Acne is a common disorder affecting up to 20% of teenagers and has recently shown an increased prevalence in adults. It is a disorder of the pilosebaceous units characterized by the presence of papules, pustules, and comedones (blackheads/whiteheads) on the face, trunk and upper back.
What is the cause of acne?
1. An increase in sebum production. Sebum is a substance produced by the oil glands. Overproduction of this substance leads to the production of fatty acids. It also acts as a nidus for the production of bacteria that eventually leads to the development of acne.
2. Cornification of the pilosebaceous unit. Thickening and plugging of the hair follicle and sebaceous glands by keratin lead to occlusion and hence the development of acne.
3. An increase in androgen production. An increase in androgens leads to a hormonal imbalance, which aggravates acne.
4.The proliferation of bacteria. There are bacteria in the skin that contribute to the development of acne, by aggravating inflammation and leading to pustule formation.
What are the clinical features of acne?
An acne patient usually presents with oily skin. The patient may present with papules, pustules, comedones, nodules, and cysts involving the face, chest, and upper back. There are variable degrees of scarring, pigmentation, and uneven skin tone depending on the severity and type of acne.
Remember the following facts:
1. Use a hypoallergenic, non-comedogenic cleanser and moisturizer
2. Do not pick or squeeze your pimples. It only serves to aggravate scars
3. Remember, that there is no quick fix solution in the treatment of acne
4. Remind yourself that acne is not a phase and therefore if untreated, will progress into adulthood with scarring
5. Treatment options include topical keratolytic, comedolytics, systemic antibiotics, oral contraceptive pills, and isotretinoin
6. Consult your practitioner or dermatologist early to prevent the sequelae ie. scarring and pigmentation from acne.
This is a condition where patients present with sudden localized or generalized hair loss with no evidence of scarring.
What is the cause?
- The exact cause of this condition is unknown.
- It is thought that it is most likely an organ-specific autoimmune disorder where the body is able to target the pigment cells in the hair follicle.
What are the clinical presentations of this condition?
Patients usually present with a round to oval sharply circumscribed smooth areas of hair loss. It usually starts as a single lesion and may expand and develop new patches. Common sites include the scalp, beard, eyebrows, and eyelashes.
Can the hair regrow with this condition?
Yes, the hair can spontaneously regrow with this condition. However, regrowth depends on the duration of the condition. The longer the duration, the poorer the chance of hair growth. When hair growth does occur, it usually occurs with a white tuft of hair.
What are the treatment options available?
- Topical steroids –to apply on the lesions
- Topical irritants eg. DNCB or dithranol cream to the affected area
- Topical stimulants eg Minoxidil (Regaine) solution/spray
- Intralesional steroids –eg celestone soluspan into the affected area
- Pulse systemic steroids eg prednisone
- Turban PUVA therapy /narrowband UVB –targeted to the areas of alopecia
- Systemic agents eg Azathioprine, Cyclosporine, Cellcept or Sulphasalazine
- Excimer laser –for localized alopecia areata –used 2x week for 24 weeks