Acne on back and the appearance industry

Acne on Back Logo Being preoccupied with appearance, the acne on back sufferer usually have a negative self image, and may develop psychological problems. Because the color, texture, and appearance of the skin, are important physical factors contributing to outer beauty; and when many people are more concerned with physical beauty, though inner beauty is more pleasing to the mind, real beauty would cease to matter. Needless to say that, it is not a person’s skin that makes them attractive but a combination of all the unique characteristics that they are. The media, and television in particular, actively promote levels of attractiveness related to appearance and particular physical properties. Attractiveness has thus shaped people attitudes in favor of physical beauty in many life aspects, such as employment, social opportunities, friendship, s*xual behavior, and marriage. The media transmit messages concerning physical beauty, perfection and disfigurement, and usually offer suggestions and practical advice as to how the influence of these aspects can be reduced or altered. As they are promoting certain products, they are creating markets for advertisers at the same time. the media have propagated the idea that perfection is a normal thing in society and that those who are unattractive can easily gain this supposedly ‘normal’ appearance. The concept of body image defined as our perception of the way that others see us, is therefore affected by any physical changes to the way that we look. As acne develops in adolescence, a time when people are generally most sensitive about their appearance; symptoms such as depression or social anxiety reflect their real concern over body image. The costs of treatment may also complicate the problem and can cause great distress. The visibility of acne on back may attract attention in certain social situations, thus making the individual feel that they can’t keep their condition private or personal.The sufferer may find that some people react negatively towards them or treat them differently because of the way that they look. Negative misconceptions about acne are still there; some people still think it is associated with a person’s inability to ‘properly take care of themselves or a lack of cleanliness and reactions to this can range from curiosity to rejection therefore, acne sufferers become socially withdrawn...to be continued.

Saturday, June 7, 2008

acne on back FAQs logoAcne Treatment, Systemic Therapy, Hormonal

Hormonal therapy of acne

Sebum secretion is increased by agents with androgenic activity, including synthetic anabolic steroids, and decreased by agents that counteract or interfere with androgen action, namely estrogens and antiandrogens. The goal of hormonal therapy is to counteract the effects of androgens on the sebaceous gland. This can be accomplished with the use of estrogens, antiandrogens, or agents designed to decrease the endogenous production of androgens by the ovary or adrenal gland, including oral contraceptives, glucocorticoids, or gonadotropin-releasing hormone (GnRH) agonists.

ESTROGENS

Any estrogen given in sufficient amounts will decrease sebum production. The dose of estrogen required to suppress sebum production, however, is greater than the dose required to suppress ovulation. Although some patients will respond to lower-dose agents containing 0.035 to 0.050 µg of ethinyl estradiol or its esters, higher doses of estrogen are often required. If estrogen therapy is indicated and if the physician is unfamiliar with its usage or side effects, it is best to work with a gynecologist. Breast examinations and Pap smears are recommended for women receiving estrogen therapy. The incidence of more serious side effects such as clotting and hypertension that follow the use of estrogens is, fortunately, rare in young healthy females. Nevertheless, the physician and patient should be aware of the possibilities, and the risk/benefit ratio should be carefully considered before undertaking estrogen therapy. Although the use of estrogen therapy for acne has decreased dramatically since oral isotretinoin has been available, there are specific patients in whom its use is still appropriate. As mentioned below, estrogens can be used in combination with glucocorticoids.

ORAL CONTRACEPTIVES

With the use of estrogen-progestin-containing oral contraceptives rather than estrogen alone, side effects such as delayed menses, menorrhagia, and premenstrual cramps are uncommon. However, other side effects such as nausea, weight gain, spotting, breast tenderness, amenorrhea, and melasma can occur. The third-generation progestins, desogestrel, norgestimate, and gestodene (not available in the United States), have the lowest intrinsic androgenic activity. Two oral contraceptives are currently FDA approved for the treatment of acne (Ortho Tri-Cyclen and Estrostep). Ortho Tri-Cyclen is a triphasic oral contraceptive comprised of a norgestimate-ethinyl estradiol (35 µg) combination. In an effort to reduce the estrogenic side effects of oral contraceptives, preparations with lower doses of estrogen (20 µg) have been developed and are being studied for the treatment of acne. Estrostep contains a graduated dose of ethinyl estradiol (20 to 35 µg) in combination with norethindrone acetate. An oral contraceptive containing a low dose of estrogen (20 µg) in combination with levonorgestrel (Alesse) has also demonstrated efficacy in acne. Side effects from oral contraceptive use include nausea, vomiting, abnormal menses, weight gain, and breast tenderness. Rare but more serious complications include thrombophlebitis, pulmonary embolism, and hypertension.

GLUCOCORTICOIDS Because of their anti-inflammatory activity, high-dose systemic glucocorticoids may be of benefit in the treatment of acne. In practice, their use is usually restricted to the severely involved patient. Furthermore, because of the potential side effects, these drugs are ordinarily used for limited periods of time, and recurrences are common after therapy is discontinued. Prolonged use may result in the appearance of steroid acne. Glucocorticoids in low dosages are also indicated in those female patients who have an elevation in serum DHEAS associated with an 11- or 21-hydroxylase deficiency or in other individuals with demonstrated androgen excess. Low-dose prednisone (2.5 mg or 5 mg) or dexamethasone can be given orally at bedtime to suppress adrenal androgen production. The combined use of glucocorticoids and estrogens has been used in recalcitrant acne in women, based upon the inhibition of sebum production by this combination. The mechanism of action is probably related to a greater reduction of plasma androgen levels by combined therapy than is produced by either drug alone.

GONADOTROPIN-RELEASING HORMONE AGONISTS GnRH agonists act on the pituitary gland to disrupt its cyclic release of gonadotropins. The net effect is suppression of ovarian steroidogenesis in women. These agents are used in the treatment of ovarian hyperandrenogenism. GnRH agonists have demonstrated efficacy in the treatment of acne and hirsutism in females both with and without endocrine disturbance. Their use, however, is limited by their side-effect profile, which includes menopausal symptoms and bone loss.

ANTIANDROGENS Cyproterone acetate is a progestational antiandrogen that blocks the androgen receptor. It is combined with ethinyl estradiol in an oral contraceptive formulation that is widely used in Europe for the treatment of acne. Cyproterone acetate is not available in the United States. Spironolactone functions both as an androgen receptor blocker and inhibitor of 5a-reductase. In doses of 50 to 100 mg twice a day, it has been shown to reduce sebum production and to improve acne. Side effects include potential hyperkalemia, irregular menstrual periods, breast tenderness, headache, and fatigue. As an antiandrogen, there is a risk of feminization of a male fetus if this medication is taken by a pregnant female. Risk to a fetus and the symptoms of irregular menstrual bleeding can be alleviated by combining spironolactone treatment with an oral contraceptive. Flutamide, an androgen receptor blocker, has been used at doses of 250 mg twice a day in combination with oral contraceptives for treatment of acne or hirsutism in females. Liver function tests should be monitored as cases of fetal hepatitis have been reported. Pregnancy should be avoided. Use of flutamide in the treatment of acne may be limited by its side effect profile.

ENZYME INHIBITORS The development of 5a-reductase inhibitors, such as finasteride, that block the conversion of testosterone to DHT in the prostate suggested the possibility of an approach to interfering with androgen action on the sebaceous glands that would be appropriate for use in males. However, finasteride does not inhibit sebum secretion. Its lack of action is attributed to the existence of two different 5a-reductases, with the enzyme in the prostate being blocked by the drug while that in the skin is unaffected. Specific inhibitors of the type 1 5a-reductase are being developed. If these agents reduce sebum production, they may be efficacious in the treatment of acne.

Posted by SSS at 1:16 PM

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