Acne

Skin is the best indicator of health. It reflects the physical, mental and psychological state of individual. Skin is a sign of beauty and thus confidence. So any skin disease affects the external appearance and becomes an issue of concern, irrespective of age.

Acne is one of the most common medical problems of adolescence. It is a disease of sebaceous glands, manifesting with pleomorphic lesions like comedones, papules, nodules and cysts. Extensive scarring can follow.

HISTORY
The term acne comes from a corruption of the greek ‘akun’ in the writings of Aetius Amidenus. This disorder was first described by Aristotle and Hippocrates 2500 years ago. Early Roman physicians used thje word. ‘varus’ means ‘pimple’ a term that appears in the medical literature well into nineteenth century.

AETIOLOGY AND PATHOLOGY

Levels of circulating sex hormones and ration of androgen to estrogen.

Alteration in the pattern of keratinization within the sebaceous follicles.

Colonization of follicular microbial flora.

Immunological factors.

Environmental factors.

*CIRCULATING SEX HORMONES

Mainly acne occurs due to excess presence of sex hormones especially androgens. The main action of the male hormone is to increase the sebum secretion and cause sebaceous gland hyperplasia.

*ALTERATION IN THE PATTERN OF KERATINIZATION

Electron microscopic and kinetic study shows there will be primary changes occurs in the patterns of keratinization. Normally keratinous material will be arranged loosely, but here it is arranged in densely.

*QUANTITY AND QUALITY OF SEBUM SECRETION

Excess sebum secretion, sebaceous gland hypertrophy and hyperplasia usually occur in acne.

*FOLLICULAR MICROBIAL FLORA

Resident bacterial flora in sebaceous follicles, namely Propionibacterium acne, P granulosum, P ovale and staphylococcal epidermidis, play an important role in the production of acne.

*IMMUNOLOGICAL FACTORS

The host response to P acnes is important as both classical and alternate pathways are activated. This antibody titre to P acne is elevated in acne patients and this antibody promotes the release of liposomal hydrolases.

*ENVIRONMENTAL FACTORS

Hot and humid climate, pollution are risk factors.

Emotional stress and strain aggravates.

External applications of oils, powders and other comedogenic chemicals cause acneform eruption.

Diet especially chocolates, fat rich diet and ice cream; a high glycaemic load carbohydrate diet induces hyperinslinaemia which results in androgen synthesis.

CLINICAL FEATURES

The inflammatory lesion namely popular, pustules, nodules and cysts indicates the severity of the diseases.

The severity of the acne can be graded as

Grade I – mild – comedones, Occasional papules

Grade II – moderate – comedones, may papules, few pustules

Grade III – severe – predominantly pustules, nodules and abscesses

Grade IV – cystic – mainly cysts/ abscesses, widespread scarring

PSYCHOLOGICAL IMPACT OF ACNE

Depression

Suicidal ideation

Anxiety

Social inhibition

Reduced self-esteem and self confidence

Anger

High rate of unemployment

PSYCHOSOMAL SYMPTOMS

Pain

Discomfort

Itching

Discoloration

Scarring

DIFFERENTIAL DIAGNOSIS 

ROSACEAE: It is a disease of adults is generally grouped with acne vulgaris because of the involvement of face, the appearance of papular or pustular lesions. It affects the flush areas of the face, manifesting with telengectasia, erythema and papulo-pustular lesions and running a chronic course.

WARTS: They present as superficial flat, skin coloured on slightly brown lesions 2-4mm in diameter, but absence of inflammation makes it differs from acne.

SEBORRHOEIC ECZEMA: Patient with eczema do not have a greasy skin but a dry skin with erythematous, scaly papules, particularly in the nasolabial fold and forehead. Similar lesions present in axilla, groin, upper trunk and scalp. There may be history / family history of asthma or hay fever.  

DIAGNOSIS
The diagnosis of acne vulgaris is clinical diagnosis. Investigations are rarely required. It is important however, to enquire about the details of previous treatment and particularly about their duration. In female patient with dymenorrhoea or hirsutism, a hormonal evaluation should be considered. Skin lesion cultures to rule out gram negative folliculitis.

COMPLICATIONS
Acne lesions may lead to permanent scarring. It causes a significant psychological and social morbidity that may be equivalent to that of asthma or epilepsy. Anxiety and depression and a reduction in social functioning are a consequence of the condition.

HOMOEOPATHIC MANAGEMENT

ANTIMONIUM CRUDUM:Pimples, vesicles, and pustules sensitive to cold bathing. Thick hard honey coloured scabs, urticarial, measles like eruption. Itching when warm in bed. Scaly, pustular eruptions with burning and itching worse at night.

BERBERIS AQUIFOLIUM:Acne, blotches and pimples. Clear complexion.

HYDROCOTYLE ASIATICA:Dry eruption, great thickening of dermoid layer and exfoliation of scales (icthyosis). Circular spots with scaly edges. Intolerable itching especially of soles. Profuse sweat syphilitic affection.

LEDUM PALUSTRE:Acne of forehead. Itching in the feet and ankles, worse scratching and warmth of bed, ecchymosis, and Long discoloration after injury, carbuncles.

KALIUM BROMATUM:Acne, papular eruption, ulcer with punched out edges with tendency to penetrate and tenacious exudation, pustular eruption resembling small pox, with burning pain, itching with vesicular eruption. 

KALI CARBONICUM:Acne of face, pustular, itching increase in chest shoulder and face.  

ARSENICUM BROMATUM:Acne rosacea with violet papules papules on nose, worse in the spring. Acne in young people.

ANTIMONIUM SULPHURATUM AURATUM:Acne pustular varities. Itching of hands and feet.

CARBO ANIMALIS:Spongy ulcers, copper coloured eruptions, acne worse in the bed, in the evening, from cold.

ASTERIAS RUBENS:Without pliability and elasticity. Itching spots. Acne worse left arm and chest. Enlarged axillary glands worse at night and in damp weather.

11. CALCAREA SILICATE:Itching, burning, cold and blue, very sensitive. Pimples, comedones, wens, psoric eruptions.

12. BELLADONNA:Dry and hot, swollen, sensitive, burm, scarlet, smooth eruption, suddenly spreading erythema pustular on the face glands swollen, tender, red boils. Alternative redness and paleness of the skin.

13. GRAPHITIS:Rough, hard, persistent dryness in the portions of the skin unaffected by eczema, pimples and acne, eruptions oozing out a sticky exudation, unhealthy skin; every little injury suppurates.

14. SULPHUR:Dry scaly, unhealthy; every little injury suppurates. Freckles, itching, burning, worse scratching and washing. Pimply eruption, pustules, rhagades, hang nails. Excoriation, especially in the fold.

15. DULCAMARA:Humid eruptions on the cheeks and face generally, vesicular eruptions, pruritis always worse in cold, wet weather. Swelling and indurated glands from exposure to cold.

16. LYCOPODIUM CLAVATUM:Acne, violent itching, fissured eruptions. Skin become thick and indurated. Worse from warm applications.

17. NATRUM MURIATICUM:Greasy, oily especially on hairy parts. Dry eruptions on the margin of hairy scalp and bends of joints. Worse from eating salt, at seashore

18. PULSATILLA:Acne at puberty. After rich food, from delayed menses.

19. SANGUINARIA CANADENSIS:Acne with scanty menses. Burning and itching, worse by heat. Circumscribes red spots over malar bones.

20. PSORINUM:Dirty, dingy look. Intolerable itching, worse from warmth of bed. Sebaceous glands secrete excessively; oily skin.

21. MERCURIUS SOLUBILIS:Almost constantly moist. Persistent dryness of the skin contraindicates. Excessive odorous, viscid perspiration, worse at night. General tendency to free perspiration; but patient is not relieved thereby. Vesicular and pustular eruptions. Pimples around the main eruption. Itching; worse from warmth of bed.

22. EUGENIA JAMBOS:Acne, simple and indurated. The pimples and some area around it is painful.

GENERAL MANAGEMENT

*Wash the face twice in a day and especially after sweating. Because sweat can make acne worse.

*Keep your hands off your face.

*Let your skin heals naturally, if you pick or squeeze your acne, it increase the risk of getting acne scars.

*Rinse with lukewarm water

*Avoid sunburn and suntan.

*Vitamin supplements: vit A and B6 are essential for skin.

*Exercise is also part of a natural acne healing process.

*Drink lots of water to clean your body off toxins and keep your skin hydrated form