24 Mar 2020

Acne symptoms, causes and treatment

Acne or acne vulgaris is a disease involving the hair follicles of the face, back and chest affecting almost every teenager during puberty, with the only exception being members of a few primitive Neolithic tribes that live in isolation. Acne is not caused by bacteria, although bacteria have an important role in its development. Some women develop acne in their mid- to late-20s.

Table of Medications

  • Doxycycline
  • spironolactone
  • Minocycline
  • Aldactone
  • Clindamycin
  • Tretinoin
  • Bactrim
  • Isotretinoin
  • Retin-A
  • Aczone
  • Epiduo
  • Differin

Overview

Acne commonly occurs during puberty when the sebaceous glands activate. But, acne may occur at any age. While there is no danger in having acne, you may skin scars after.

The sebaceous glands produce oil. They get stimulated by the male hormones from the adrenal glands in both females and males.

Acne vulgaris is a typical teenage problem which is characterized by three types of lesions:

  • the comedo or blackhead
  • the inflammatory papule
  • the pustule or pimple

Acne may appear in the skin as:

  • occluded pores or comedones, known also as whiteheads or blackheads
  • tender red bumps are known also as pimples or zits
  • pustules or bumps that contain pus, 
  • cysts, the deep pimples and boils of cystic acne

Many people treat their acne using products sold at drugstores or cosmetic counters without having to get a prescription from a doctor. However, tougher cases of acne require the person to consult a physician for treatment options.

Symptoms of Acne

Acne signs and symptoms vary depending on the severity of the condition:

  • whiteheads, which are closed plugged pores 
  • blackheads, which are plugged open pores
  • tender, small red bumps or papules
  • pimples or pustules, which are papules with pus at the tips
  • painful, solid, large lumps beneath the skin’s surface 
  • pus-filled and painful lumps beneath the skin’s surface or cystic lesions

Causes of Acne

Acne is not caused by a single factor. It appears when sebaceous glands in the hair follicles get stimulated during puberty or when there are other changes in hormones. Sebum is a natural substance that lubricates and protects the skin. Together with an increase in the production of oil is a change in the way in which the skin cells mature, making them prone to plugging the follicular pore nasal polyps. The plug may appear as a whitehead if it is covered by a thin layer of the skin, or if exposed to the air, the darker exposed portion of the plug is called a blackhead. The plugged hair follicle enlarges gradually to produce a bump. As the follicle enlarges, the wall may rupture to allow irritating substances and normal skin bacteria access into the skin’s deeper layer, ultimately producing inflammation. Inflammation near the surface of the skin produces a pustule; deeper inflammation often results in a papule or pimple. If the inflammation is still deeper, it forms a cyst.

The following are factors that do not usually play a role in acne:

  • Food – People often tell teens to avoid fried and greasy food, as well as junk food. These foods may not be good for overall health, but they do not play a causal role in acne. Some recent studies have linked high-carbohydrate diet, milk, and pure chocolate in making acne worse, the findings are not yet established.
  • Dirt – Blackheads are oxidized oil, not dirt. Perspiration does not cause acne as it is produced entirely by a different gland in the skin. Excessive washing may dry and irritate the skin.
  • Stress – Some individuals become so upset with their pimples that they pick on them, which makes them last longer. Stress does not play much of a direct role in causing acne.

In some individuals, the following may be contributory factors to developing acne:

  • Heredity – If one of your parents had severe acne, it is very likely that your acne will be difficult to control.
  • Pressure – In some individuals, pressure on the skin form chin straps, helmets, collars, suspenders, and the like can make acne worse.
  • Drugs – Some medications may cause or worsen acne such as medications that contain iodides, bromides, oral or injectable steroids. Other drugs that may cause or aggravate acne include anticonvulsant medications and lithium. Most cases of acne are not caused by drugs.
  • Occupation – Some jobs are exposed to products such as oil that may cause acne.
  • Cosmetics – Some skincare products can clog the pores. There are various brands of skincare products, which makes it important to read the list of ingredients and choose those with water listed ingredients. Water-based products are usually best for people with acne.

Diagnosis and Treatment

Diagnosis

Acne is diagnosed by your doctor using a simple visual examination. The diagnosis of acne usually does not involve any test. Sometimes, a doctor may scrape or take a swab of a pustule or lesion for microbiological examination or culture to make sure that there are no other sources of infection.

Treatment

If you have used over-the-counter acne products for many weeks and they have not worked, your doctor can prescribe stronger medications. Typically, your doctor will refer you to a dermatologist who can help you:

Acne medications help reduce the production of oil, speed up the turnover of skin cells, reduce inflammation or fight the bacterial infection. Most prescription drugs like corticosteroids for acne begin to work after four or eight weeks. You will notice that your skin might get worse before it gets better. It could take months or years before your acne is cleared completely. 

The treatment that your doctor will recommend will be based on your age, the type of acne you have, and their severity. You may be required to wash the affected skin and apply medications twice daily for many weeks. You may also be required to take oral medications.  If you are pregnant, your doctor cannot prescribe medications for your acne.

Topical medications for acne

The most common medications for topical administration for acne include:

  • Retinoids and similar drugs – They come as gels, creams, or lotions. Retinoid is derived from vitamin A. It includes tretinoin and tazarotene. It prevents the plugging of the hair follicles.
  • Antibiotic – Antibiotics kill excess bacteria in the skin and also reduce redness.
  • Salicylic acid and azelaic acid – Azelaic acid is found in whole-grain cereal and animal products. It has antibacterial properties. Salicylic acid prevents the plugging of the hair follicles.
  • Dapsone – It is used for the treatment of inflammatory acne of adult females.

Oral medications for acne

  • Antibiotics – Oral antibiotics are needed to fight inflammation and reduce bacteria in moderate to severe acne.
  • Combined oral contraceptives – The FDA has approved the use of a combination of four oral contraceptives for acne therapy in women who also use contraceptives.
  • Anti-androgen agents – This type of drug is recommended for adolescent girls and women who used antibiotics but failed to solve the problem.
  • Isotretinoin – This powerful drug is typically recommended for people whose acne does not respond to other treatments.

Therapies

Therapies are recommended in select cases:

    • Lasers and photodynamic therapy – It is a light-based therapy.
    • Chemical peel – It involves repeated use of a chemical solution to treat acne.
    • Extraction of whiteheads and blackheads – Your doctor will employ special tools for the removal of whiteheads and blackheads.
  • Steroid injection – This procedure involves the injection of a steroid drug into cystic and nodular lesions.

What are the normal conditions

Normal skin is widely used to refer to well-balanced skin. The scientific term for healthy skin is eudermic. The T-zone of the face – the forehead, nose, and chin- could be a little bit oily, but when the overall sebum and moisture are balanced and the skin is neither too oily or too dry, the skin is healthy. 

Normal skin has:

  • fine pores
  • good blood circulation
  • fresh, rosy color with uniform transparency
  • a velvety, soft and smooth texture
  • no blemishes

The normal skin becomes dryer as the person gets old. 

Risk of Having Acne

Risk factors of acne include genetics, anxiety and stress, the menstrual cycle, hot and humid climates, the use of oil-based makeup, and squeezing of the pimples.

Other risk factors of acne include:

  • Age – People of all ages can get acne, but it is most common in teenagers.
  • Hormonal changes – Hormonal changes are common in teenagers, girls and women, and people who use certain medications, such as those that contain androgens, corticosteroids, and lithium.
  • Family history – Genetics plays a role in acne. You are likely to develop acne if both of your parents had acne.
  • Greasy or oily substances – You are likely to develop acne where your skin comes into contact with oily creams and lotions or with grease in a work area, such as in a kitchen.
  • Stress – Stress does not cause acne, but if you already have acne, stress may make it worse.
  • Friction or pressure on your skin – This may be caused by items such as cellphones, tight collars, helmets, or backpacks.

When to Seek Medical Attention

If self-treatment does not clear the acne, you should see your doctor. Your doctor may prescribe the use of stronger medications. If acne persists or worsens, you may seek medical treatment from a skin specialist – a dermatologist.

For many women, acne may persist for many years, with flares commonly appearing a week before menstruation. This type of acne will clear up without treatment in women who are using contraceptives.

In the elderly, a sudden appearance of severe acne could be a sign of an underlying disease that requires medical attention. 

The Food and Drug Administration has issued a warning that some nonprescription acne lotions, cleansers, and other skin products could cause a serious reaction. The type of reaction is rare that should not be confused with the irritation, redness, or itchiness where you have application medications or products.

Seek emergency medical help if after using the skin product you experience:

Overview

Mouth ulcers are quite common and can be managed at home, without having to see your doctor or dentist. 

Mouth ulcers are typically oval or round sores that appear inside the mouth on the cheeks, lips, and tongue. They can be red, white, grey, or yellow and may be swollen. Mouth ulcers may grow one at a time or may grow and spread.

Mouth ulcers are different from cold sores, which are small blisters that form around the mouth or the lips. Cold sores start with itching, tingling, or burning sensation around the mouth.

There are three types of mouth ulcers:

  • Minor ulcers are the most common among ulcers, which account for about 80% of ulcer cases. These ulcers are small, with a diameter of 2 to 8 mm, and heal naturally within two weeks. This type of ulcer will cause scarring.
  • Major ulcers are larger and deeper than minor ulcers. They usually have irregular or raised border. Major ulcers usually have a diameter of 1 cm or more. They take several weeks to heal and may cause scarring.
  • Herpetiform ulcers are multiple, pinhead-sized sores, numbering from five to 100. The tiny ulcers fuse to form irregular and larger sores, which could be very painful. About 10% of mouth ulcers are herpetiform. This type of ulcers has no relation to the herpes virus.

Mouth ulcers are common, with most people experiencing at least once during their lifetime. Mouth ulcers affect approximately 20% of the general population. These ulcers are more common in women than in men. They are also common in young adults.

Mouth ulcers are not transferred from person to person, even when one kisses someone with mouth ulcers.

Most people have mouth ulcers occasionally, although some have developed mouth ulcers on a frequent or recurring basis. In general, one out of five persons has recurring mouth ulcers. It is estimated that about 10% of children have recurring mouth ulcers. The factors causing recurrent mouth ulcers are different from those that cause single ulcers.

Causes of Mouth Ulcers

Most mouth ulcers are not caused by an infection. As such, mouth ulcers are not passed from one person to another.  Most minor ulcers are caused by damage to the mouth, such as when you accidentally bite the inside of your cheek while eating, using toothbrushes incorrectly, or from a sharp tooth or tooth filling.

The cause of recurrent mouth ulcers is not established, but many factors can increase your chances of getting recurrent ulcers, including:

  • Stress and anxiety
  • Oral trauma, such as chewing hard or sharp foods, or excessive tooth brushing.
  • Hormonal changes – Some women develop mouth ulcers while menstruating. This is due to the changes in the hormone levels during the menstrual cycle.

The consumption of certain foods may also increase your risk of developing mouth ulcers. The following foods are known to increase your risk of getting mouth ulcers:

  • Coffee
  • Chocolate
  • Almonds
  • Peanuts
  • Strawberries
  • Tomatoes
  • Cheese
  • Wheat flour

It is believed that recurrent mouth ulcers are hereditary because around 40% of people with mouth ulcers have a family history of the condition.

People develop more mouth ulcers than usual when they first stop smoking. This is a reaction of the body to the chemical changes that occur when quitting smoking. When you give up smoking, you will notice that there is an increase in your mouth sores, a temporary situation that should not discourage you from stopping smoking. Remember that the long-term health benefits of quitting smoking are greater than the short-term discomfort brought by mouth ulcers. When you stop smoking, you will significantly lower your risk of developing smoking-related conditions such as lung cancer and heart disease.

Underlying conditions

Recurrent mouth ulcers may be due to some underlying conditions, including:

  • Iron deficiency – A diet that lacks in iron means the red blood cells will be unable to carry as much oxygen, leaving you feeling lethargic, tired, and dizzy. Iron deficiency can cause mouth ulcers.
  • Vitamin B12 deficiency – This vitamin aids in making red blood cells and keeps the body’s nervous system healthy. A lack of this vitamin can result in shortness of breath, tiredness, and mouth ulcers.
  • Celiac disease – This condition is caused by an intolerance to gluten, a form of protein found in barley, wheat, and rye. The condition inflames the small intestine. Adults with celiac disease often have mouth ulcers.
  • Crohn’s disease – It is a condition that results in the inflammation of the gut, which leads to the development of ulcers in the stomach and mouth.
  • Reactive arthritis – It is a reaction of the body to another infection. It can cause inflammation that may spread to the mouth.
  • Immunodeficiency – This refers to a condition that suppresses or attacks the body’s immune system and may cause the person to develop mouth ulcers. 

Medication

Mouth ulcers may be caused by your body’s reaction to a medicine you are taking. Some of the medications that may cause mouth ulcers include:

  • Non-steroidal anti-inflammatory drugs or NSAIDs – They are medicines for pain. Children below the age of 16 should not take aspirin.
  • Beta-blockers – These medicines are used for the treatment of various conditions that affect blood flow and the heart, such as abnormal heart rhythms, angina, high blood pressure, and heart failure.

When you start taking any of these medications, you may notice the beginning of ulcers in your when. Mouth ulcers may appear also when you increase the dosage of these medicines.

Diagnosis and Treatment of Mouth Ulcers

Your doctor can diagnose mouth ulcers by conducting a visual exam. If you have recurring mouth ulcers, your doctor might test you for other medical conditions.

Treatment

Most cases of mouth ulcers do not require treatment as they will go away on their own. But, if you have recurrent and painful mouth ulcers, several treatments can decrease the pain and the healing time. The treatments include:

  • Putting milk of magnesia on the mouth ulcer
  • Using a mouth rinse made of saltwater and baking soda
  • Covering your mouth ulcers with a paste of baking soda
  • Using topical anesthetic products like Anbesol and Orajel, which are over-the-counter products
  • Applying ice to the mouth ulcers
  • Using a mouth rinse that contains a steroid to reduce the swelling and pain
  • Placing damp tea bags on your mouth ulcer
  • Using topical pastes
  • Taking supplements such as Vitamin B-6, folic acid, vitamin B-12, and zinc
  • Trying some natural remedies including echinacea, chamomile tea, licorice root, and myrrh

Preventing mouth ulcers

Some steps may help reduce the occurrence of mouth ulcers. You should avoid foods that will irritate your mouth, including acidic fruits such as oranges, grapefruit, pineapple, and lemon, as well as chips, nuts, and spicy food. In place of these foods, choose alkaline fruits and vegetables, and whole grains. Eating a well-balanced diet and taking vitamin supplements will help you avoid mouth ulcers.

Accidental bites cause mouth ulcers. Avoid talking while you are chewing your food to prevent this accident. Maintaining good oral hygiene by regularly brushing and flossing will help. Avoid stress and get adequate rest and sleep. This will help you prevent many illnesses, including the problem of mouth ulcers.

Ask your dentist for a wax that can cover dental or orthodontic devices in the mouth that have sharp edges.

Risks of Having Mouth Ulcers

The risks of having mouth ulcers are high in people who smoke or use products that contain tobacco. Smokers who are also heavy drinkers of alcoholic products have a much higher risk of having mouth ulcers compared to the general population.

People who are infected with the human papillomavirus (HPV), that causes genital warts may also be at risk of having mouth ulcers.

When to Seek Medical Attention

People who frequently get mouth ulcers must make an appointment to see their doctor.

There are some instances when a person should see a doctor immediately, such as during:

  • the appearance of a non-painful ulcer in several areas of the mouth
  • ulcers that are spreading
  • unusual ulcers that appear in a new spot in the mouth
  • ulcers that last longer than 3 weeks

Some people may seek medical attention for their ulcers if:

  • they are particularly big or painful
  • the mouth ulcers are accompanied by a fever
  • the mouth ulcers develop after taking a new medicine
  • secondary bacterial infection.

Usually, mouth ulcers clear up on their own, and the pain that usually comes with the ulcer disappears in a matter of a few days. There are medications, either an ointment or solution, that may reduce the pain and swelling, but they are not necessary for the mouth ulcers to heal. 

Future outbreaks of mouth ulcers can be avoided by reducing stress and anxiety.

Table of Medications

  • triamcinolone
  • dexamethasone
  • Oralone
  • FIRST Mouthwash BLM
  • benzocaine
  • Orajel
  • Anbesol
  • Trianex
  • De-Sone LA
  • Pediaderm TA