and non-inflammatory acne exhibits all types of lesions during female menopause).
because of its conversion to testosterone, causes the overestimated by patients, especially adolescents, due including severe inflammatory lesions (markedly In the closed microcomedone or comedone, the increase in acne seen with female menopause.
About 17 million Americans have acne. It is the most to the severe social stigma that can develop as the reddened pustules) and possibly cystic lesions (lesions • Increased sebum production and desquamation epithelial duct wall ruptures and the acne lesion common skin disease treated by physicians. Acne can result of even a few mild or moderate lesions. Since more than 0.5 cm in diameter with a soft top that are (flaking) of epithelial-lining cells contribute to progresses from comedone to pustule or papule. The OTHER CAUSES OF ACNE appear at any age, although there are peaks of acne most commonly involves the face, lesions are losing their inflammation). It is most common to have a obstruction of the pore and lead to formation of term "cyst" is a misnomer and refers to what actually incidence in adolescence and again for females near readily obvious in social settings. Individuals with deep mixture of lesions at any one time. Treatment is the microcomedone. The microcomedone is very is a large, inflamed, pus-filled nodule greater than 0.5 For adult females taking oral contraceptives (birth the time of menopause. Acne and adolescence are so inflammatory nodules and cysts may be scarred for life chosen based on severity of disease, so this small and cannot be seen. Alterations in sebum cm in diameter in which the cell wall is composed of control pills) can cause acne. The choice of which type closely associated that 80–90% of all teenagers have at in more than one way. Studies have shown that estimation is important.
lipids interfere with normal sebocyte inflammatory cells and scar tissue. of birth control medicine to take is most important in least some lesions at any given time.
persons who have moderate to severe acne in youth differentiation, thus affecting sebum production. determining its effect on acne. Most oral frequently fail to realize their full potential in ACNE CAUSATION AND PROGRESSION Ratios of saturated to unsaturated fatty acids A substantial number of severely inflamed pustules or contraceptives contain both estrogens and progestins In adolescence, acne affects both males and females. finding jobs or choosing careers suitable to their change. Squalene is one of the most common papules leading to "cyst" development can be termed The Pilosebaceous Unit (synthetic progesterone). Those containing progestins Boys tend to have more lesions and more severe actual abilities.
lipids produced by the skin. During an nodular cystic acne. The body will repair severe that are more androgenic can contribute to acne. Pills disease than do girls. This is probably due to the causal The basic skin structure most commonly affected by inflammatory process, such as acne, squalene can inflammation with scarring. Scars are permanent, can containing relatively more estrogen and a progestin association with androgen (testosterone) levels. In The most common measurement tool for acne is a acne is the pilosebaceous unit, comprising the be oxidized by free radicals and form squalene be deep or superficial, and will persist throughout life. that is less androgenic do not contribute to acne adulthood, acne is more common in women, grading system which classifies according to the sebaceous gland, vellus hair, and pore (duct). peroxide, which is particularly pro-inflammatory.
development and are sometimes used to treat acne. particularly the week or 2 before menses and at the severity of lesions in grades 1 through 4, as follows: Hormonal influences are very important in acne The "progesterone only" method of birth control, onset of menopause. In menstruating females, the The function of the sebaceous gland is to produce • The bacterial organism involved in the development and progression. Acne actually begins to either by pill or by injection, can contribute to acne occurrence of lesions prior to menses is related to the Grade 1: mild acne, comedones present, minimal to no sebum, an oily or lipid-based substance. It was once pathogenesis (cause) of acne is P. acnes develop at age 8 or 9, when adrenarche occurs. progression via androgenic effects.
increase in progesterone levels after ovulation and just thought that sebum had no particular function; (Propionibacterium acnes). P. acnes is a normal Adrenarche is the activation of the adrenal gland, before menses. Progesterone has androgenic effects Grade 2: moderate acne, some inflammation present, however, recent research has shown that sebum inhabitant of skin. However, the increased amount occurring before puberty and associated with increased Other Medications and therefore causes these increases in acne lesions. some papules and pustules present; transports the antioxidant vitamin E to the skin's of sebum and obstruction of the pore provide an DHEA levels. DHEA is one of the hormones produced by The occurrence in menopausal females is also related Grade 3: moderately severe acne, larger nodules and surface. The pore is the opening that carries sebum to environment conducive to proliferation of P. acnes. the adrenal gland. Some of the DHEA is converted to Other medicines that can be related to the to relative androgen predominance in the face of pustules with inflammation; the epidermal surface and is lined with epidermal cells.
As P. acnes increases in number, it uses sebum as a androgens by a metabolic pathway, leading to development of acne include lithium, cortisone-type declining estrogen levels seen with menopause. Grade 4: severe acne, large nodules and cysts, scarring.
nutritive source, causing sebum conversion to free microcomedone development. With puberty in the medicines, and anabolic (testosterone-type or Neonates (just-born babies) can present with acne The number of pilosebaceous units that appear on the fatty acids, which are very irritating. The immune female, DHEA is the primary source of androgens, since androgenic) steroids. Some medicines used to treat because of the intra-uterine hormonal stimulation from This system considers the progression of severity from face, upper neck, and chest is 9 times the number system is activated by both the free fatty acids and some of it is converted to androgens. With female cancer, such as epidermal growth factor receptor maternal hormones. slightly visible comedones to inflammatory lesions to found elsewhere on the body. The pilosebaceous unit is the large amounts of P. acnes, and inflammation puberty, both estrogen and progesterone increase as inhibitors, can cause an acneiform (acne-like) rash. multiple severe pustular and cystic lesions. under stimulation at birth from maternal hormones, thus ensues.
menarche (the beginning of menses) occurs and the Although the rash looks like typical acne, closer People with acne, especially teenagers, tend to atrophies (becomes smaller and less active) during ovaries begin to produce female hormones. Some of inspection reveals the signature lesion of acne, the self-medicate. Each year in the United States, more Another system for grading acne divides the face into childhood, and then re-emerges during adolescence, • Abnormal keratinization causes overcornification this ovarian estrogen is converted to androgens as comedone, is absent.
than $100 million is spent on over-the-counter regions and then counts the number of lesions. The again due to hormonal stimulation. Hormonal of skin, further contributing to pore obstruction a byproduct.
products to treat acne.
lesion count can further be divided by type into stimulation can occur also during menopause.
and inflammation.
Endocrine Disorders comedones, inflammatory lesions, and nodular and Progesterone itself has androgenic effects. The Another rare but possible cause of acne is endocrine People with acne, especially teenagers, tend to cystic lesions. This is quite time-consuming and increased severity of acne in male adolescents is due to disorders of various types, which lead to overproduction self-medicate. Each year in the US over $100 million is probably more useful in research studies than in a Microcomedones increase in size to form comedones. their higher androgen secretion compared to females. The primary cause of acne is obstruction of the of androgenic substances.
spent on over-the-counter products to treat acne.
clinical setting. The comedone, which may be open or closed, is the As puberty passes, hormonal levels decrease and acne pilosebaceous unit. Hormones, sebum, abnormal essential focus lesion in acne. Open comedones resolves. However, in adult women progesterone keratinization, and bacteria contribute to the Environmental Factors (blackheads), have an enlarged pore due to the increases in the 2 weeks before menses, causing effects obstruction of the pilosebaceous unit in the that are more androgenic and leading to the spike in Environmental factors occasionally play a role in acne. All materials contained on this document are protected by United States copyright law. You may not modify, remove, delete, publish, transmit, reproduce or in any way exploit the content of this document, in whole or in part.
2014 Science of Skincare, LLC. All rights reserved.
Young people employed in places where they come pilosebaceous unit if pomade comes into contact a variety of effects that include antibacterial activity, with steroids to control inflammation, while severe iS products helpful in treating acne include: EXTREME into contact with grease, such as auto repair shops or with the skin, leading to acne development. This mild anti-inflammatory activity, lipid-dissolving nodular cystic acne usually requires Accutane PROTECT SPF 30, ECLIPSE SPF 50+, fast-food restaurants, may experience a worsening can be prevented by being careful to avoid facial cleansing action to remove lipid plugs from pores, and (isotretinoin, or 13-cis-retinoic acid). Accutane is a pill EXFOLIATING ENZYME TREATMENT.
skin when placing these products on the hair.
desquamative activity to remove dead epithelial cells on with significant potential side effects, usually reserved the skin and pore surfaces, and encourage epithelial for the most severe acne cases. It causes drying of the • Cosmetics, including makeup and moisturizers, skin, eyes, mouth, and mucus membranes in all people, At the present time, we are unsure if stress can that contain large amounts of oil can worsen acne. as well as desquamation of skin. Because Accutane is O'Daniel TG, "Multimodal Management of Atrophic Acne Scarring in the Aging Face," Aesthetic Plast Surg. 2011 exacerbate acne or if the acne itself causes the Two or more agents may be required for teratogenic (tumor-causing) and will cause increased stress. An increase in lesion number has been • Acne is related to hormonal factors, as explained non-inflammatory acne that is not responsive to a malformations in 60% of exposed fetuses, doctors will Kraft J et al, "Management of Acne," CMAJ. 2011 noted and may relate to relative increases in cortisol, above. Young women may experience flare-ups single agent, or for inflammatory acne. If two or more never place a female patient on Accutane unless there which is androgenic, with stress.
just prior to menses. Because of the hormonal different agents are chosen, they should have different is reliable protection against pregnancy. Accutane also influences occurring during adolescence, it is an mechanisms of action, so as to potentiate each other. requires blood-test monitoring.
Webster GF, "Acne Vulgaris," BMJ. 2002Aug31;325:475-79.
PATIENT EDUCATION FACTS AND MYTHS acne-prone period for both young men and Bershad SV, "The Modern Age of Acne Therapy: A Review of Current Treatment Options," Mt Sinai J Med, There are many public misconceptions about acne. women. The perimenopausal period is another Common topical therapies include benzoyl peroxide, Hormonal therapy with non-androgenic oral Some important facts for general patient education are acne-prone time for women. topical antibiotics (clindamycin topical or erythromycin contraceptives may be used to combat severe Toyoda M et al, "Pathogenesis of Acne," Med Electron Microsc, topical), topical retinoids (tretinoin, adapalene, or inflammatory acne. If not effective, treatment with • The treatment of acne requires some time. It will tazarotene), azelaic acid, salicylic acid, milk and fruit spironolactone, an anti-androgen, may be tried.
Webster GF, "Acne and Rosacea," Med Clin North Am, • Acne is not caused by dirty skin. Washing the skin not go away overnight but requires persistence acids (also called alpha hydroxy acids, or AHAs, which more, or more vigorously, is not warranted and will and consistent, effective treatment. Usually, weeks include glycolic acid, lactic acid, malic acid, citric Krowchuk DP, "Managing Acne in Adolescents," Ped Clin North Am, not be helpful, and injury induced by vigorous are required with any treatment before acid, and mixed fruit acids), and products Scars are often thought to be permanent, persist into washing may cause more inflammation and induce improvement is seen. When treatment is stopped adulthood, and be treatable only with a procedure. Krowchuk DP, "Treating Acne. A Practical Guide," Med Clin North progression of lesions. The visible black part of the prematurely, the acne returns. However, superficial scarring can be improved with blackhead is not dirt—it is melanin and oxidized Sometimes the extraction (removal) of comedones with topical products that have resurfacing activity.
Russell JJ, "Topical Therapy for Acne," Am Fam Phys, material, and cannot be removed by washing.
• Deep scars are permanent. The object of a small instrument, called a comedone extractor, may continuing treatment and being consistent with be done in the doctor's office. Some medical literature Strasburger VC; "Acne. What every Pediatrician Should Know about Each of these therapies, whether topical or systemic, has Treatment," Ped Clin North Am, 1997Dec;44(6):1505-24.
• Dietary factors sometimes may relate to acne. The treatment is to avoid progression to severe lesions terms this surgery, although it is not surgery in the a list of advantages, disadvantages, potential toxicities, Western diet, which encourages insulin resistance and scarring. Scar treatment has become traditional sense and cannot be used to treat scarring. Kligman AM; "The Treatment of Acne with Topical Retinoids: One and contraindications depending upon its own unique Man's Opinion," J Am Acad Dermatol, and tends toward obesity, is high in sugars and multimodal and now includes chemical peels, Removal of comedone contents with a comedone properties. Most of them may be used in combination, simple carbohydrates. This type of diet predisposes dermabrasion, ablative and non-ablative laser extractor in the doctor's office is acceptable and although Accutane is used alone as monotherapy. The to acne development and worsens existing acne. resurfacing, dermal fillers, and excision. These helpful. It differs greatly from "picking at" lesions at topical agents may be used singly for comedonal Insulin resistance stimulates androgen receptors techniques also may be combined with treatment home, which causes more inflammation and is harmful.
non-inflammatory acne, but if this type of acne is highly which then become more sensitive to androgens, of the aging face. inflammatory or non-responsive to therapy with a single thus contributing to acne development.
Severe Inflammatory Acne topical agent, then therapy with more than one agent is Topical treatment alone will not be effective in treating usually required.
• Therapy succeeds by preventing the formation of Treatments for acne include counteracting androgens, severe inflammatory acne, because it cannot penetrate new acne lesions. Therefore, it is important to decreasing inflammation, decreasing sebum deeply enough through the skin's surface to treat the PRODUCT RECOMMENDATIONS treat all acne-prone skin, and not just single acne production, preventing follicular plugging, and most severely inflamed nodules and cysts. Severe acne iS CLINICAL® products helpful in treating acne include: lesions, with topical agents. reducing P. acnes proliferation.
requires systemic treatment (medicine taken orally). ACTIVE SERUM™, PRO-HEAL® SERUM ADVANCE ®, Systemic therapies cause distribution of the drug HYDRA-COOL® SERUM, CLEANSING COMPLEX, • Any practice that further traumatizes (injures) acne Non-inflammatory Acne throughout the entire body. Common systemic WHITE LIGHTENING™ SERUM, lesions contributes to more inflammation and Non-inflammatory acne and comedones may be treated therapies include oral antibiotics (erythromycin and the WHITE LIGHTENING™ COMPLEX.
progression of disease. This includes picking at with a single agent applied topically. Topical therapy tetracyclines, including tetracycline, minocycline, and lesions and wearing athletic gear over lesions. refers to putting a treatment on top of the skin. There doxycycline) and hormonal therapy (oral • Use of pomade on hair may plug the are a variety of single agents available, which may have contraceptives). Cystic lesions also may be injected Mild or comedonal acne consists of comedones material within, are open to the surface, and have a acne lesions during this time. With female menopause, (blackheads and whiteheads) only and is • Higher androgen levels cause the overproduction of black color due to melanin pigment in the cells that estrogen and progesterone levels decrease as the non-inflammatory. Inflammatory acne consists of both sebum, which can occur during direct elevation of were shed and decomposed. Closed comedones ovaries fail (stop hormone production). At this point, comedones and a substantial number of inflammatory androgens (during both male and female puberty) or (whiteheads) have a layer of epithelial cells that covers without the overriding effect of high estrogen and Dr. Charlene DeHaven M.D.
ESTIMATING SEVERITY OF DISEASE lesions (pustules and papules). Inflammatory lesions can relatively higher androgen levels compared to the pore and a tiny, microscopic opening to the skin progesterone levels, DHEA from the adrenals again Clinical Director, INNOVATIVE SKINCARE® Unfortunately, the severity of acne is often overlooked leave permanent scars. A mixture of both inflammatory estrogen levels (during the premenstrual period, surface, which is the pore of the pilosebaceous unit. becomes important. The DHEA, which is androgenic or minimized by physicians. Conversely, severity is often and non-inflammatory acne exhibits all types of lesions during female menopause).
because of its conversion to testosterone, causes the overestimated by patients, especially adolescents, due including severe inflammatory lesions (markedly In the closed microcomedone or comedone, the increase in acne seen with female menopause.
About 17 million Americans have acne. It is the most to the severe social stigma that can develop as the reddened pustules) and possibly cystic lesions (lesions • Increased sebum production and desquamation epithelial duct wall ruptures and the acne lesion common skin disease treated by physicians. Acne can result of even a few mild or moderate lesions. Since more than 0.5 cm in diameter with a soft top that are (flaking) of epithelial-lining cells contribute to progresses from comedone to pustule or papule. The OTHER CAUSES OF ACNE appear at any age, although there are peaks of acne most commonly involves the face, lesions are losing their inflammation). It is most common to have a obstruction of the pore and lead to formation of term "cyst" is a misnomer and refers to what actually incidence in adolescence and again for females near readily obvious in social settings. Individuals with deep mixture of lesions at any one time. Treatment is the microcomedone. The microcomedone is very is a large, inflamed, pus-filled nodule greater than 0.5 For adult females taking oral contraceptives (birth the time of menopause. Acne and adolescence are so inflammatory nodules and cysts may be scarred for life chosen based on severity of disease, so this small and cannot be seen. Alterations in sebum cm in diameter in which the cell wall is composed of control pills) can cause acne. The choice of which type closely associated that 80–90% of all teenagers have at in more than one way. Studies have shown that estimation is important.
lipids interfere with normal sebocyte inflammatory cells and scar tissue. of birth control medicine to take is most important in least some lesions at any given time.
persons who have moderate to severe acne in youth differentiation, thus affecting sebum production. determining its effect on acne. Most oral frequently fail to realize their full potential in ACNE CAUSATION AND PROGRESSION Ratios of saturated to unsaturated fatty acids A substantial number of severely inflamed pustules or contraceptives contain both estrogens and progestins In adolescence, acne affects both males and females. finding jobs or choosing careers suitable to their change. Squalene is one of the most common papules leading to "cyst" development can be termed The Pilosebaceous Unit (synthetic progesterone). Those containing progestins Boys tend to have more lesions and more severe actual abilities.
lipids produced by the skin. During an nodular cystic acne. The body will repair severe that are more androgenic can contribute to acne. Pills disease than do girls. This is probably due to the causal The basic skin structure most commonly affected by inflammatory process, such as acne, squalene can inflammation with scarring. Scars are permanent, can containing relatively more estrogen and a progestin association with androgen (testosterone) levels. In The most common measurement tool for acne is a acne is the pilosebaceous unit, comprising the be oxidized by free radicals and form squalene be deep or superficial, and will persist throughout life. that is less androgenic do not contribute to acne adulthood, acne is more common in women, grading system which classifies according to the sebaceous gland, vellus hair, and pore (duct). peroxide, which is particularly pro-inflammatory.
development and are sometimes used to treat acne. particularly the week or 2 before menses and at the severity of lesions in grades 1 through 4, as follows: Hormonal influences are very important in acne The "progesterone only" method of birth control, onset of menopause. In menstruating females, the The function of the sebaceous gland is to produce • The bacterial organism involved in the development and progression. Acne actually begins to either by pill or by injection, can contribute to acne occurrence of lesions prior to menses is related to the Grade 1: mild acne, comedones present, minimal to no sebum, an oily or lipid-based substance. It was once pathogenesis (cause) of acne is P. acnes develop at age 8 or 9, when adrenarche occurs. progression via androgenic effects.
increase in progesterone levels after ovulation and just thought that sebum had no particular function; (Propionibacterium acnes). P. acnes is a normal Adrenarche is the activation of the adrenal gland, before menses. Progesterone has androgenic effects Grade 2: moderate acne, some inflammation present, however, recent research has shown that sebum inhabitant of skin. However, the increased amount occurring before puberty and associated with increased Other Medications and therefore causes these increases in acne lesions. some papules and pustules present; transports the antioxidant vitamin E to the skin's of sebum and obstruction of the pore provide an DHEA levels. DHEA is one of the hormones produced by The occurrence in menopausal females is also related Grade 3: moderately severe acne, larger nodules and surface. The pore is the opening that carries sebum to environment conducive to proliferation of P. acnes. the adrenal gland. Some of the DHEA is converted to Other medicines that can be related to the to relative androgen predominance in the face of pustules with inflammation; the epidermal surface and is lined with epidermal cells.
As P. acnes increases in number, it uses sebum as a androgens by a metabolic pathway, leading to development of acne include lithium, cortisone-type declining estrogen levels seen with menopause. Grade 4: severe acne, large nodules and cysts, scarring.
nutritive source, causing sebum conversion to free microcomedone development. With puberty in the medicines, and anabolic (testosterone-type or Neonates (just-born babies) can present with acne The number of pilosebaceous units that appear on the fatty acids, which are very irritating. The immune female, DHEA is the primary source of androgens, since androgenic) steroids. Some medicines used to treat because of the intra-uterine hormonal stimulation from This system considers the progression of severity from face, upper neck, and chest is 9 times the number system is activated by both the free fatty acids and some of it is converted to androgens. With female cancer, such as epidermal growth factor receptor maternal hormones. slightly visible comedones to inflammatory lesions to found elsewhere on the body. The pilosebaceous unit is the large amounts of P. acnes, and inflammation puberty, both estrogen and progesterone increase as inhibitors, can cause an acneiform (acne-like) rash. multiple severe pustular and cystic lesions. under stimulation at birth from maternal hormones, thus ensues.
menarche (the beginning of menses) occurs and the Although the rash looks like typical acne, closer People with acne, especially teenagers, tend to atrophies (becomes smaller and less active) during ovaries begin to produce female hormones. Some of inspection reveals the signature lesion of acne, the self-medicate. Each year in the United States, more Another system for grading acne divides the face into childhood, and then re-emerges during adolescence, • Abnormal keratinization causes overcornification this ovarian estrogen is converted to androgens as comedone, is absent.
than $100 million is spent on over-the-counter regions and then counts the number of lesions. The again due to hormonal stimulation. Hormonal of skin, further contributing to pore obstruction a byproduct.
products to treat acne.
lesion count can further be divided by type into stimulation can occur also during menopause.
and inflammation.
Endocrine Disorders comedones, inflammatory lesions, and nodular and Progesterone itself has androgenic effects. The Another rare but possible cause of acne is endocrine People with acne, especially teenagers, tend to cystic lesions. This is quite time-consuming and increased severity of acne in male adolescents is due to disorders of various types, which lead to overproduction self-medicate. Each year in the US over $100 million is probably more useful in research studies than in a Microcomedones increase in size to form comedones. their higher androgen secretion compared to females. The primary cause of acne is obstruction of the of androgenic substances.
spent on over-the-counter products to treat acne.
clinical setting. The comedone, which may be open or closed, is the As puberty passes, hormonal levels decrease and acne pilosebaceous unit. Hormones, sebum, abnormal essential focus lesion in acne. Open comedones resolves. However, in adult women progesterone keratinization, and bacteria contribute to the Environmental Factors (blackheads), have an enlarged pore due to the increases in the 2 weeks before menses, causing effects obstruction of the pilosebaceous unit in the that are more androgenic and leading to the spike in Environmental factors occasionally play a role in acne. All materials contained on this document are protected by United States copyright law. You may not modify, remove, delete, publish, transmit, reproduce or in any way exploit the content of this document, in whole or in part.
2014 Science of Skincare, LLC. All rights reserved.
Young people employed in places where they come pilosebaceous unit if pomade comes into contact a variety of effects that include antibacterial activity, with steroids to control inflammation, while severe iS products helpful in treating acne include: EXTREME into contact with grease, such as auto repair shops or with the skin, leading to acne development. This mild anti-inflammatory activity, lipid-dissolving nodular cystic acne usually requires Accutane PROTECT SPF 30, ECLIPSE SPF 50+, fast-food restaurants, may experience a worsening can be prevented by being careful to avoid facial cleansing action to remove lipid plugs from pores, and (isotretinoin, or 13-cis-retinoic acid). Accutane is a pill EXFOLIATING ENZYME TREATMENT.
skin when placing these products on the hair.
desquamative activity to remove dead epithelial cells on with significant potential side effects, usually reserved the skin and pore surfaces, and encourage epithelial for the most severe acne cases. It causes drying of the • Cosmetics, including makeup and moisturizers, skin, eyes, mouth, and mucus membranes in all people, At the present time, we are unsure if stress can that contain large amounts of oil can worsen acne. as well as desquamation of skin. Because Accutane is O'Daniel TG, "Multimodal Management of Atrophic Acne Scarring in the Aging Face," Aesthetic Plast Surg. 2011 exacerbate acne or if the acne itself causes the Two or more agents may be required for teratogenic (tumor-causing) and will cause increased stress. An increase in lesion number has been • Acne is related to hormonal factors, as explained non-inflammatory acne that is not responsive to a malformations in 60% of exposed fetuses, doctors will Kraft J et al, "Management of Acne," CMAJ. 2011 noted and may relate to relative increases in cortisol, above. Young women may experience flare-ups single agent, or for inflammatory acne. If two or more never place a female patient on Accutane unless there which is androgenic, with stress.
just prior to menses. Because of the hormonal different agents are chosen, they should have different is reliable protection against pregnancy. Accutane also influences occurring during adolescence, it is an mechanisms of action, so as to potentiate each other. requires blood-test monitoring.
Webster GF, "Acne Vulgaris," BMJ. 2002Aug31;325:475-79.
PATIENT EDUCATION FACTS AND MYTHS acne-prone period for both young men and Bershad SV, "The Modern Age of Acne Therapy: A Review of Current Treatment Options," Mt Sinai J Med, There are many public misconceptions about acne. women. The perimenopausal period is another Common topical therapies include benzoyl peroxide, Hormonal therapy with non-androgenic oral Some important facts for general patient education are acne-prone time for women. topical antibiotics (clindamycin topical or erythromycin contraceptives may be used to combat severe Toyoda M et al, "Pathogenesis of Acne," Med Electron Microsc, topical), topical retinoids (tretinoin, adapalene, or inflammatory acne. If not effective, treatment with • The treatment of acne requires some time. It will tazarotene), azelaic acid, salicylic acid, milk and fruit spironolactone, an anti-androgen, may be tried.
Webster GF, "Acne and Rosacea," Med Clin North Am, • Acne is not caused by dirty skin. Washing the skin not go away overnight but requires persistence acids (also called alpha hydroxy acids, or AHAs, which more, or more vigorously, is not warranted and will and consistent, effective treatment. Usually, weeks include glycolic acid, lactic acid, malic acid, citric Krowchuk DP, "Managing Acne in Adolescents," Ped Clin North Am, not be helpful, and injury induced by vigorous are required with any treatment before acid, and mixed fruit acids), and products Scars are often thought to be permanent, persist into washing may cause more inflammation and induce improvement is seen. When treatment is stopped adulthood, and be treatable only with a procedure. Krowchuk DP, "Treating Acne. A Practical Guide," Med Clin North progression of lesions. The visible black part of the prematurely, the acne returns. However, superficial scarring can be improved with blackhead is not dirt—it is melanin and oxidized Sometimes the extraction (removal) of comedones with topical products that have resurfacing activity.
Russell JJ, "Topical Therapy for Acne," Am Fam Phys, material, and cannot be removed by washing.
• Deep scars are permanent. The object of a small instrument, called a comedone extractor, may continuing treatment and being consistent with be done in the doctor's office. Some medical literature Strasburger VC; "Acne. What every Pediatrician Should Know about Each of these therapies, whether topical or systemic, has Treatment," Ped Clin North Am, 1997Dec;44(6):1505-24.
• Dietary factors sometimes may relate to acne. The treatment is to avoid progression to severe lesions terms this surgery, although it is not surgery in the a list of advantages, disadvantages, potential toxicities, Western diet, which encourages insulin resistance and scarring. Scar treatment has become traditional sense and cannot be used to treat scarring. Kligman AM; "The Treatment of Acne with Topical Retinoids: One and contraindications depending upon its own unique Man's Opinion," J Am Acad Dermatol, and tends toward obesity, is high in sugars and multimodal and now includes chemical peels, Removal of comedone contents with a comedone properties. Most of them may be used in combination, simple carbohydrates. This type of diet predisposes dermabrasion, ablative and non-ablative laser extractor in the doctor's office is acceptable and although Accutane is used alone as monotherapy. The to acne development and worsens existing acne. resurfacing, dermal fillers, and excision. These helpful. It differs greatly from "picking at" lesions at topical agents may be used singly for comedonal Insulin resistance stimulates androgen receptors techniques also may be combined with treatment home, which causes more inflammation and is harmful.
non-inflammatory acne, but if this type of acne is highly which then become more sensitive to androgens, of the aging face. inflammatory or non-responsive to therapy with a single thus contributing to acne development.
Severe Inflammatory Acne topical agent, then therapy with more than one agent is Topical treatment alone will not be effective in treating usually required.
• Therapy succeeds by preventing the formation of Treatments for acne include counteracting androgens, severe inflammatory acne, because it cannot penetrate new acne lesions. Therefore, it is important to decreasing inflammation, decreasing sebum deeply enough through the skin's surface to treat the PRODUCT RECOMMENDATIONS treat all acne-prone skin, and not just single acne production, preventing follicular plugging, and most severely inflamed nodules and cysts. Severe acne iS CLINICAL® products helpful in treating acne include: lesions, with topical agents. reducing P. acnes proliferation.
requires systemic treatment (medicine taken orally). ACTIVE SERUM™, PRO-HEAL® SERUM ADVANCE ®, Systemic therapies cause distribution of the drug HYDRA-COOL® SERUM, CLEANSING COMPLEX, • Any practice that further traumatizes (injures) acne Non-inflammatory Acne throughout the entire body. Common systemic WHITE LIGHTENING™ SERUM, lesions contributes to more inflammation and Non-inflammatory acne and comedones may be treated therapies include oral antibiotics (erythromycin and the WHITE LIGHTENING™ COMPLEX.
progression of disease. This includes picking at with a single agent applied topically. Topical therapy tetracyclines, including tetracycline, minocycline, and lesions and wearing athletic gear over lesions. refers to putting a treatment on top of the skin. There doxycycline) and hormonal therapy (oral • Use of pomade on hair may plug the are a variety of single agents available, which may have contraceptives). Cystic lesions also may be injected Mild or comedonal acne consists of comedones material within, are open to the surface, and have a acne lesions during this time. With female menopause, (blackheads and whiteheads) only and is • Higher androgen levels cause the overproduction of black color due to melanin pigment in the cells that estrogen and progesterone levels decrease as the non-inflammatory. Inflammatory acne consists of both sebum, which can occur during direct elevation of were shed and decomposed. Closed comedones ovaries fail (stop hormone production). At this point, comedones and a substantial number of inflammatory androgens (during both male and female puberty) or (whiteheads) have a layer of epithelial cells that covers without the overriding effect of high estrogen and Dr. Charlene DeHaven M.D.
ESTIMATING SEVERITY OF DISEASE lesions (pustules and papules). Inflammatory lesions can relatively higher androgen levels compared to the pore and a tiny, microscopic opening to the skin progesterone levels, DHEA from the adrenals again Clinical Director, INNOVATIVE SKINCARE® Unfortunately, the severity of acne is often overlooked leave permanent scars. A mixture of both inflammatory estrogen levels (during the premenstrual period, surface, which is the pore of the pilosebaceous unit. becomes important. The DHEA, which is androgenic or minimized by physicians. Conversely, severity is often and non-inflammatory acne exhibits all types of lesions during female menopause).
because of its conversion to testosterone, causes the overestimated by patients, especially adolescents, due including severe inflammatory lesions (markedly In the closed microcomedone or comedone, the increase in acne seen with female menopause.
About 17 million Americans have acne. It is the most to the severe social stigma that can develop as the reddened pustules) and possibly cystic lesions (lesions • Increased sebum production and desquamation epithelial duct wall ruptures and the acne lesion common skin disease treated by physicians. Acne can result of even a few mild or moderate lesions. Since more than 0.5 cm in diameter with a soft top that are (flaking) of epithelial-lining cells contribute to progresses from comedone to pustule or papule. The OTHER CAUSES OF ACNE appear at any age, although there are peaks of acne most commonly involves the face, lesions are losing their inflammation). It is most common to have a obstruction of the pore and lead to formation of term "cyst" is a misnomer and refers to what actually incidence in adolescence and again for females near readily obvious in social settings. Individuals with deep mixture of lesions at any one time. Treatment is the microcomedone. The microcomedone is very is a large, inflamed, pus-filled nodule greater than 0.5 For adult females taking oral contraceptives (birth the time of menopause. Acne and adolescence are so inflammatory nodules and cysts may be scarred for life chosen based on severity of disease, so this small and cannot be seen. Alterations in sebum cm in diameter in which the cell wall is composed of control pills) can cause acne. The choice of which type closely associated that 80–90% of all teenagers have at in more than one way. Studies have shown that estimation is important.
lipids interfere with normal sebocyte inflammatory cells and scar tissue. of birth control medicine to take is most important in least some lesions at any given time.
persons who have moderate to severe acne in youth differentiation, thus affecting sebum production. determining its effect on acne. Most oral frequently fail to realize their full potential in ACNE CAUSATION AND PROGRESSION Ratios of saturated to unsaturated fatty acids A substantial number of severely inflamed pustules or contraceptives contain both estrogens and progestins In adolescence, acne affects both males and females. finding jobs or choosing careers suitable to their change. Squalene is one of the most common papules leading to "cyst" development can be termed The Pilosebaceous Unit (synthetic progesterone). Those containing progestins Boys tend to have more lesions and more severe actual abilities.
lipids produced by the skin. During an nodular cystic acne. The body will repair severe that are more androgenic can contribute to acne. Pills disease than do girls. This is probably due to the causal The basic skin structure most commonly affected by inflammatory process, such as acne, squalene can inflammation with scarring. Scars are permanent, can containing relatively more estrogen and a progestin association with androgen (testosterone) levels. In The most common measurement tool for acne is a acne is the pilosebaceous unit, comprising the be oxidized by free radicals and form squalene be deep or superficial, and will persist throughout life. that is less androgenic do not contribute to acne adulthood, acne is more common in women, grading system which classifies according to the sebaceous gland, vellus hair, and pore (duct). peroxide, which is particularly pro-inflammatory.
development and are sometimes used to treat acne. particularly the week or 2 before menses and at the severity of lesions in grades 1 through 4, as follows: Hormonal influences are very important in acne The "progesterone only" method of birth control, onset of menopause. In menstruating females, the The function of the sebaceous gland is to produce • The bacterial organism involved in the development and progression. Acne actually begins to either by pill or by injection, can contribute to acne occurrence of lesions prior to menses is related to the Grade 1: mild acne, comedones present, minimal to no sebum, an oily or lipid-based substance. It was once pathogenesis (cause) of acne is P. acnes develop at age 8 or 9, when adrenarche occurs. progression via androgenic effects.
increase in progesterone levels after ovulation and just thought that sebum had no particular function; (Propionibacterium acnes). P. acnes is a normal Adrenarche is the activation of the adrenal gland, before menses. Progesterone has androgenic effects Grade 2: moderate acne, some inflammation present, however, recent research has shown that sebum inhabitant of skin. However, the increased amount occurring before puberty and associated with increased Other Medications and therefore causes these increases in acne lesions. some papules and pustules present; transports the antioxidant vitamin E to the skin's of sebum and obstruction of the pore provide an DHEA levels. DHEA is one of the hormones produced by The occurrence in menopausal females is also related Grade 3: moderately severe acne, larger nodules and surface. The pore is the opening that carries sebum to environment conducive to proliferation of P. acnes. the adrenal gland. Some of the DHEA is converted to Other medicines that can be related to the to relative androgen predominance in the face of pustules with inflammation; the epidermal surface and is lined with epidermal cells.
As P. acnes increases in number, it uses sebum as a androgens by a metabolic pathway, leading to development of acne include lithium, cortisone-type declining estrogen levels seen with menopause. Grade 4: severe acne, large nodules and cysts, scarring.
nutritive source, causing sebum conversion to free microcomedone development. With puberty in the medicines, and anabolic (testosterone-type or Neonates (just-born babies) can present with acne The number of pilosebaceous units that appear on the fatty acids, which are very irritating. The immune female, DHEA is the primary source of androgens, since androgenic) steroids. Some medicines used to treat because of the intra-uterine hormonal stimulation from This system considers the progression of severity from face, upper neck, and chest is 9 times the number system is activated by both the free fatty acids and some of it is converted to androgens. With female cancer, such as epidermal growth factor receptor maternal hormones. slightly visible comedones to inflammatory lesions to found elsewhere on the body. The pilosebaceous unit is the large amounts of P. acnes, and inflammation puberty, both estrogen and progesterone increase as inhibitors, can cause an acneiform (acne-like) rash. multiple severe pustular and cystic lesions. under stimulation at birth from maternal hormones, thus ensues.
menarche (the beginning of menses) occurs and the Although the rash looks like typical acne, closer People with acne, especially teenagers, tend to atrophies (becomes smaller and less active) during ovaries begin to produce female hormones. Some of inspection reveals the signature lesion of acne, the self-medicate. Each year in the United States, more Another system for grading acne divides the face into childhood, and then re-emerges during adolescence, • Abnormal keratinization causes overcornification this ovarian estrogen is converted to androgens as comedone, is absent.
than $100 million is spent on over-the-counter regions and then counts the number of lesions. The again due to hormonal stimulation. Hormonal of skin, further contributing to pore obstruction a byproduct.
products to treat acne.
lesion count can further be divided by type into stimulation can occur also during menopause.
and inflammation.
Endocrine Disorders comedones, inflammatory lesions, and nodular and Progesterone itself has androgenic effects. The Another rare but possible cause of acne is endocrine People with acne, especially teenagers, tend to cystic lesions. This is quite time-consuming and increased severity of acne in male adolescents is due to disorders of various types, which lead to overproduction self-medicate. Each year in the US over $100 million is probably more useful in research studies than in a Microcomedones increase in size to form comedones. their higher androgen secretion compared to females. The primary cause of acne is obstruction of the of androgenic substances.
spent on over-the-counter products to treat acne.
clinical setting. The comedone, which may be open or closed, is the As puberty passes, hormonal levels decrease and acne pilosebaceous unit. Hormones, sebum, abnormal essential focus lesion in acne. Open comedones resolves. However, in adult women progesterone keratinization, and bacteria contribute to the Environmental Factors (blackheads), have an enlarged pore due to the increases in the 2 weeks before menses, causing effects obstruction of the pilosebaceous unit in the that are more androgenic and leading to the spike in Environmental factors occasionally play a role in acne. All materials contained on this document are protected by United States copyright law. You may not modify, remove, delete, publish, transmit, reproduce or in any way exploit the content of this document, in whole or in part.
2014 Science of Skincare, LLC. All rights reserved.
Young people employed in places where they come pilosebaceous unit if pomade comes into contact a variety of effects that include antibacterial activity, with steroids to control inflammation, while severe iS products helpful in treating acne include: EXTREME into contact with grease, such as auto repair shops or with the skin, leading to acne development. This mild anti-inflammatory activity, lipid-dissolving nodular cystic acne usually requires Accutane PROTECT SPF 30, ECLIPSE SPF 50+, fast-food restaurants, may experience a worsening can be prevented by being careful to avoid facial cleansing action to remove lipid plugs from pores, and (isotretinoin, or 13-cis-retinoic acid). Accutane is a pill EXFOLIATING ENZYME TREATMENT.
skin when placing these products on the hair.
desquamative activity to remove dead epithelial cells on with significant potential side effects, usually reserved the skin and pore surfaces, and encourage epithelial for the most severe acne cases. It causes drying of the • Cosmetics, including makeup and moisturizers, skin, eyes, mouth, and mucus membranes in all people, At the present time, we are unsure if stress can that contain large amounts of oil can worsen acne. as well as desquamation of skin. Because Accutane is O'Daniel TG, "Multimodal Management of Atrophic Acne Scarring in the Aging Face," Aesthetic Plast Surg. 2011 exacerbate acne or if the acne itself causes the Two or more agents may be required for teratogenic (tumor-causing) and will cause increased stress. An increase in lesion number has been • Acne is related to hormonal factors, as explained non-inflammatory acne that is not responsive to a malformations in 60% of exposed fetuses, doctors will Kraft J et al, "Management of Acne," CMAJ. 2011 noted and may relate to relative increases in cortisol, above. Young women may experience flare-ups single agent, or for inflammatory acne. If two or more never place a female patient on Accutane unless there which is androgenic, with stress.
just prior to menses. Because of the hormonal different agents are chosen, they should have different is reliable protection against pregnancy. Accutane also influences occurring during adolescence, it is an mechanisms of action, so as to potentiate each other. requires blood-test monitoring.
Webster GF, "Acne Vulgaris," BMJ. 2002Aug31;325:475-79.
PATIENT EDUCATION FACTS AND MYTHS acne-prone period for both young men and Bershad SV, "The Modern Age of Acne Therapy: A Review of Current Treatment Options," Mt Sinai J Med, There are many public misconceptions about acne. women. The perimenopausal period is another Common topical therapies include benzoyl peroxide, Hormonal therapy with non-androgenic oral Some important facts for general patient education are acne-prone time for women. topical antibiotics (clindamycin topical or erythromycin contraceptives may be used to combat severe Toyoda M et al, "Pathogenesis of Acne," Med Electron Microsc, topical), topical retinoids (tretinoin, adapalene, or inflammatory acne. If not effective, treatment with • The treatment of acne requires some time. It will tazarotene), azelaic acid, salicylic acid, milk and fruit spironolactone, an anti-androgen, may be tried.
Webster GF, "Acne and Rosacea," Med Clin North Am, • Acne is not caused by dirty skin. Washing the skin not go away overnight but requires persistence acids (also called alpha hydroxy acids, or AHAs, which more, or more vigorously, is not warranted and will and consistent, effective treatment. Usually, weeks include glycolic acid, lactic acid, malic acid, citric Krowchuk DP, "Managing Acne in Adolescents," Ped Clin North Am, not be helpful, and injury induced by vigorous are required with any treatment before acid, and mixed fruit acids), and products Scars are often thought to be permanent, persist into washing may cause more inflammation and induce improvement is seen. When treatment is stopped adulthood, and be treatable only with a procedure. Krowchuk DP, "Treating Acne. A Practical Guide," Med Clin North progression of lesions. The visible black part of the prematurely, the acne returns. However, superficial scarring can be improved with blackhead is not dirt—it is melanin and oxidized Sometimes the extraction (removal) of comedones with topical products that have resurfacing activity.
Russell JJ, "Topical Therapy for Acne," Am Fam Phys, material, and cannot be removed by washing.
• Deep scars are permanent. The object of a small instrument, called a comedone extractor, may continuing treatment and being consistent with be done in the doctor's office. Some medical literature Strasburger VC; "Acne. What every Pediatrician Should Know about Each of these therapies, whether topical or systemic, has Treatment," Ped Clin North Am, 1997Dec;44(6):1505-24.
• Dietary factors sometimes may relate to acne. The treatment is to avoid progression to severe lesions terms this surgery, although it is not surgery in the a list of advantages, disadvantages, potential toxicities, Western diet, which encourages insulin resistance and scarring. Scar treatment has become traditional sense and cannot be used to treat scarring. Kligman AM; "The Treatment of Acne with Topical Retinoids: One and contraindications depending upon its own unique Man's Opinion," J Am Acad Dermatol, and tends toward obesity, is high in sugars and multimodal and now includes chemical peels, Removal of comedone contents with a comedone properties. Most of them may be used in combination, simple carbohydrates. This type of diet predisposes dermabrasion, ablative and non-ablative laser extractor in the doctor's office is acceptable and although Accutane is used alone as monotherapy. The to acne development and worsens existing acne. resurfacing, dermal fillers, and excision. These helpful. It differs greatly from "picking at" lesions at topical agents may be used singly for comedonal Insulin resistance stimulates androgen receptors techniques also may be combined with treatment home, which causes more inflammation and is harmful.
non-inflammatory acne, but if this type of acne is highly which then become more sensitive to androgens, of the aging face. inflammatory or non-responsive to therapy with a single thus contributing to acne development.
Severe Inflammatory Acne topical agent, then therapy with more than one agent is Topical treatment alone will not be effective in treating usually required.
• Therapy succeeds by preventing the formation of Treatments for acne include counteracting androgens, severe inflammatory acne, because it cannot penetrate new acne lesions. Therefore, it is important to decreasing inflammation, decreasing sebum deeply enough through the skin's surface to treat the PRODUCT RECOMMENDATIONS treat all acne-prone skin, and not just single acne production, preventing follicular plugging, and most severely inflamed nodules and cysts. Severe acne iS CLINICAL® products helpful in treating acne include: lesions, with topical agents. reducing P. acnes proliferation.
requires systemic treatment (medicine taken orally). ACTIVE SERUM™, PRO-HEAL® SERUM ADVANCE ®, Systemic therapies cause distribution of the drug HYDRA-COOL® SERUM, CLEANSING COMPLEX, • Any practice that further traumatizes (injures) acne Non-inflammatory Acne throughout the entire body. Common systemic WHITE LIGHTENING™ SERUM, lesions contributes to more inflammation and Non-inflammatory acne and comedones may be treated therapies include oral antibiotics (erythromycin and the WHITE LIGHTENING™ COMPLEX.
progression of disease. This includes picking at with a single agent applied topically. Topical therapy tetracyclines, including tetracycline, minocycline, and lesions and wearing athletic gear over lesions. refers to putting a treatment on top of the skin. There doxycycline) and hormonal therapy (oral • Use of pomade on hair may plug the are a variety of single agents available, which may have contraceptives). Cystic lesions also may be injected Mild or comedonal acne consists of comedones material within, are open to the surface, and have a acne lesions during this time. With female menopause, (blackheads and whiteheads) only and is • Higher androgen levels cause the overproduction of black color due to melanin pigment in the cells that estrogen and progesterone levels decrease as the non-inflammatory. Inflammatory acne consists of both sebum, which can occur during direct elevation of were shed and decomposed. Closed comedones ovaries fail (stop hormone production). At this point, comedones and a substantial number of inflammatory androgens (during both male and female puberty) or (whiteheads) have a layer of epithelial cells that covers without the overriding effect of high estrogen and Dr. Charlene DeHaven M.D.
ESTIMATING SEVERITY OF DISEASE lesions (pustules and papules). Inflammatory lesions can relatively higher androgen levels compared to the pore and a tiny, microscopic opening to the skin progesterone levels, DHEA from the adrenals again Clinical Director, INNOVATIVE SKINCARE® Unfortunately, the severity of acne is often overlooked leave permanent scars. A mixture of both inflammatory estrogen levels (during the premenstrual period, surface, which is the pore of the pilosebaceous unit. becomes important. The DHEA, which is androgenic or minimized by physicians. Conversely, severity is often and non-inflammatory acne exhibits all types of lesions during female menopause).
because of its conversion to testosterone, causes the overestimated by patients, especially adolescents, due including severe inflammatory lesions (markedly In the closed microcomedone or comedone, the increase in acne seen with female menopause.
About 17 million Americans have acne. It is the most to the severe social stigma that can develop as the reddened pustules) and possibly cystic lesions (lesions • Increased sebum production and desquamation epithelial duct wall ruptures and the acne lesion common skin disease treated by physicians. Acne can result of even a few mild or moderate lesions. Since more than 0.5 cm in diameter with a soft top that are (flaking) of epithelial-lining cells contribute to progresses from comedone to pustule or papule. The OTHER CAUSES OF ACNE appear at any age, although there are peaks of acne most commonly involves the face, lesions are losing their inflammation). It is most common to have a obstruction of the pore and lead to formation of term "cyst" is a misnomer and refers to what actually incidence in adolescence and again for females near readily obvious in social settings. Individuals with deep mixture of lesions at any one time. Treatment is the microcomedone. The microcomedone is very is a large, inflamed, pus-filled nodule greater than 0.5 For adult females taking oral contraceptives (birth the time of menopause. Acne and adolescence are so inflammatory nodules and cysts may be scarred for life chosen based on severity of disease, so this small and cannot be seen. Alterations in sebum cm in diameter in which the cell wall is composed of control pills) can cause acne. The choice of which type closely associated that 80–90% of all teenagers have at in more than one way. Studies have shown that estimation is important.
lipids interfere with normal sebocyte inflammatory cells and scar tissue. of birth control medicine to take is most important in least some lesions at any given time.
persons who have moderate to severe acne in youth differentiation, thus affecting sebum production. determining its effect on acne. Most oral frequently fail to realize their full potential in ACNE CAUSATION AND PROGRESSION Ratios of saturated to unsaturated fatty acids A substantial number of severely inflamed pustules or contraceptives contain both estrogens and progestins In adolescence, acne affects both males and females. finding jobs or choosing careers suitable to their change. Squalene is one of the most common papules leading to "cyst" development can be termed The Pilosebaceous Unit (synthetic progesterone). Those containing progestins Boys tend to have more lesions and more severe actual abilities.
lipids produced by the skin. During an nodular cystic acne. The body will repair severe that are more androgenic can contribute to acne. Pills disease than do girls. This is probably due to the causal The basic skin structure most commonly affected by inflammatory process, such as acne, squalene can inflammation with scarring. Scars are permanent, can containing relatively more estrogen and a progestin association with androgen (testosterone) levels. In The most common measurement tool for acne is a acne is the pilosebaceous unit, comprising the be oxidized by free radicals and form squalene be deep or superficial, and will persist throughout life. that is less androgenic do not contribute to acne adulthood, acne is more common in women, grading system which classifies according to the sebaceous gland, vellus hair, and pore (duct). peroxide, which is particularly pro-inflammatory.
development and are sometimes used to treat acne. particularly the week or 2 before menses and at the severity of lesions in grades 1 through 4, as follows: Hormonal influences are very important in acne The "progesterone only" method of birth control, onset of menopause. In menstruating females, the The function of the sebaceous gland is to produce • The bacterial organism involved in the development and progression. Acne actually begins to either by pill or by injection, can contribute to acne occurrence of lesions prior to menses is related to the Grade 1: mild acne, comedones present, minimal to no sebum, an oily or lipid-based substance. It was once pathogenesis (cause) of acne is P. acnes develop at age 8 or 9, when adrenarche occurs. progression via androgenic effects.
increase in progesterone levels after ovulation and just thought that sebum had no particular function; (Propionibacterium acnes). P. acnes is a normal Adrenarche is the activation of the adrenal gland, before menses. Progesterone has androgenic effects Grade 2: moderate acne, some inflammation present, however, recent research has shown that sebum inhabitant of skin. However, the increased amount occurring before puberty and associated with increased Other Medications and therefore causes these increases in acne lesions. some papules and pustules present; transports the antioxidant vitamin E to the skin's of sebum and obstruction of the pore provide an DHEA levels. DHEA is one of the hormones produced by The occurrence in menopausal females is also related Grade 3: moderately severe acne, larger nodules and surface. The pore is the opening that carries sebum to environment conducive to proliferation of P. acnes. the adrenal gland. Some of the DHEA is converted to Other medicines that can be related to the to relative androgen predominance in the face of pustules with inflammation; the epidermal surface and is lined with epidermal cells.
As P. acnes increases in number, it uses sebum as a androgens by a metabolic pathway, leading to development of acne include lithium, cortisone-type declining estrogen levels seen with menopause. Grade 4: severe acne, large nodules and cysts, scarring.
nutritive source, causing sebum conversion to free microcomedone development. With puberty in the medicines, and anabolic (testosterone-type or Neonates (just-born babies) can present with acne The number of pilosebaceous units that appear on the fatty acids, which are very irritating. The immune female, DHEA is the primary source of androgens, since androgenic) steroids. Some medicines used to treat because of the intra-uterine hormonal stimulation from This system considers the progression of severity from face, upper neck, and chest is 9 times the number system is activated by both the free fatty acids and some of it is converted to androgens. With female cancer, such as epidermal growth factor receptor maternal hormones. slightly visible comedones to inflammatory lesions to found elsewhere on the body. The pilosebaceous unit is the large amounts of P. acnes, and inflammation puberty, both estrogen and progesterone increase as inhibitors, can cause an acneiform (acne-like) rash. multiple severe pustular and cystic lesions. under stimulation at birth from maternal hormones, thus ensues.
menarche (the beginning of menses) occurs and the Although the rash looks like typical acne, closer People with acne, especially teenagers, tend to atrophies (becomes smaller and less active) during ovaries begin to produce female hormones. Some of inspection reveals the signature lesion of acne, the self-medicate. Each year in the United States, more Another system for grading acne divides the face into childhood, and then re-emerges during adolescence, • Abnormal keratinization causes overcornification this ovarian estrogen is converted to androgens as comedone, is absent.
than $100 million is spent on over-the-counter regions and then counts the number of lesions. The again due to hormonal stimulation. Hormonal of skin, further contributing to pore obstruction a byproduct.
products to treat acne.
lesion count can further be divided by type into stimulation can occur also during menopause.
and inflammation.
Endocrine Disorders comedones, inflammatory lesions, and nodular and Progesterone itself has androgenic effects. The Another rare but possible cause of acne is endocrine People with acne, especially teenagers, tend to cystic lesions. This is quite time-consuming and increased severity of acne in male adolescents is due to disorders of various types, which lead to overproduction self-medicate. Each year in the US over $100 million is probably more useful in research studies than in a Microcomedones increase in size to form comedones. their higher androgen secretion compared to females. The primary cause of acne is obstruction of the of androgenic substances.
spent on over-the-counter products to treat acne.
clinical setting. The comedone, which may be open or closed, is the As puberty passes, hormonal levels decrease and acne pilosebaceous unit. Hormones, sebum, abnormal essential focus lesion in acne. Open comedones resolves. However, in adult women progesterone keratinization, and bacteria contribute to the Environmental Factors (blackheads), have an enlarged pore due to the increases in the 2 weeks before menses, causing effects obstruction of the pilosebaceous unit in the that are more androgenic and leading to the spike in Environmental factors occasionally play a role in acne. Young people employed in places where they come pilosebaceous unit if pomade comes into contact a variety of effects that include antibacterial activity, with steroids to control inflammation, while severe iS products helpful in treating acne include: EXTREME into contact with grease, such as auto repair shops or with the skin, leading to acne development. This mild anti-inflammatory activity, lipid-dissolving nodular cystic acne usually requires Accutane PROTECT SPF 30, ECLIPSE SPF 50+, fast-food restaurants, may experience a worsening can be prevented by being careful to avoid facial cleansing action to remove lipid plugs from pores, and (isotretinoin, or 13-cis-retinoic acid). Accutane is a pill EXFOLIATING ENZYME TREATMENT.
skin when placing these products on the hair.
desquamative activity to remove dead epithelial cells on with significant potential side effects, usually reserved the skin and pore surfaces, and encourage epithelial for the most severe acne cases. It causes drying of the • Cosmetics, including makeup and moisturizers, skin, eyes, mouth, and mucus membranes in all people, At the present time, we are unsure if stress can that contain large amounts of oil can worsen acne. as well as desquamation of skin. Because Accutane is O'Daniel TG, "Multimodal Management of Atrophic Acne Scarring in the Aging Face," Aesthetic Plast Surg. 2011 exacerbate acne or if the acne itself causes the Two or more agents may be required for teratogenic (tumor-causing) and will cause increased stress. An increase in lesion number has been • Acne is related to hormonal factors, as explained non-inflammatory acne that is not responsive to a malformations in 60% of exposed fetuses, doctors will Kraft J et al, "Management of Acne," CMAJ. 2011 noted and may relate to relative increases in cortisol, above. Young women may experience flare-ups single agent, or for inflammatory acne. If two or more never place a female patient on Accutane unless there which is androgenic, with stress.
just prior to menses. Because of the hormonal different agents are chosen, they should have different is reliable protection against pregnancy. Accutane also influences occurring during adolescence, it is an mechanisms of action, so as to potentiate each other. requires blood-test monitoring.
Webster GF, "Acne Vulgaris," BMJ. 2002Aug31;325:475-79.
PATIENT EDUCATION FACTS AND MYTHS acne-prone period for both young men and Bershad SV, "The Modern Age of Acne Therapy: A Review of Current Treatment Options," Mt Sinai J Med, There are many public misconceptions about acne. women. The perimenopausal period is another Common topical therapies include benzoyl peroxide, Hormonal therapy with non-androgenic oral Some important facts for general patient education are acne-prone time for women. topical antibiotics (clindamycin topical or erythromycin contraceptives may be used to combat severe Toyoda M et al, "Pathogenesis of Acne," Med Electron Microsc, topical), topical retinoids (tretinoin, adapalene, or inflammatory acne. If not effective, treatment with • The treatment of acne requires some time. It will tazarotene), azelaic acid, salicylic acid, milk and fruit spironolactone, an anti-androgen, may be tried.
Webster GF, "Acne and Rosacea," Med Clin North Am, • Acne is not caused by dirty skin. Washing the skin not go away overnight but requires persistence acids (also called alpha hydroxy acids, or AHAs, which more, or more vigorously, is not warranted and will and consistent, effective treatment. Usually, weeks include glycolic acid, lactic acid, malic acid, citric Krowchuk DP, "Managing Acne in Adolescents," Ped Clin North Am, not be helpful, and injury induced by vigorous are required with any treatment before acid, and mixed fruit acids), and products Scars are often thought to be permanent, persist into washing may cause more inflammation and induce improvement is seen. When treatment is stopped adulthood, and be treatable only with a procedure. Krowchuk DP, "Treating Acne. A Practical Guide," Med Clin North progression of lesions. The visible black part of the prematurely, the acne returns. However, superficial scarring can be improved with blackhead is not dirt—it is melanin and oxidized Sometimes the extraction (removal) of comedones with topical products that have resurfacing activity.
Russell JJ, "Topical Therapy for Acne," Am Fam Phys, material, and cannot be removed by washing.
• Deep scars are permanent. The object of a small instrument, called a comedone extractor, may continuing treatment and being consistent with be done in the doctor's office. Some medical literature Strasburger VC; "Acne. What every Pediatrician Should Know about Each of these therapies, whether topical or systemic, has Treatment," Ped Clin North Am, 1997Dec;44(6):1505-24.
• Dietary factors sometimes may relate to acne. The treatment is to avoid progression to severe lesions terms this surgery, although it is not surgery in the a list of advantages, disadvantages, potential toxicities, Western diet, which encourages insulin resistance and scarring. Scar treatment has become traditional sense and cannot be used to treat scarring. Kligman AM; "The Treatment of Acne with Topical Retinoids: One and contraindications depending upon its own unique Man's Opinion," J Am Acad Dermatol, and tends toward obesity, is high in sugars and multimodal and now includes chemical peels, Removal of comedone contents with a comedone properties. Most of them may be used in combination, simple carbohydrates. This type of diet predisposes dermabrasion, ablative and non-ablative laser extractor in the doctor's office is acceptable and although Accutane is used alone as monotherapy. The to acne development and worsens existing acne. resurfacing, dermal fillers, and excision. These helpful. It differs greatly from "picking at" lesions at topical agents may be used singly for comedonal Insulin resistance stimulates androgen receptors techniques also may be combined with treatment home, which causes more inflammation and is harmful.
non-inflammatory acne, but if this type of acne is highly which then become more sensitive to androgens, of the aging face. inflammatory or non-responsive to therapy with a single thus contributing to acne development.
Severe Inflammatory Acne topical agent, then therapy with more than one agent is Topical treatment alone will not be effective in treating usually required.
• Therapy succeeds by preventing the formation of Treatments for acne include counteracting androgens, severe inflammatory acne, because it cannot penetrate new acne lesions. Therefore, it is important to decreasing inflammation, decreasing sebum deeply enough through the skin's surface to treat the PRODUCT RECOMMENDATIONS treat all acne-prone skin, and not just single acne production, preventing follicular plugging, and most severely inflamed nodules and cysts. Severe acne iS CLINICAL® products helpful in treating acne include: lesions, with topical agents. reducing P. acnes proliferation.
requires systemic treatment (medicine taken orally). ACTIVE SERUM™, PRO-HEAL® SERUM ADVANCE ®, Systemic therapies cause distribution of the drug HYDRA-COOL® SERUM, CLEANSING COMPLEX, • Any practice that further traumatizes (injures) acne Non-inflammatory Acne throughout the entire body. Common systemic WHITE LIGHTENING™ SERUM, lesions contributes to more inflammation and Non-inflammatory acne and comedones may be treated therapies include oral antibiotics (erythromycin and the WHITE LIGHTENING™ COMPLEX.
progression of disease. This includes picking at with a single agent applied topically. Topical therapy tetracyclines, including tetracycline, minocycline, and lesions and wearing athletic gear over lesions. refers to putting a treatment on top of the skin. There doxycycline) and hormonal therapy (oral • Use of pomade on hair may plug the are a variety of single agents available, which may have contraceptives). Cystic lesions also may be injected All materials contained on this document are protected by United States copyright law. You may not modify, remove, delete, publish, transmit, reproduce or in any way exploit the content of this document, in whole or in part.
2014 Science of Skincare, LLC. All rights reserved.
Mild or comedonal acne consists of comedones material within, are open to the surface, and have a acne lesions during this time. With female menopause, (blackheads and whiteheads) only and is • Higher androgen levels cause the overproduction of black color due to melanin pigment in the cells that estrogen and progesterone levels decrease as the non-inflammatory. Inflammatory acne consists of both sebum, which can occur during direct elevation of were shed and decomposed. Closed comedones ovaries fail (stop hormone production). At this point, comedones and a substantial number of inflammatory androgens (during both male and female puberty) or (whiteheads) have a layer of epithelial cells that covers without the overriding effect of high estrogen and Dr. Charlene DeHaven M.D.
ESTIMATING SEVERITY OF DISEASE lesions (pustules and papules). Inflammatory lesions can relatively higher androgen levels compared to the pore and a tiny, microscopic opening to the skin progesterone levels, DHEA from the adrenals again Clinical Director, INNOVATIVE SKINCARE® Unfortunately, the severity of acne is often overlooked leave permanent scars. A mixture of both inflammatory estrogen levels (during the premenstrual period, surface, which is the pore of the pilosebaceous unit. becomes important. The DHEA, which is androgenic or minimized by physicians. Conversely, severity is often and non-inflammatory acne exhibits all types of lesions during female menopause).
because of its conversion to testosterone, causes the overestimated by patients, especially adolescents, due including severe inflammatory lesions (markedly In the closed microcomedone or comedone, the increase in acne seen with female menopause.
About 17 million Americans have acne. It is the most to the severe social stigma that can develop as the reddened pustules) and possibly cystic lesions (lesions • Increased sebum production and desquamation epithelial duct wall ruptures and the acne lesion common skin disease treated by physicians. Acne can result of even a few mild or moderate lesions. Since more than 0.5 cm in diameter with a soft top that are (flaking) of epithelial-lining cells contribute to progresses from comedone to pustule or papule. The OTHER CAUSES OF ACNE appear at any age, although there are peaks of acne most commonly involves the face, lesions are losing their inflammation). It is most common to have a obstruction of the pore and lead to formation of term "cyst" is a misnomer and refers to what actually incidence in adolescence and again for females near readily obvious in social settings. Individuals with deep mixture of lesions at any one time. Treatment is the microcomedone. The microcomedone is very is a large, inflamed, pus-filled nodule greater than 0.5 For adult females taking oral contraceptives (birth the time of menopause. Acne and adolescence are so inflammatory nodules and cysts may be scarred for life chosen based on severity of disease, so this small and cannot be seen. Alterations in sebum cm in diameter in which the cell wall is composed of control pills) can cause acne. The choice of which type closely associated that 80–90% of all teenagers have at in more than one way. Studies have shown that estimation is important.
lipids interfere with normal sebocyte inflammatory cells and scar tissue. of birth control medicine to take is most important in least some lesions at any given time.
persons who have moderate to severe acne in youth differentiation, thus affecting sebum production. determining its effect on acne. Most oral frequently fail to realize their full potential in ACNE CAUSATION AND PROGRESSION Ratios of saturated to unsaturated fatty acids A substantial number of severely inflamed pustules or contraceptives contain both estrogens and progestins In adolescence, acne affects both males and females. finding jobs or choosing careers suitable to their change. Squalene is one of the most common papules leading to "cyst" development can be termed The Pilosebaceous Unit (synthetic progesterone). Those containing progestins Boys tend to have more lesions and more severe actual abilities.
lipids produced by the skin. During an nodular cystic acne. The body will repair severe that are more androgenic can contribute to acne. Pills disease than do girls. This is probably due to the causal The basic skin structure most commonly affected by inflammatory process, such as acne, squalene can inflammation with scarring. Scars are permanent, can containing relatively more estrogen and a progestin association with androgen (testosterone) levels. In The most common measurement tool for acne is a acne is the pilosebaceous unit, comprising the be oxidized by free radicals and form squalene be deep or superficial, and will persist throughout life. that is less androgenic do not contribute to acne adulthood, acne is more common in women, grading system which classifies according to the sebaceous gland, vellus hair, and pore (duct). peroxide, which is particularly pro-inflammatory.
development and are sometimes used to treat acne. particularly the week or 2 before menses and at the severity of lesions in grades 1 through 4, as follows: Hormonal influences are very important in acne The "progesterone only" method of birth control, onset of menopause. In menstruating females, the The function of the sebaceous gland is to produce • The bacterial organism involved in the development and progression. Acne actually begins to either by pill or by injection, can contribute to acne occurrence of lesions prior to menses is related to the Grade 1: mild acne, comedones present, minimal to no sebum, an oily or lipid-based substance. It was once pathogenesis (cause) of acne is P. acnes develop at age 8 or 9, when adrenarche occurs. progression via androgenic effects.
increase in progesterone levels after ovulation and just thought that sebum had no particular function; (Propionibacterium acnes). P. acnes is a normal Adrenarche is the activation of the adrenal gland, before menses. Progesterone has androgenic effects Grade 2: moderate acne, some inflammation present, however, recent research has shown that sebum inhabitant of skin. However, the increased amount occurring before puberty and associated with increased Other Medications and therefore causes these increases in acne lesions. some papules and pustules present; transports the antioxidant vitamin E to the skin's of sebum and obstruction of the pore provide an DHEA levels. DHEA is one of the hormones produced by The occurrence in menopausal females is also related Grade 3: moderately severe acne, larger nodules and surface. The pore is the opening that carries sebum to environment conducive to proliferation of P. acnes. the adrenal gland. Some of the DHEA is converted to Other medicines that can be related to the to relative androgen predominance in the face of pustules with inflammation; the epidermal surface and is lined with epidermal cells.
As P. acnes increases in number, it uses sebum as a androgens by a metabolic pathway, leading to development of acne include lithium, cortisone-type declining estrogen levels seen with menopause. Grade 4: severe acne, large nodules and cysts, scarring.
nutritive source, causing sebum conversion to free microcomedone development. With puberty in the medicines, and anabolic (testosterone-type or Neonates (just-born babies) can present with acne The number of pilosebaceous units that appear on the fatty acids, which are very irritating. The immune female, DHEA is the primary source of androgens, since androgenic) steroids. Some medicines used to treat because of the intra-uterine hormonal stimulation from This system considers the progression of severity from face, upper neck, and chest is 9 times the number system is activated by both the free fatty acids and some of it is converted to androgens. With female cancer, such as epidermal growth factor receptor maternal hormones. slightly visible comedones to inflammatory lesions to found elsewhere on the body. The pilosebaceous unit is the large amounts of P. acnes, and inflammation puberty, both estrogen and progesterone increase as inhibitors, can cause an acneiform (acne-like) rash. multiple severe pustular and cystic lesions. under stimulation at birth from maternal hormones, thus ensues.
menarche (the beginning of menses) occurs and the Although the rash looks like typical acne, closer People with acne, especially teenagers, tend to atrophies (becomes smaller and less active) during ovaries begin to produce female hormones. Some of inspection reveals the signature lesion of acne, the self-medicate. Each year in the United States, more Another system for grading acne divides the face into childhood, and then re-emerges during adolescence, • Abnormal keratinization causes overcornification this ovarian estrogen is converted to androgens as comedone, is absent.
than $100 million is spent on over-the-counter regions and then counts the number of lesions. The again due to hormonal stimulation. Hormonal of skin, further contributing to pore obstruction a byproduct.
products to treat acne.
lesion count can further be divided by type into stimulation can occur also during menopause.
and inflammation.
Endocrine Disorders comedones, inflammatory lesions, and nodular and Progesterone itself has androgenic effects. The Another rare but possible cause of acne is endocrine People with acne, especially teenagers, tend to cystic lesions. This is quite time-consuming and increased severity of acne in male adolescents is due to disorders of various types, which lead to overproduction self-medicate. Each year in the US over $100 million is probably more useful in research studies than in a Microcomedones increase in size to form comedones. their higher androgen secretion compared to females. The primary cause of acne is obstruction of the of androgenic substances.
spent on over-the-counter products to treat acne.
clinical setting. The comedone, which may be open or closed, is the As puberty passes, hormonal levels decrease and acne pilosebaceous unit. Hormones, sebum, abnormal essential focus lesion in acne. Open comedones resolves. However, in adult women progesterone keratinization, and bacteria contribute to the Environmental Factors (blackheads), have an enlarged pore due to the increases in the 2 weeks before menses, causing effects obstruction of the pilosebaceous unit in the that are more androgenic and leading to the spike in Environmental factors occasionally play a role in acne. Young people employed in places where they come pilosebaceous unit if pomade comes into contact a variety of effects that include antibacterial activity, with steroids to control inflammation, while severe iS products helpful in treating acne include: EXTREME into contact with grease, such as auto repair shops or with the skin, leading to acne development. This mild anti-inflammatory activity, lipid-dissolving nodular cystic acne usually requires Accutane PROTECT SPF 30, ECLIPSE SPF 50+, fast-food restaurants, may experience a worsening can be prevented by being careful to avoid facial cleansing action to remove lipid plugs from pores, and (isotretinoin, or 13-cis-retinoic acid). Accutane is a pill EXFOLIATING ENZYME TREATMENT.
skin when placing these products on the hair.
desquamative activity to remove dead epithelial cells on with significant potential side effects, usually reserved the skin and pore surfaces, and encourage epithelial for the most severe acne cases. It causes drying of the • Cosmetics, including makeup and moisturizers, skin, eyes, mouth, and mucus membranes in all people, At the present time, we are unsure if stress can that contain large amounts of oil can worsen acne. as well as desquamation of skin. Because Accutane is O'Daniel TG, "Multimodal Management of Atrophic Acne Scarring in the Aging Face," Aesthetic Plast Surg. 2011 exacerbate acne or if the acne itself causes the Two or more agents may be required for teratogenic (tumor-causing) and will cause increased stress. An increase in lesion number has been • Acne is related to hormonal factors, as explained non-inflammatory acne that is not responsive to a malformations in 60% of exposed fetuses, doctors will Kraft J et al, "Management of Acne," CMAJ. 2011 noted and may relate to relative increases in cortisol, above. Young women may experience flare-ups single agent, or for inflammatory acne. If two or more never place a female patient on Accutane unless there which is androgenic, with stress.
just prior to menses. Because of the hormonal different agents are chosen, they should have different is reliable protection against pregnancy. Accutane also influences occurring during adolescence, it is an mechanisms of action, so as to potentiate each other. requires blood-test monitoring.
Webster GF, "Acne Vulgaris," BMJ. 2002Aug31;325:475-79.
PATIENT EDUCATION FACTS AND MYTHS acne-prone period for both young men and Bershad SV, "The Modern Age of Acne Therapy: A Review of Current Treatment Options," Mt Sinai J Med, There are many public misconceptions about acne. women. The perimenopausal period is another Common topical therapies include benzoyl peroxide, Hormonal therapy with non-androgenic oral Some important facts for general patient education are acne-prone time for women. topical antibiotics (clindamycin topical or erythromycin contraceptives may be used to combat severe Toyoda M et al, "Pathogenesis of Acne," Med Electron Microsc, topical), topical retinoids (tretinoin, adapalene, or inflammatory acne. If not effective, treatment with • The treatment of acne requires some time. It will tazarotene), azelaic acid, salicylic acid, milk and fruit spironolactone, an anti-androgen, may be tried.
Webster GF, "Acne and Rosacea," Med Clin North Am, • Acne is not caused by dirty skin. Washing the skin not go away overnight but requires persistence acids (also called alpha hydroxy acids, or AHAs, which more, or more vigorously, is not warranted and will and consistent, effective treatment. Usually, weeks include glycolic acid, lactic acid, malic acid, citric Krowchuk DP, "Managing Acne in Adolescents," Ped Clin North Am, not be helpful, and injury induced by vigorous are required with any treatment before acid, and mixed fruit acids), and products Scars are often thought to be permanent, persist into washing may cause more inflammation and induce improvement is seen. When treatment is stopped adulthood, and be treatable only with a procedure. Krowchuk DP, "Treating Acne. A Practical Guide," Med Clin North progression of lesions. The visible black part of the prematurely, the acne returns. However, superficial scarring can be improved with blackhead is not dirt—it is melanin and oxidized Sometimes the extraction (removal) of comedones with topical products that have resurfacing activity.
Russell JJ, "Topical Therapy for Acne," Am Fam Phys, material, and cannot be removed by washing.
• Deep scars are permanent. The object of a small instrument, called a comedone extractor, may continuing treatment and being consistent with be done in the doctor's office. Some medical literature Strasburger VC; "Acne. What every Pediatrician Should Know about Each of these therapies, whether topical or systemic, has Treatment," Ped Clin North Am, 1997Dec;44(6):1505-24.
• Dietary factors sometimes may relate to acne. The treatment is to avoid progression to severe lesions terms this surgery, although it is not surgery in the a list of advantages, disadvantages, potential toxicities, Western diet, which encourages insulin resistance and scarring. Scar treatment has become traditional sense and cannot be used to treat scarring. Kligman AM; "The Treatment of Acne with Topical Retinoids: One and contraindications depending upon its own unique Man's Opinion," J Am Acad Dermatol, and tends toward obesity, is high in sugars and multimodal and now includes chemical peels, Removal of comedone contents with a comedone properties. Most of them may be used in combination, simple carbohydrates. This type of diet predisposes dermabrasion, ablative and non-ablative laser extractor in the doctor's office is acceptable and although Accutane is used alone as monotherapy. The to acne development and worsens existing acne. resurfacing, dermal fillers, and excision. These helpful. It differs greatly from "picking at" lesions at topical agents may be used singly for comedonal Insulin resistance stimulates androgen receptors techniques also may be combined with treatment home, which causes more inflammation and is harmful.
non-inflammatory acne, but if this type of acne is highly which then become more sensitive to androgens, of the aging face. inflammatory or non-responsive to therapy with a single thus contributing to acne development.
Severe Inflammatory Acne topical agent, then therapy with more than one agent is Topical treatment alone will not be effective in treating usually required.
• Therapy succeeds by preventing the formation of Treatments for acne include counteracting androgens, severe inflammatory acne, because it cannot penetrate new acne lesions. Therefore, it is important to decreasing inflammation, decreasing sebum deeply enough through the skin's surface to treat the PRODUCT RECOMMENDATIONS treat all acne-prone skin, and not just single acne production, preventing follicular plugging, and most severely inflamed nodules and cysts. Severe acne iS CLINICAL® products helpful in treating acne include: lesions, with topical agents. reducing P. acnes proliferation.
requires systemic treatment (medicine taken orally). ACTIVE SERUM™, PRO-HEAL® SERUM ADVANCE ® Systemic therapies cause distribution of the drug HYDRA-COOL® SERUM, CLEANSING COMPLEX, • Any practice that further traumatizes (injures) acne Non-inflammatory Acne throughout the entire body. Common systemic WHITE LIGHTENING™ SERUM, lesions contributes to more inflammation and Non-inflammatory acne and comedones may be treated therapies include oral antibiotics (erythromycin and the WHITE LIGHTENING™ COMPLEX.
progression of disease. This includes picking at with a single agent applied topically. Topical therapy tetracyclines, including tetracycline, minocycline, and lesions and wearing athletic gear over lesions. refers to putting a treatment on top of the skin. There doxycycline) and hormonal therapy (oral • Use of pomade on hair may plug the are a variety of single agents available, which may have contraceptives). Cystic lesions also may be injected All materials contained on this document are protected by United States copyright law. You may not modify, remove, delete, publish, transmit, reproduce or in any way exploit the content of this document, in whole or in part.
2014 Science of Skincare, LLC. All rights reserved.
Mild or comedonal acne consists of comedones material within, are open to the surface, and have a acne lesions during this time. With female menopause, (blackheads and whiteheads) only and is • Higher androgen levels cause the overproduction of black color due to melanin pigment in the cells that estrogen and progesterone levels decrease as the non-inflammatory. Inflammatory acne consists of both sebum, which can occur during direct elevation of were shed and decomposed. Closed comedones ovaries fail (stop hormone production). At this point, comedones and a substantial number of inflammatory androgens (during both male and female puberty) or (whiteheads) have a layer of epithelial cells that covers without the overriding effect of high estrogen and Dr. Charlene DeHaven M.D.
ESTIMATING SEVERITY OF DISEASE lesions (pustules and papules). Inflammatory lesions can relatively higher androgen levels compared to the pore and a tiny, microscopic opening to the skin progesterone levels, DHEA from the adrenals again Clinical Director, INNOVATIVE SKINCARE® Unfortunately, the severity of acne is often overlooked leave permanent scars. A mixture of both inflammatory estrogen levels (during the premenstrual period, surface, which is the pore of the pilosebaceous unit. becomes important. The DHEA, which is androgenic or minimized by physicians. Conversely, severity is often and non-inflammatory acne exhibits all types of lesions during female menopause).
because of its conversion to testosterone, causes the overestimated by patients, especially adolescents, due including severe inflammatory lesions (markedly In the closed microcomedone or comedone, the increase in acne seen with female menopause.
About 17 million Americans have acne. It is the most to the severe social stigma that can develop as the reddened pustules) and possibly cystic lesions (lesions • Increased sebum production and desquamation epithelial duct wall ruptures and the acne lesion common skin disease treated by physicians. Acne can result of even a few mild or moderate lesions. Since more than 0.5 cm in diameter with a soft top that are (flaking) of epithelial-lining cells contribute to progresses from comedone to pustule or papule. The OTHER CAUSES OF ACNE appear at any age, although there are peaks of acne most commonly involves the face, lesions are losing their inflammation). It is most common to have a obstruction of the pore and lead to formation of term "cyst" is a misnomer and refers to what actually incidence in adolescence and again for females near readily obvious in social settings. Individuals with deep mixture of lesions at any one time. Treatment is the microcomedone. The microcomedone is very is a large, inflamed, pus-filled nodule greater than 0.5 For adult females taking oral contraceptives (birth the time of menopause. Acne and adolescence are so inflammatory nodules and cysts may be scarred for life chosen based on severity of disease, so this small and cannot be seen. Alterations in sebum cm in diameter in which the cell wall is composed of control pills) can cause acne. The choice of which type closely associated that 80–90% of all teenagers have at in more than one way. Studies have shown that estimation is important.
lipids interfere with normal sebocyte inflammatory cells and scar tissue. of birth control medicine to take is most important in least some lesions at any given time.
persons who have moderate to severe acne in youth differentiation, thus affecting sebum production. determining its effect on acne. Most oral frequently fail to realize their full potential in ACNE CAUSATION AND PROGRESSION Ratios of saturated to unsaturated fatty acids A substantial number of severely inflamed pustules or contraceptives contain both estrogens and progestins In adolescence, acne affects both males and females. finding jobs or choosing careers suitable to their change. Squalene is one of the most common papules leading to "cyst" development can be termed The Pilosebaceous Unit (synthetic progesterone). Those containing progestins Boys tend to have more lesions and more severe actual abilities.
lipids produced by the skin. During an nodular cystic acne. The body will repair severe that are more androgenic can contribute to acne. Pills disease than do girls. This is probably due to the causal The basic skin structure most commonly affected by inflammatory process, such as acne, squalene can inflammation with scarring. Scars are permanent, can containing relatively more estrogen and a progestin association with androgen (testosterone) levels. In The most common measurement tool for acne is a acne is the pilosebaceous unit, comprising the be oxidized by free radicals and form squalene be deep or superficial, and will persist throughout life. that is less androgenic do not contribute to acne adulthood, acne is more common in women, grading system which classifies according to the sebaceous gland, vellus hair, and pore (duct). peroxide, which is particularly pro-inflammatory.
development and are sometimes used to treat acne. particularly the week or 2 before menses and at the severity of lesions in grades 1 through 4, as follows: Hormonal influences are very important in acne The "progesterone only" method of birth control, onset of menopause. In menstruating females, the The function of the sebaceous gland is to produce • The bacterial organism involved in the development and progression. Acne actually begins to either by pill or by injection, can contribute to acne occurrence of lesions prior to menses is related to the Grade 1: mild acne, comedones present, minimal to no sebum, an oily or lipid-based substance. It was once pathogenesis (cause) of acne is P. acnes develop at age 8 or 9, when adrenarche occurs. progression via androgenic effects.
increase in progesterone levels after ovulation and just thought that sebum had no particular function; (Propionibacterium acnes). P. acnes is a normal Adrenarche is the activation of the adrenal gland, before menses. Progesterone has androgenic effects Grade 2: moderate acne, some inflammation present, however, recent research has shown that sebum inhabitant of skin. However, the increased amount occurring before puberty and associated with increased Other Medications and therefore causes these increases in acne lesions. some papules and pustules present; transports the antioxidant vitamin E to the skin's of sebum and obstruction of the pore provide an DHEA levels. DHEA is one of the hormones produced by The occurrence in menopausal females is also related Grade 3: moderately severe acne, larger nodules and surface. The pore is the opening that carries sebum to environment conducive to proliferation of P. acnes. the adrenal gland. Some of the DHEA is converted to Other medicines that can be related to the to relative androgen predominance in the face of pustules with inflammation; the epidermal surface and is lined with epidermal cells.
As P. acnes increases in number, it uses sebum as a androgens by a metabolic pathway, leading to development of acne include lithium, cortisone-type declining estrogen levels seen with menopause. Grade 4: severe acne, large nodules and cysts, scarring.
nutritive source, causing sebum conversion to free microcomedone development. With puberty in the medicines, and anabolic (testosterone-type or Neonates (just-born babies) can present with acne The number of pilosebaceous units that appear on the fatty acids, which are very irritating. The immune female, DHEA is the primary source of androgens, since androgenic) steroids. Some medicines used to treat because of the intra-uterine hormonal stimulation from This system considers the progression of severity from face, upper neck, and chest is 9 times the number system is activated by both the free fatty acids and some of it is converted to androgens. With female cancer, such as epidermal growth factor receptor maternal hormones. slightly visible comedones to inflammatory lesions to found elsewhere on the body. The pilosebaceous unit is the large amounts of P. acnes, and inflammation puberty, both estrogen and progesterone increase as inhibitors, can cause an acneiform (acne-like) rash. multiple severe pustular and cystic lesions. under stimulation at birth from maternal hormones, thus ensues.
menarche (the beginning of menses) occurs and the Although the rash looks like typical acne, closer People with acne, especially teenagers, tend to atrophies (becomes smaller and less active) during ovaries begin to produce female hormones. Some of inspection reveals the signature lesion of acne, the self-medicate. Each year in the United States, more Another system for grading acne divides the face into childhood, and then re-emerges during adolescence, • Abnormal keratinization causes overcornification this ovarian estrogen is converted to androgens as comedone, is absent.
than $100 million is spent on over-the-counter regions and then counts the number of lesions. The again due to hormonal stimulation. Hormonal of skin, further contributing to pore obstruction a byproduct.
products to treat acne.
lesion count can further be divided by type into stimulation can occur also during menopause.
and inflammation.
Endocrine Disorders comedones, inflammatory lesions, and nodular and Progesterone itself has androgenic effects. The Another rare but possible cause of acne is endocrine People with acne, especially teenagers, tend to cystic lesions. This is quite time-consuming and increased severity of acne in male adolescents is due to disorders of various types, which lead to overproduction self-medicate. Each year in the US over $100 million is probably more useful in research studies than in a Microcomedones increase in size to form comedones. their higher androgen secretion compared to females. The primary cause of acne is obstruction of the of androgenic substances.
spent on over-the-counter products to treat acne.
clinical setting. The comedone, which may be open or closed, is the As puberty passes, hormonal levels decrease and acne pilosebaceous unit. Hormones, sebum, abnormal essential focus lesion in acne. Open comedones resolves. However, in adult women progesterone keratinization, and bacteria contribute to the Environmental Factors (blackheads), have an enlarged pore due to the increases in the 2 weeks before menses, causing effects obstruction of the pilosebaceous unit in the that are more androgenic and leading to the spike in Environmental factors occasionally play a role in acne. Young people employed in places where they come pilosebaceous unit if pomade comes into contact a variety of effects that include antibacterial activity, with steroids to control inflammation, while severe iS products helpful in treating acne include: EXTREME into contact with grease, such as auto repair shops or with the skin, leading to acne development. This mild anti-inflammatory activity, lipid-dissolving nodular cystic acne usually requires Accutane PROTECT SPF 30, ECLIPSE SPF 50+, fast-food restaurants, may experience a worsening can be prevented by being careful to avoid facial cleansing action to remove lipid plugs from pores, and (isotretinoin, or 13-cis-retinoic acid). Accutane is a pill EXFOLIATING ENZYME TREATMENT.
skin when placing these products on the hair.
desquamative activity to remove dead epithelial cells on with significant potential side effects, usually reserved the skin and pore surfaces, and encourage epithelial for the most severe acne cases. It causes drying of the • Cosmetics, including makeup and moisturizers, skin, eyes, mouth, and mucus membranes in all people, At the present time, we are unsure if stress can that contain large amounts of oil can worsen acne. as well as desquamation of skin. Because Accutane is O'Daniel TG, "Multimodal Management of Atrophic Acne Scarring in the Aging Face," Aesthetic Plast Surg. 2011 exacerbate acne or if the acne itself causes the Two or more agents may be required for teratogenic (tumor-causing) and will cause increased stress. An increase in lesion number has been • Acne is related to hormonal factors, as explained non-inflammatory acne that is not responsive to a malformations in 60% of exposed fetuses, doctors will Kraft J et al, "Management of Acne," CMAJ. 2011 noted and may relate to relative increases in cortisol, above. Young women may experience flare-ups single agent, or for inflammatory acne. If two or more never place a female patient on Accutane unless there which is androgenic, with stress.
just prior to menses. Because of the hormonal different agents are chosen, they should have different is reliable protection against pregnancy. Accutane also influences occurring during adolescence, it is an mechanisms of action, so as to potentiate each other. requires blood-test monitoring.
Webster GF, "Acne Vulgaris," BMJ. 2002Aug31;325:475-79.
PATIENT EDUCATION FACTS AND MYTHS acne-prone period for both young men and Bershad SV, "The Modern Age of Acne Therapy: A Review of Current Treatment Options," Mt Sinai J Med, There are many public misconceptions about acne. women. The perimenopausal period is another Common topical therapies include benzoyl peroxide, Hormonal therapy with non-androgenic oral Some important facts for general patient education are acne-prone time for women. topical antibiotics (clindamycin topical or erythromycin contraceptives may be used to combat severe Toyoda M et al, "Pathogenesis of Acne," Med Electron Microsc, topical), topical retinoids (tretinoin, adapalene, or inflammatory acne. If not effective, treatment with • The treatment of acne requires some time. It will tazarotene), azelaic acid, salicylic acid, milk and fruit spironolactone, an anti-androgen, may be tried.
Webster GF, "Acne and Rosacea," Med Clin North Am, • Acne is not caused by dirty skin. Washing the skin not go away overnight but requires persistence acids (also called alpha hydroxy acids, or AHAs, which more, or more vigorously, is not warranted and will and consistent, effective treatment. Usually, weeks include glycolic acid, lactic acid, malic acid, citric Krowchuk DP, "Managing Acne in Adolescents," Ped Clin North Am, not be helpful, and injury induced by vigorous are required with any treatment before acid, and mixed fruit acids), and products Scars are often thought to be permanent, persist into washing may cause more inflammation and induce improvement is seen. When treatment is stopped adulthood, and be treatable only with a procedure. Krowchuk DP, "Treating Acne. A Practical Guide," Med Clin North progression of lesions. The visible black part of the prematurely, the acne returns. However, superficial scarring can be improved with blackhead is not dirt—it is melanin and oxidized Sometimes the extraction (removal) of comedones with topical products that have resurfacing activity.
Russell JJ, "Topical Therapy for Acne," Am Fam Phys, material, and cannot be removed by washing.
• Deep scars are permanent. The object of a small instrument, called a comedone extractor, may continuing treatment and being consistent with be done in the doctor's office. Some medical literature Strasburger VC; "Acne. What every Pediatrician Should Know about Each of these therapies, whether topical or systemic, has Treatment," Ped Clin North Am, 1997Dec;44(6):1505-24.
• Dietary factors sometimes may relate to acne. The treatment is to avoid progression to severe lesions terms this surgery, although it is not surgery in the a list of advantages, disadvantages, potential toxicities, Western diet, which encourages insulin resistance and scarring. Scar treatment has become traditional sense and cannot be used to treat scarring. Kligman AM; "The Treatment of Acne with Topical Retinoids: One and contraindications depending upon its own unique Man's Opinion," J Am Acad Dermatol, and tends toward obesity, is high in sugars and multimodal and now includes chemical peels, Removal of comedone contents with a comedone properties. Most of them may be used in combination, simple carbohydrates. This type of diet predisposes dermabrasion, ablative and non-ablative laser extractor in the doctor's office is acceptable and although Accutane is used alone as monotherapy. The to acne development and worsens existing acne. resurfacing, dermal fillers, and excision. These helpful. It differs greatly from "picking at" lesions at topical agents may be used singly for comedonal Insulin resistance stimulates androgen receptors techniques also may be combined with treatment home, which causes more inflammation and is harmful.
non-inflammatory acne, but if this type of acne is highly which then become more sensitive to androgens, of the aging face. inflammatory or non-responsive to therapy with a single thus contributing to acne development.
Severe Inflammatory Acne topical agent, then therapy with more than one agent is Topical treatment alone will not be effective in treating usually required.
• Therapy succeeds by preventing the formation of Treatments for acne include counteracting androgens, severe inflammatory acne, because it cannot penetrate new acne lesions. Therefore, it is important to decreasing inflammation, decreasing sebum deeply enough through the skin's surface to treat the PRODUCT RECOMMENDATIONS treat all acne-prone skin, and not just single acne production, preventing follicular plugging, and most severely inflamed nodules and cysts. Severe acne iS CLINICAL® products helpful in treating acne include: lesions, with topical agents. reducing P. acnes proliferation.
requires systemic treatment (medicine taken orally). ACTIVE SERUM™, PRO-HEAL® SERUM ADVANCE ®, Systemic therapies cause distribution of the drug HYDRA-COOL® SERUM, CLEANSING COMPLEX, • Any practice that further traumatizes (injures) acne Non-inflammatory Acne throughout the entire body. Common systemic WHITE LIGHTENING™ SERUM, lesions contributes to more inflammation and Non-inflammatory acne and comedones may be treated therapies include oral antibiotics (erythromycin and the WHITE LIGHTENING™ COMPLEX.
progression of disease. This includes picking at with a single agent applied topically. Topical therapy tetracyclines, including tetracycline, minocycline, and lesions and wearing athletic gear over lesions. refers to putting a treatment on top of the skin. There doxycycline) and hormonal therapy (oral • Use of pomade on hair may plug the are a variety of single agents available, which may have contraceptives). Cystic lesions also may be injected All materials contained on this document are protected by United States copyright law. You may not modify, remove, delete, publish, transmit, reproduce or in any way exploit the content of this document, in whole or in part.
2014 Science of Skincare, LLC. All rights reserved.

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Juan Pablo Aguilar Andrade Derecho administrativo y transigibilidad Juan Pablo Aguilar Andrade* SUMARIO: 1. Sobre el concepto de transigibilidad en el Derecho Ad- ministrativo. 2. Transigibilidad y discrecionalidad. 2.1. La búsqueda de las materias transigibles 2.2. Transigibilidad y Derecho Administrativo.

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