ACNE TREATMENT PATIENT ADVOCATE
Equity Press-HealthScouter.com
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ACNE TREATMENT PATIENT ADVOCATE
Edited By: Katrina Robinson
Includes Acne from Wikipedia http://en.wikipedia.org/wiki/Acne
ISBN: 978-1-60332-114-3
Smashwords Edition
Edited Components are Copyright (c) 2009 Equity Press
Permission is granted to copy, distribute and/or modify this document under the terms of the GNU Free Documentation License, Version 1.2 or any later version published by the Free Software Foundation; with no Invariant Sections, no Front-Cover Texts, and no Back-Cover Texts. A copy of the license is included in the section entitled "GNU Free Documentation License".
HealthScouter and Equity Press do not provide medical advice. The contents of this book are for informational purposes only and are not intended to substitute for professional medical advice, diagnosis or treatment. Always seek advice from a qualified physician or health care professional about any medical concern, and do not disregard professional medical advice because of anything you may read in this book or on a HealthScouter web site. The views of individuals quoted in this book are not necessarily those of HealthScouter or Equity Press.
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History of some acne treatments
Preferred treatments by types of acne vulgaris
Diseases of the skin that develop papules
References: Propionibacterium Acnes
GNU Free Documentation License
Dear Reader,
I like to think of myself as a polite, well-reasoned person. I rarely speak out or complain. When a waitress spills something on me, or if my meal is cold—or if I’m overcharged—I generally try to be as polite as possible. I don’t like to make very many waves. I often secretly hope that the manager will hear about my predicament and come out and offer me a free meal, or something similar. I generally hope that my polite and respectful demeanor pays off. And it does happen from time to time. You know, I think many people are brought up to believe that this is just good manners. It’s how you’re supposed to behave. And if you knew me personally, I think you’d agree that I’m generally pretty reserved. Of course my wife may raise an objection or two (!), but I really believe that it’s important to treat others as you would like to be treated. We’re talking about the golden rule here—it works well and it applies to almost every life circumstance.
But I have to admit that when it comes to my health, or the health of someone I care about—all bets are off. I want to know what’s going on—when, why, where, and how. And I make these feelings known. I tend to get downright assertive. It’s just something I feel very strongly about. And I feel that when you are in a hospital, or if you’re brushing up against the healthcare system, that you should feel the same way. It’s unfamiliar turf, and the professionals who work in this system often take advantage of their positions. They may use some jargon to hide the whole truth— or they may say something without checking to make sure you understand completely. They may presentthe options that are best for them, perhaps the most profitable or convenient. Now I’m not saying this goes on everywhere. There are many professionals in thebusiness of health who go out of their way to make sure you have the best care. And I’m not suggesting that you should become a bully, or purposefully annoying—absolutely not. But I am suggesting that I think it’s OK for you to step outside of your typical comfort zone, and put on your patient advocate hat. Because you, the patient or patient advocate, care the most about your care—not the medical system or healthcare providers.
HealthScouter was created to help patients become better advocates for their own medical care. Because when it comes to your healthcare, the stakes are high. There are none higher. And healthcare is one area where consumers (us, the sick people) are notoriously unaware of their options. And that’s why I’m publishing these books. To help you understand your options, and to help you get the best care possible. I want to help you become a better advocate for yourself and for your loved ones.
It’s my sincere hope that you can take this book with you to the hospital, to be read in the waiting room or by the bedside—and when you see a relevant patient comment you can use this book to ask questions of your health care providers. My advice: Ask lots of questions! Providers are busy people who generally go about their business with little questioning, delivering care as they see fit—making quick decisions—and again, nobody is going to care as much about your health as you. So now, more than ever, you need tools at your disposal to get the best care possible. One of the tools at your disposal is this HealthScouter book and the material within. You need to be armed with questions, and you need to ask questions all of the time. And so the difficult part is now to understand the right questions to ask.
That brings me to an explanation of how these books are structured. HealthScouter books include a number of what we call patient comments. These patient comments are summaries of what people have experienced. They’re first hand accounts of what you may expect. These experiences effectively help you “catch up,” and understand what outcomes are possible. They expose you to the treatments are available, and provide insight as to potential outcomes. They help you understand what other people are doing. So if you find yourself stuck feeling like you’re receiving substandard medical care—or if you need a push to broach the subject, you can take this book to your provider and say, “Hey, I read here that another patient had this treatment—is that an option for me? If not, Why?” I believe that other peoples’ experience is the most valuable way for you to formulate and build a list of good questions for your healthcare providers.
That notion is at the core of the HealthScouter philosophy.
So HealthScouter, by providing patient comments about a particular medical condition, will help expose you to what other people have experienced about a particular medical problem. If you know what other people have experienced, you can better understand what your options are. You’ll be better informed and you’ll have some questions to ask—it’ll be like you’ve had access to dozens of other people who have gone through the same thing you’re going through. And so armed, maybe you’ll be able to move through your condition and get back on the road to health, and maybe you’ll be able to do this with more grace than I have. And that is my sincere wish.
It’s also my wish that perhaps when a doctor or nurse sees this little book, that they’ll think twice about the care they’re about to provide—knowing that the owner is a little bit better prepared, a little bit better armed—and yes, maybe even downright assertive.
I hope this book helps.
Yours truly,
Jim Stewart
San Diego, California
The purpose of HealthScouter is to help you understand your medical condition as quickly and easily as possible. We believe this can best be accomplished by reading about other people and their experiences negotiating their health and care. We try to leave out complicated medical jargon. And we’ve spent a considerable amount of time structuring this book so that it’s easy to use. It’s important to know that this is not the sort of book you read from beginning to end. Of course you may do so, but this book is more meaningful if you flip through quickly and scan for applicable material. Again, it’s all about the patient commentary: The darkly shaded comments indicate one patient initiating a new discussion, and the light or clear comments are other comments associated with that same condition. So you should begin by looking for information from other patients who are experiencing the same aspect of the same medical condition that you studying. You can do this quickly by scanning through the book, focusing on the dark shaded comment boxes.
By scanning the patient comments you’ll find information about various aspects of a condition, all grouped together, in an easy-to-read format. In this way you can immediately begin reading about other patients and their experiences with your particular medical condition – and you can benefit immediately from their experiences.
Acne vulgaris (commonly called acne) is a common skin condition, caused by changes in the pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland via androgen stimulation. It is characterized by noninflammatory follicular papules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. Acne vulgaris affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.[1] Acne lesions are commonly referred to as pimples, blemishes, spots, zits, or acne.
Acne is most common during adolescence, affecting more than 85% of teenagers, and frequently continues into adulthood. The cause in adolescence is generally an increase in male sex hormones, which people of both genders accrue during puberty. [2] For most people, acne diminishes over time and tends to disappear—or at the very least decrease—after one reaches one's early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will continue to suffer well into their thirties, forties and beyond.[3]
The face and upper neck are the most commonly affected, but the chest, back and shoulders may have acne as well. The upper arms can also have acne, but lesions found there are often keratosis pilaris, not acne. Typical acne lesions are comedones, inflammatory papules, pustules and nodules. Some of the large nodules were previously called "cysts" and the term nodulocystic has been used to describe severe cases of inflammatory acne. [4]
Aside from scarring, its main effects are psychological, such as reduced self-esteem[5] and, according to at least one study, depression or suicide.[6] Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall impact to individuals.
Patient 1:
Since college, my acne has been getting progressively worse, leaving more dark spots all over my face. I'm in my mid-20s now, with no clear solution as to control the acne. It flares up right before my period but maintains a consistent level all throughout the cycle.
I have tried all kinds of over the counter washes, toners, leave-ons, etc. Nothing really works. I need to find a way to get rid of the spots but also spot the acne from reemerging. Any suggestions?
Patient 2:
Have you ever tried Yaz birth control? Since I had hormonally-related acne, I tried Yaz and the results were miraculous. Unfortunately, I had such a severe side-effect (depression) that I got off the medicine.
There is one lotion, however, that seems to have a very noticeable effect on my skin. Ironically, the miracle lotion is Palmers Shea Butter Lotion. It is not labeled as non-comedogenic, but I have been using it for three years and notice a big difference when I don't use it. Unfortunately, it is not a cure-all, but I think the lotion calms the skin to a level that the acne is not as damaging.
Some of the products are not cheap, but they last forever. I use Cellex-C Betaplex foaming wash in the morning (contains alpha hydroxy acid, aloe, etc). If I have any active acne, I dab on Duac lotion (prescription). Then I put on the Lancome cream “High Resolution with Fibrelastin” followed by sun block. In the evening I wash my face with a salicylic acid face wash (I prefer Neutrogena). Then I put on the Palmer's shea butter.
You should also make sure that your makeup is not aggravating the acne. I have found that bare minerals work the best.
Patient 1:
I've been suffering mild-moderate acne for about four years now. I've tried all sorts of over the counter topical products from the drugstore, but because my skin is so sensitive, most things would only make me red and blotchy and itchy, or they would make me break out. All of my acne is underneath the surface of the skin - closed comedones that very rarely ever come to a head, and their emergence is heavily tied to my menstrual cycle. I believe that treating this kind of acne as you would treat someone mostly suffering pustules is pointless, as the clogged pores aren't receptive to medicines that only serve the purpose of killing bacteria. Because of this, I think the type of acne that consists mostly of closed comedones, while being the mildest type in terms of pain and appearance, is some of the most difficult to treat. All of these years I have been treating my acne as if I was dealing with pustules, but reducing the bacteria on my skin's surface was doing very little or nothing to help unclog my pores.
After doing a little research on prescription acne meds and how they work, particularly Retin-A (which seems to be one of the few meds designed specifically for my variety of acne), I've changed everything I used to believe about acne treatments and how they show their effectiveness.
Now, I think that the years of frustration of using a product and then being discouraged by the subsequent breakout of pustules and stopping the regimen, was the biggest mistake I've made consistently in my struggle with my skin. Acne products generally advertise immediate results - a shrinking in blemish size, a calming of the redness of the skin, an overall smoother appearance, after a few treatments. We expect and hope that a spot will shrink and disappear if we slather some product onto it, not that the skin will erupt in pustules (which my skin has done in response to almost every regimen I've tried). But now that I understand the type of acne I'm dealing with, this process makes perfect sense. Every time I've disregarded an acne product because instead of helping reduce inflammation or shrink my pores, it caused a breakout, I've actually been ceasing treatment at the most crucial point, the point when I should be looking positively upon the treatment. This breakout doesn't signal ineffectiveness, it signals the purging of my pores.
More specifically, I'm talking about salycic acid. Whenever I've used it in the past, I've felt disgusted and ripped off when a couple days later my skin looked ten times worse because the tiny, closed comedones were replaced by “real” pimples. Immediately I assumed that my skin was too sensitive and was reacting poorly to treatment, and I would stop the treatment and go back to simple cleansing and occasional exfoliation, and the comedones would continue to dominate my skin - stubborn and infuriating. But now I realize that perhaps the breakout phase is a necessary part of controlling the type of acne typified by closed comedones. The clogged pores must be forced to bring the clogged material to the surface, form a pustule, then heal. I'm going to suggest a regimen for people with my kind of acne, 99% closed comedones underneath the skin, with heavy hormonal influence. The regimen is this:
1) Salycic acid, either in cleanser form or in wipe/pad form after gentle cleansing (I'll be using the pads), for as long as it takes for closed comedones/whiteheads to form into pustules.
2) Then limit salycic acid treatment to areas of whitehead persistence, while treating pustules with Benzoyl Peroxide
3) SPF oil-free noncomedogenic moisturizer every single day, and a noncomedogenic moisturizer at night if desired.
The above images show different types of Acne Vulgaris: A: Cystic acne on the face, B: Subsiding tropical acne of trunk, C: Extensive acne on chest and shoulders.
The term acne comes from a corruption of the Greek άκμή (acne in the sense of a skin eruption) in the writings of Aëtius Amidenus. Used by itself, the term "acne" refers to the presence of pustules and papules.[7] The most common form of acne is known as "acne vulgaris", meaning "common acne". Many teenagers get this type of acne. Use of the term "acne vulgaris" implies the presence of comedones.[8]
The term "acne rosacea" is a synonym for rosacea.[9] Chloracne is associated with chlorine toxicity.
Patient 1:
Does anyone know if masks are supposed to make you break out and why? Should I continue to put them on my skin, despite getting these awful cysts, to just keep “purging” my skin?
Patient 2:
Masks can definitely make you break out, as they are drawing everything out and upwards from deep within your skin. I have moderate acne and have had quite a few cystic ones along my cheeks and jaw line. I am currently on a prescription Benzaclin gel pump and that took care of my cystic ones (they were starting to scar). However it did NOT get rid of anything else--the blackheads, whiteheads, etc. So today I got a Retin-A .1% gel, so I hope that helps.
Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo (whitehead). Whiteheads are the direct result of skin pores becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedo, which results in redness and may result in scarring or hyperpigmentation.[10]
Patient 1:
Has anyone else who has stopped using Yasmin experienced a gradual increase in acne/breakouts?
Patient 2:
That’s the exact reason I got back on Yasmin. I was off for four months, and the only thing that got worse was my face and it was five times worse then when I was even put on birth control to begin with.
The root causes of why some people get acne and some do not are not fully known. It is known to be partly hereditary. Several factors are known to be linked to acne:
Family/Genetic history. The tendency to develop acne runs in families. For example, school-age boys with acne often have other members in their family with acne as well. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.[11]
Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the follicular glands to get larger and make more sebum.[12]
Inflammation, skin irritation or scratching of any sort will activate inflammation. Anti-inflammatories are known to improve acne.
Stress, through increased output of hormones from the adrenal (stress) glands. While the connection between acne and stress has been debated, scientific research indicates that “increased acne severity” is “significantly associated with increased stress levels.” [13] The National Institutes of Health list stress as a factor that “can cause an acne flare.” [14] A study of adolescents in Singapore “observed a statistically significant positive correlation…between stress levels and severity of acne.” [15]
Hyperactive sebaceous glands, secondary to the three hormone sources above.
Accumulation of dead skin cells that block or cover pores.
Bacteria in the pores. Propionibacterium acnes (P. acnes) are the anaerobic bacterium that causes acne. In-vitro resistance of P. acnes to commonly used antibiotics has been increasing.[16]
Use of anabolic steroids.[17]
Any medication containing lithium, barbiturates or androgens.
Exposure to certain chemical compounds. Chloracne is particularly linked to toxic exposure to dioxins, namely Chlorinated dioxins.
Exposure to halogens. Halogen acne is linked to exposure to halogens (e.g. iodides, chlorides, bromides, fluorides).
Chronic use of amphetamines or other similar drugs.[18]
Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I). In addition, acne-prone skin has been shown to be insulin resistant.
Development of acne vulgaris in later years is uncommon, although this is the age group for Rosacea which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).
Patient 1:
My skin is very prone to acne; it's in my genes. But before getting pregnant, I was on birth control and that seemed to clear my face up. After being off the pill for about three months, my face was still clear. Now, my face is breaking out with this pimply rash thing. So I’m guessing my face is breaking out due to my hormones going crazy. Has anyone else gone through this while pregnant and did it clear up after a while or is this something I’m going to have to live with for nine months?
Patient 2:
I have never had what you could diagnose as acne but I've always had far from perfect skin. My skin is prone to regular breakouts but not severe acne. My first 12 weeks, my breakouts got worse but not horrible before they got better. I'm 21 weeks now, and as I entered my second trimester, week by week my skin got clearer and stayed that way. I still get breakouts but I don't keep them and they aren't bad whatsoever. The good news for me was it noticeably cleared up in my second trimester and it still doing okay. The best thing you can do is wash your face twice a day with a good cleanser and your hormones will do the rest.
Patient 3:
The very first sign that I know I'm pregnant is the acne. Like you, I was on the pill for years and it was under control. Pregnancy seemed to bring it out in me, though. During my first pregnancy, it went away after the first trimester. In my second pregnancy it ended about the same time I was told the fetus had died (seven weeks). This time, I'm eight weeks and have acne galore! I just hope it subsides at about 12 weeks again.
Patient 1:
Has anyone found a safe and effective way to treat acne while pregnant?
Patient 2:
The best thing to treat an acne skin while pregnant is to try and find a product range that uses only natural ingredients and not chemicals and has been classified as a cosmeseutical (which means it has cosmetic but also pharmaceutical properties). Another tip is do not skip a step in your cleansing routine: cleanse, tone and then moisturize and most importantly use an exfoliator (scrub). Make sure you buy a product best suited for your skin type. If you can also try go for a facial every 4-6 weeks so that your skin can be steamed cleaned out properly.
Patient 1:
For years I had pretty bad acne, and I know there is not much concrete study related to diet and effects, but let me tell you, I guarantee the stuff I eat affects me and it does so pretty bad. It seems that any dairy and bread products are what are doing it, also corn, potatoes, etc. I need to find a diet that eliminates this stuff. I was thinking about trying a fish/chicken/red meat diet but I need other stuff as well, and don’t want to strictly take supplements to achieve it. Anybody have any ideas on what I can do?
Patient 2:
Your diet seems very limited on fruit and vegetables - and in my experience they are the main food group that has really helped my skin when I eat a lot of them. Fruit and vegetables are packed with antioxidants, vitamins, minerals, fiber which all help your digestive system work smoothly and keep you in good health and make your skin brighter. They also have high water contents, and we all know how important drinking water is for the skin.
The popular belief that consumption of chocolate can cause acne is not supported by scientific studies. [19][20] As discussed below, various studies point not to chocolate, but to the high glycemic nature of certain foods containing simple carbohydrates as a cause of acne. Chocolate itself has a low glycemic index [21]
Recently, three epidemiological studies from the same group of scientists found an association between acne and consumption of partially skimmed milk, instant breakfast drink, sherbet, cottage cheese, and cream cheese.[22][23][24] The researchers hypothesize that the association may be caused by hormones (such as several sex hormones and bovine insulin-like growth factor 1 (IGF-1)) or even iodine[25] present in cow milk.
Patient 1:
I have been a lacto-ovo-vegetarian for six years and I am wondering if that has any affect on my skin. I read some articles on detoxification and they said to avoid dairy products, which are my main source of protein. I work out a lot so loading up with protein is very important.
Patient 2:
A vegetarian diet should help your skin, as far as I know. Maybe you can try excluding diary if you think that's the problem, but in my experience the difference is trivial.
Patient 3:
I have been reading up on the effects of milk on acne. Supposedly milk from pregnant cows contains hormones that “turn on” oil glands.
The long-held belief that there is no link between diets high in refined sugars and processed foods, and acne, has recently been challenged.[26] The previous belief was based on earlier studies (some using chocolate and Coca Cola) that were methodologically flawed.[26][27][28] The recent low glycemic-load hypothesis postulates that rapidly digested carbohydrate foods (such as soft drinks, sweets, white bread) produce an overload in blood glucose (hyperglycemia) that stimulates the secretion of insulin, which in turn triggers the release of IGF-1.[26] IGF-1 has direct effects on the pilosebaceous unit (and insulin at high concentrations can also bind to the IGF-1 receptor)[29] and has been shown to stimulate hyperkeratosis and epidermal hyperplasia.[30] These events facilitate acne formation. Sugar consumption might also influence the activity of androgens via a decrease in sex hormone-binding globulin concentration.[31][32]