Mechanisms, manifestations and acne skin treatment

Mechanisms of development and strategies to treat

Treatment should be aimed at achieving clearance of acne, prevention of scarring and, where necessary, relief from any psychologic stress resulting from the acne. Early treatment of acne may be commenced in the disease process in order to prevent scarring and it is important to select appropriate therapies according to the clinical signs and psychologic disability. Coming up with a protocol for adult acne cure requires understanding of acne mode of development. Although, the precise mechanisms of acne are not known, it is clearly accepted that there are these four major etiological factors involved in development of acne:

1. An increased sebum production

2. Ductal hypercornification (hyperproliferation of ductal epidermis) Hypercornification is overproduction of epithelial cells lining follicles (sebaceous ducts, these ducts conduct sebum to the skin). Hypercornification may result in closure of the ducts and cause comedone and acne

3. Bacterial colonization of the duct with Propionibacterium acnes (see photo)

4. Further production of inflammation in acne sites

Acne and sebum generation: Several factors influence sebum production, but it is predominantly hormonally stimulated. In treatment of acne androgens, and their influence must be considered. Androgens especially from the testes and adrenals, stimulate the sebaceous gland directly and influence acne inflammations. Estrogens exert a variable inhibitory effect in pharmacological doses. Sebum excretion is significantly greater in patients with cystic acne and attempts pharmacologically to reduce the sebum excretion are a logical approach to its topical treatment.

The sebaceous glands ( part of sebaceous follicles ) are under endocrine control and so it is not surprising that sebum production shows change according to age and sex of an acne patient. Sebum production is dramatically greater than that in females in normal individuals as well as acne patients. There is an increase in sebum generation with a peak at about age 40. Any approach to control androgens appear to be relevant to adult acne since the sebaceous follicle ( Sebaceous glands are located in the dermis (the middle layer of skin) and secrete oil onto the skin.
) is an organ targeted by androgens.

Hyper proliferation of ductal epidermis is associated with development of adult acne. A possible stimulus to pilosebaceous duct hypercornification could be hormones, in particular androgens. Within the duct, variations in the lipid composition have been put forward to explain comedone ( a initial acne lesion ) formation, which could be either closed (whiteheads, see photo) or open (blackheads, see photo). Such variations include an increased concentration of squalene, squalene oxide, and certain fatty acids. A decrease in the linloleic acid fraction of the skin surface lipids has been shown in a patient with acne. Micro-organisms have also been implicated.

Skin surfaces in the acne prone areas are colonized with Staphylococcus epidermidis and Propionibacterium acnes. However, P. acnes appear to be the main organism in acne and its elimination should be addressed during the course of acne. Studies suggest that bacteria have nothing to do with the initiation of comedogenesis. However, P. acnes, in particular, may in some situations be important in the initiation of inflammation. It is also quite likely that they are involved in a perpetuation of inflammation once established.

The adult acne inflammation is not, in most cases, an abnormal response of the immune system. The inflammation represents a normal immune and nonimmune response to foreign substances penetrating the dermis. It is important for a patient on a blemish treatment to know that acne is not infectious. In most cases the inflammation settles, papules and pustules lasting about 3-14 days but larger lesions persist longer. The larger and more actively inflamed lesions will in some instances produce permanent dermal damage and result in acne scars. Could acne be cured? Most treatments target the present lesions and do not eliminate the underlying cause. Relapses are very common and could be triggered by cauasative factors among them stress and hormonal imbalance.

Manifestations of acne

Patients almost always demonstrate lesions on the face. Smaller percentages exhibit acne on the back and on the chest. Acne lesions are divided in two major groups. Inflammatory and non-inflammatory lesions. Skin treatment of these two types of acne may vary. Non-inflammatory lesions or comedones are subdivded into white heads and black heads. White heads are closed comedones with some pathological changes in pilosebaceous duct (hypercornification of the duct, which results in closure of the follicle). Black heads or open comedones presents as an obvious black lesion especially on the top.1-3 mm in diameter. Accumulation of the melanin (skin pigment) in blackheads cause the black color. There are many patients who have few or no black heads. Manifestations of adult acne in form of white heads and black heads is very common and they may be the starting point for an inflammatory lesion.

Inflammatory lesions such as papules, pustules, nodules, cysts, macules and scars are among other manifestations of acne. Papules and pustules are more superficial compare to the rest of inflammatory acne and their cure takes a shorter period of time, 5-10 days. These pimples are caused by blockage of oil glands. Papules are red lesions (pimples). Pustules are similar to papules but with a central collection of white pus at their top. Nodules are deep-seated structures and tend to remain for as long as eight weeks before finally resolving. Cysts ( cystic acne ) are not very common but when they occur they may reach several centimeter in diameter. Cysts are tender, sensitive, deeper and larger pimples filled with pus. Cystic acne is considered a severe acne form and its treatment must be consulted with a physician. Cystic acne cure may take longer period of time and its recurrency is very likely.

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There are three major therapeutic goals for acne vulgaris: Resolve existing acne, prevent scarring, and suppress the development of new clinical lesions by treating and preventing the development of subclinical microcomedones. Hippocrates skin treatment is aimed at these objectives. Benzoyl peroxide, alpha and beta hydroxy acids, and azelaic acid are appropriate therapeutic options for use in maintenance therapy. Those agents that demonstrate the best cutaneous tolerability, are easily integrated into patients' lifestyles, and are associated with potential therapeutic dividends such as "skin-repairing" effects offer the highest potential for patient adherence.

Hippocrates adult acne skin treatment Kit has been bioengineered to respond to the four etiological factors responsible in development of acne. Increased sebum excretion is controlled during the day by "Day Effect", an element of Hippocrates acne kit, and overnights by the acne serum. Depletion of essential fatty acids (linolenic acid) is associated with sebaceous gland hypertrophy and hyperkeratinizaton of the ducts, two features relevant to acne even cystic lesions. "Day Effect" and Hippocrates Acne serum by providing the skin with essential fatty acids regulate sebum excretion. This regulating cream also targets bacterial colonization. "One-Step Cleanser and Toner" is an aimed weapon toward bacterial colonization in acne.

"Day Effect", sebum regulator, keeps fighting bacterial colonization during the daily activities while controls skin's secretions. Acne inflammation which is far greater in cystic form, is controlled by extracts and essential oils of Chamomile, Lavender Sage, Licorice root and Green tea present in Hippocrates serums such as Hippocrates serum for acne, "Day Effect" and "One-Step Cleanser and Toner". Bioflavanoids, Greentea extract and alpha lipoic acid help to mitigate stratum corneum changes as a result of depletion of its antioxidants.

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