ACNE
Acne vulgaris (or simply acne) is a common human skin disease, characterized by areas of seborrhoea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), nodules (large papules), pimples, and possibly scarring. Aside from scarring, its main effects are psychological, such as reduced self-esteem ,shame , embarrassment , at times due to unresolved case of acne patient may have to face various social stigma – a mark of infamy or disgrace , inturn the patient may go into depression , suicidal thoughts . In adolescence, acne is usually caused by an increase in androgens such as testosterone, which occurs during puberty, regardless of sex. Acne more often affects skin with a greater number of oil glands; these areas include the face, the upper part of the chest, and the back Severe acne is inflammatory. The skin changes are caused by changes in pilosebaceous unit.
The pilosebaceous unit consists of the hair shaft, the hair follicle, and the sebaceous gland which makes sebum.
Human skin, especially on the face, neck, back, and the chest are covered in hundreds of thousands of microscopic hair follicles, often called pores.
For reasons no one completely understands, these follicles sometimes overproduce cells and become blocked. Sebum (oil) which normally drains to the surface gets trapped and bacteria begins to grow. All acne lesions start out as a micro-comedones.
Normal follicle
Debris and bacteria collect in these clogged pores which then leads to inflammation: papules and pustules with erythema (redness) and edema (swelling with suppuration -pus formation).
CAUSES OF ACNE
Acne Vulgaris is related to –
– Presence of hormones (androgens)
– Sebaceous gland activity (increased in presence of androgens)
– Plugging of the hair follicle as a result of abnormal keratinization of the upper portion (gives rise to comedones)
P. acnes (bacteria) in the hair follicle (lives on the oil and breaks it down to free fatty acids which cause inflammation)
– Open comedones
– Closed comedones
– Pustules
– Inflamed pustules
– Scarring
Acne occurs most commonly during adolescence, affecting an estimated 80–90% of teenagers in the Western world. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will carry this condition well into their thirties, forties, and beyond.
Acne vulgaris often referred to as “acne,” is a disorder of pilosebaceous follicles
Typically presents at ages 8-12 (often the first sign of puberty), peaks at ages 15-18, and resolves by age 25.
Affects 90% of adolescents and affects races equally.
Family history is often positive.
12% of women and 3% of men will have acne until their 40s.
In women, it is not uncommon to have a first outbreak at 20-35 years of age.
Acne can be distressing and annoyingly persistent. Acne lesions heal slowly, and when one begins to resolve, others seem to crop up.
Signs and symptoms
Typical features of acne include seborrhea (increased oil-sebum secretion), comedones, papules, pustules, nodules (large papules), and possibly scarring. The appearance of acne varies with skin colour. It may result in psychological and social problems.
Some of the large nodules were previously called “cysts” and the term nodulocystic has been used to describe severe cases of inflammatory acne. The “cysts,” or boils that accompany cystic acne, can appear on the buttocks, groin, and armpit area, and anywhere else where sweat collects in hair follicles and perspiration ducts. Cystic acne affects deeper skin tissue than does common acne.
1. Non-inflammatory acne
Microcomedones can spontaneously become unplugged and heal or they become non-inflamed skin blemishes called comedones- either a whitehead or a blackhead:12-13
Whitehead
When the trapped sebum and bacteria stay below the skin surface, a whitehead is formed. Whiteheads may show up as tiny white spots or they may be so small that they are invisible to the naked eye.
Blackhead
A blackhead occurs when the pore opens to the surface and the sebum, which contains the skin pigment melanin, oxidizes and turns a brown/black colour. It is not dirt and can not be washed away. Blackheads can last for a long time because the contents very slowly drain to the surface.1,13
2. Inflammatory acne
Blackhead or whitehead can release its contents to the surface and heal or the follicle wall can rupture and inflammatory acne can ensue. This rupture can be caused by a random occurrence or by picking or touching the skin. This is why it is important to leave acne-prone skin relatively untouched.
PAPULE
A papule occurs when there is a break in the follicular wall. White blood cells rush in and the pore becomes inflamed.13
PUSTULE
A pustule forms several days later when white blood cells make their way to the surface of the skin. This is what people usually refer to as a “zit” or a “pimple.”13
A papule or pustule can completely collapse or explode, severely inflaming the surrounding skin and may engulf neighbouring follicles. These lesions are called cysts or nodules:1,13
CYST
Sometimes a severe inflammatory reaction can result in very large pus-filled lesions.1,13
NODULE
When a follicle breaks along the bottom, total collapse can occur, causing a large, inflamed bump that can be sore to the touch.13
SCARS
Acne scars are the result of inflammation within the dermis brought on by acne. The scar is created by the wound trying to heal itself resulting in too much collagen in one spot. This is because the scars tend to cause an indentation in the skin’s surface. There is a range of treatments available deep pits, that are the most common and a classic sign of acne scarring.
Boxcar scars: Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep.
Hypertrophic scars: Thickened, or keloid scars.
PIGMENTATION
Pigmented scars is a slightly misleading term, as it suggests a change in the skin’s pigmentation and that they are true scars; however, neither is true. Pigmented scars are usually the result of nodular or cystic acne (the painful ‘bumps’ lying under the skin). They often leave behind an inflamed red mark. Often, the pigmentation scars can be avoided simply by avoiding the aggravation of the nodule or cyst. Pigmentation scars nearly always fade with time taking between three months to two years to do so, although they can last indefinitely if untreated.
Development of acne vulgaris in later years is uncommon, although the incidence of rosacea, which may have a similar presentation, is increased in older age groups. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy, or disorders such as polycystic ovary syndrome, hirsutism, Genetic, psychological stress as a factor that can cause an acne flare, Infections.
Propionibacterium acnes (P. acnes) is the anaerobic bacterium species that is widely concluded to cause acne, though Staphylococcus aureus has been universally discovered to play some role since normal pores appear colonized only by P. acnes. the resistance of P. acnes to commonly used antibiotics has been increasing, as well.
The relationship between diet and acne is unclear as there is no good-quality evidence. However, a high glycemic load diet is associated with worsening acne. There is also a positive association between the consumption of milk and a greater rate and severity of acne. Other associations such as chocolate and salt are not supported by the evidence. Chocolate does contain a varying amount of sugar that can lead to a high glycemic load and it can be made with or without milk.
Pathophysiology
Acne develops as a result of blockages in the 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. The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo. Comedones are the direct result of sebaceous glands’ becoming clogged with sebum, a naturally occurring oil, and dead skin cells In these conditions, the naturally occurring largely commensal bacterium Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedones, which results in redness and may result in scarring or hyperpigmentation.
Management
In allopathy, acnes are treated by external application of ointment which leads to suppression resulting in drastic severe conditions which are not the case in homoeopathy because homoeopathy deals with the overall condition of the patient and treating the root cause thereby preventing suppression.
Conventional Allopathic method of treating acne
1. Medications Benzoyl peroxide
Benzoyl peroxide cream
Benzoyl peroxide is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects (mainly irritant dermatitis). It works against P. acnes, helps prevent formation of comedones, and has anti-inflammatory properties. Benzoyl peroxide normally causes dryness of the skin, slight redness, and occasional peeling when side effects occur.
2. Antibiotics
– Antibiotics are reserved for more severe cases and decrease acne due to their antimicrobial activity against P. acnes in conjunction with anti-inflammatory properties. With increasing resistance of P. acnes worldwide, they are becoming less effective. topical antibiotics biotics that may be used to treat acne in pregnant women, but have received less extensive study.
– Systemic and topical retinoids, systemic and topical antimicrobials, and systemic hormonal therapies are the main classes of treatment
– Multiple agents are often used with activity against different pathogenic causes (e.g. topical antibiotic plus retinoid)
– Use topical antibiotics with benzoyl peroxide to prevent the development of antibiotic resistance
Acne scarring is difficult to treat, therefore aggressive prevention is important.
3. Salicylic acid
Helps to lessen acne due to its bacteriostatic and keratolytic properties. Additionally, salicylic acid can open obstructed skin pores and promotes shedding of epithelial skin cells. Hyperpigmentation of the skin has been observed in individuals with darker skin types who use salicylic acid.
4. Hormones
In females, acne can be improved with the use of any combined oral contraceptive.
5. Other procedures:
Comedo extraction may help those with comedones that do not improve with standard treatment, at least temporarily A procedure with high patient satisfaction] for immediate relief is the injection of corticosteroids into the inflamed acne comedones. There is no evidence that microdermabrasion is effective.
Light therapy and lasers are insufficient to recommend them for routine use. Light therapy is an expensive treatment modality and while it appears to provide short term benefit, there is a lack of long term outcome data or data in those with severe acne.
Laser surgery can be used to reduce the scars left behind by acne.
For people with cystic acne, boils can be drained surgically.
Acne usually improves around the age of 20 but may persist into adulthood. Permanent scarring may occur.
The conventional methods tend to suppress due to external application and chances of relapse/recurrence does occur as the disease is not uprooted from its root cause.
HOMOEOPATHY FOR ACNE
…any internal derangement is reflected outwardly onto the skin…so an efficient homoeopath would definitely focus on the internal cause to rearrange the skin to normalcy…so it all depends on patient’s immunity and course of time taken and the cause for development of this case which would further decide the time to be taken to cure.
Homoeopathy treats the person as a whole. It means that homoeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homoeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also taken into account.
The miasmatic totality
The totality of symptoms
The essence, the gestures, postures behaviour, keynote symptoms the PQRS ( peculiar queer, rare, strange ) symptoms are to be taken into consideration in homoeopathic prescribing.
The diagnosis helps in surface miasm
The totality of symptoms, the miasm, the facial expressions, the peculiar, queer, rare strange symptoms all go hand in hand.
The homoeopathic physician must ensure remedy covers the miasm.
The homoeopathic physician then administers the remedy which covers the miasm along with the totality of symptoms.
Dermatological (acne) Symptoms of the Miasms
A – Psoric Miasm: Dirty, dry, itching without pus or discharge, burning, scaly eruptions, sweat profuse < during sleep, offensive.
B – Sycotic Miasm: Warts, moles, unnatural thickening of skin, herpes, scars, nails are thick, irregular & corrugated, oily skin with oozing, disturbed pigment in patches.
C – Syphilitic Miasm: boils, discharge of fluids and pus, offensive, slow to heal eruptions < by heat
The true natural chronic diseases are those that arise from a chronic miasm, when left to themselves, improper treatment, go on to increase, growing worse and torment the patient to the end of his life.” §78 Organon of Medicine
Reportorial rubric:
[Kent] skin, Eruptions, Pimples
[Murphy] skin, Acne
[Boericke] skin, Face, Eruption on face, Acne rosacea/Acne simplex
[Boennighausen’s] Face, Acne
[Synthesis repertory] – skin inflammation
[Skin – itching ]
Homoeopathic Remedies for Acne
Sulphur, Kali bromatum, Berberis aquifolium, Belladonna, Natrum muriaticum, Hepar Sulphur, Nux vomica,
Sulphur
Is perhaps the remedy most often indicated in this affection, especially if chronic. The skin is rough and hard and the acne is associated with comedones and constipation; great aggravation from water is the characteristic leading to Sulphur in skin affections. Face is pale, sickly colour. Heat and spotted redness of the face. Black pores. Itching intensely in the evening and from warmth. is the variety corresponding most nearly to Sulphur.
Kali bromatum
Acne on the face, neck and shoulders. This remedy is especially adapted to the females , especially in hypersensitive , nervous females. Face flushed. Acne of face, pustules. Sad, melancholic. tremulousness Itching of skin worse on chest, shoulders, and face.
Berberis aquifolium
It is useful where the skin is rough and the acne persistent.
Natrum muriaticum
It acts especially on the sebaceous glands and is a very helpful remedy in acne. In this affection attention temperament and tendencies and the general symptoms are far more important than the general ones
Belladonna
Acne rosacea. Alternate redness and paleness of the skin. Skin dry, hot and swollen, pustules on face. The face is red, bluish-red, hot, swollen, and shining. The patient is restless and talks fast. Acuteness of all senses.
Hepar Sulphur
Papules prone to suppurate and extend. Acne in youth. Suppurate with prickly pain. Easily bleed. Unhealthy skin; every little injury suppurates. Cannot bear to be uncovered; wants to be wrapped up warmly. Sticking or pricking in afflicted parts. Great sensitiveness to slightest touch. Constant offensive exhalation from the body Face, Yellowish complexion. Suits especially scrofulous and lymphatic constitutions that are inclined to have eruptions and glandular swellings. Unhealthy skin. Great sensitiveness to all impressions. The lesions spread by the formation of small papules around the side of the old lesion. Chilliness, hypersensitiveness, splinter-like pains, craving for sour and strong things are very characteristic.
Nux vomica
Acne; skin red and blotchy. Body burning hot, especially face; yet cannot move or uncover without feeling chilly. The typical Nux patient is rather thin, spare, quick, active, nervous, and irritable. Nux patients are easily chilled, avoid open air. Very irritable: sensitive to all impressions. Ugly, malicious. Does not want to be touched. Face Pale, yellowish. Yellow about nose, mouth or eyes. Red, swollen.
Skin care to prevent acne
1. Clean skin gently- Gently wash face with a mild cleanser [according to the type of skin], once in the morning and once in the evening, as well as after heavy exercise. It is also important to shampoo hair regularly. If you have oily hair, wash hair frequently . Wash your face with plain water frequently.
2. Avoid frequent handling of the skin. Avoid rubbing and touching skin lesions. Squeezing, pinching or picking scan lead to the development of scars or dark blotches.
3. Choose cosmetics carefully.
Products such as facial scrubs, astringents and masks generally aren’t recommended because they tend to irritate the skin, which can aggravate acne. Excessive washing and scrubbing also can irritate skin. If acne around your hairline, shampoo your hair frequently.
4. Avoid irritants. Avoid oily or greasy cosmetics, sunscreens, hairstyling products or acne concealers. Use products labeled “water-based” or “noncomedogenic.”
5. Protect yourself from sun. For some people, exposure the sun worsens acne.
6. Avoid touching and rupturing the acne cause it may lead to spread of infection which in turn aggravates acne.
To get rid of pimples you have to change your meal. Please don’t take non-veg & much spicy food or fast food/Many fried & oily preparations. Minimise excessive consumption of coffee or tea. Seasonal fruits & green leafy vegetables are added into your diet. Steam bath your face twice a day & wipe gently with a towel. Also, wash your face with water at least 4 times a day & wipe gently.
