Acne On Back

Get Rid of Your Back Acne

2009-06-18T07:21:00.000-07:00

Get Rid of Your Back Acne in Time for Swimsuit Season

Look better than ever in your swimsuit by clearing up your back acne.

Is your back acne the only thing from standing in the way of looking great in your swimsuit this summer? You exercised and dieted so you would look great. You 'shopped till you dropped' to find the perfect figure-flattering suit. Now if you can only clear up your back acne, you will look drop dead gorgeous. Don't worry. This can be done. Follow these tips to get rid of your acne in time for summer.

Back acne tips

Back acne is a little trickier to treat because of its location -- but it can be done with just a few simple changes.

Tip #1 -- Buy a back scrubber

You can find a back scrubber in your local drug store or discount store in the health and beauty aids department. Back scrubbers usually come in two styles -- a long-handled brush (like a back scratcher) or long-mesh netting with a loop on each end for handles.

Your back has the same oil glands that you have on your face. When these glands get clogged, they form pimples. It's harder to clean your back simply because you can't reach it. But with one of these back scrubbers, you can.

Be sure and wash your back with the back scrubber at least once per day. It would be better and your back acne would clear up faster if you washed it twice a day -- once in the morning before you dress and once at night before you go to bed. This way, you wash off the oil and dead skin that has accumulated overnight and during the day underneath your clothing.

Tip #2 -- Use acne medication

Most people use acne medication on their face but it doesn't occur to them to use it on their backs. If you have back acne, after you scrub your back daily or twice daily, have someone rub your medication on your back. If you live alone, you may have to rig up your back scrubber and use it to apply your medication. You can do this by pinning a clean wash cloth on your back scrubber and putting the medication on the cloth. Then use the scrubber to apply the medication.

It's very important that you clean and apply medication to your back every day. By doing these two simple things, you can clear up your back acne and knock em' dead in that new summer swim suit.

Acne On Back

2009-06-15T20:19:00.000-07:00

Acne on back
Because the back is covered with sebaceous glands (which secrete sebum to protect and moisturize the skin), it is as susceptible to acne as the face is. This is especially true during puberty, when sebaceous glands produce more sebum due to the hormonal changes of adolescence. Acne on back describes acne outbreaks on the back, although concealed by clothing, acne on back can cause emotional distress and lead to persistent scarring if left untreated.
What causes it?
acne on back is caused by the same chain of events that leads to facial acne.
An overgrowth of sebum in a clogged hair follicle causes inflammation. This results in bumps called comedones (whiteheads and blackheads). When the clogged pores become infected with a bacteria called P. acnes, the comedones become inflamed, red, and painful. This leads to the nodules and cysts of inflammatory acne. More commonly, these acne lesions are called zits and pimples.
How is it different than facial acne?
Although the causes of back acne are similar, the triggers may be different. For example, clothing that covers the body is more likely to trap sweat, oils, and other substances that can clog pores, creating an ideal condition for breakouts, especially after exercise or working in a warm environment, such as a kitchen. The treatment of acne on back is also different from facial acne. The thicker skin of the body can withstand medications that might be irritating to facial skin. The thicker skin also makes acne on back slower to respond to treatment. This makes it important to remain on therapy as recommend by your physician.

Reluctance to talk about acne on back
Over half of patients visiting their dermatologist for facial acne also had acne elsewhere on their body that they did not report to their physician. Not talking about body acne makes likely that it is not sufficiently treated.

How is acne on back treated?
acne on back can often be treated using the same methods as those for acne on the face, including:

* Over-the-counter medications applied on the skin, such as benzoyl peroxide (Proactiv) and Sensiclear.
* Prescriptions medications applied on the skin, such as topical retinoids and antibiotics. Topical retinoids are often used as the first-line of treatment for acne. These include (Differin, Epiduo, Retin A Micro, Tazorac, tretinoin, and Ziana)
* Prescription medications taken by mouth, such as antibiotics (minocycline), isotretinoin (Accutane), and oral contraceptives (Yaz, Ortho Tri-Cyclen)

However, there are certain challenges that are unique to acne on back:

* Acne on large areas of the body or hard-to-reach spots, such as the back, may make it difficult to apply topical medications.
* Some topical treatments may discolor or bleach clothing.
* Left untreated, acne on back may lead to a type of scarring and pigmentation.

In choosing a treatment for acne on back, dermatologists will take into account several factors:

* Severity—mild or moderate cases may respond to topical medications alone, while more severe cases may require oral medications.
* Results of previous treatments
* Gender—some treatments are only available for females, such as birth control pills.
* Location—in a hard-to-reach area, a topical foam (such as clindamycin) may be easier to apply than a thick ointment or gel.
* Clothing—some patients with acne on back may have to try different topical treatments to find one that won’t stain clothing.
In some cases, dermatologists will combine topical and oral medications.

How can I prevent future outbreaks?
For all types of acne, follow these guidelines:

* Clean skin gently twice a day and pat dry.
* Do not pick at acne lesions, as this can cause scarring and other skin damage.
* Give your treatment time to work—your skin may look worse before it starts to improve, and stopping early can prevent you from seeing good results.

For acne on back, there are a few additional tips:

* Wear loose-fitting breathable fabrics (such as cotton or linen) to keep skin well ventilated and prevent clogged pores.
* After exercising, remove snug-fitting clothing that may trap sweat or dirt (such as a restaurant uniform, jog bra, or coveralls).
* Shower and gently clean your skin after exercising or any activity that makes you perspire.

Knowing the Causes of Back Acne

2009-06-13T09:45:00.000-07:00

Knowing the Causes of Back Acne

By Carolyn Anderson

Acne may be commonly experienced in the face or on the neck, but acne can occur in the chest, the forehead, the body and the back. At times, acne is specifically referred to depending on where it is located. It may be referred to as facial acne, body acne, neck acne or back acne. These parts of the body where acne usually appears are the parts that have the most sebaceous glands beneath the skin. The sebaceous glands are responsible for the oily secretion called sebum that helps moisturize the skin. Acne appearing in these different parts of the body is also treated differently as the skin can vary from the most sensitive ones to parts that have thick skin.

What are the causes of back acne, and how are they formed?

Back acne, or acne that appears on the back or on the shoulders, develops the same way as acne on the face or on any other part of the body. It develops when there is excess production of sebum in the sebaceous glands found in the skin. Acne starts to develop when excess oil in the skin clog up the pores and trap dead skin cells. When bacteria in the surface of the skin invade these clogged pores, skin infection can start and thus the development skin inflammation and acne.

The skin on the back is thick and tough, and it contains larger sebaceous glands thus it produces more sebum. The back therefore has higher possibility of developing more severe skin lesions than in the face or neck. Back acne is often prone to the formation of acne characterized by nodules and cysts - the more severe type of acne vulgaris.

The causes of back acne and other forms of acne have not yet been determined, but there are factors identified that said to cause flare-ups and worsen the existing skin condition. In the case of back acne, it is often aggravated by constant friction on the back, from clothing, backpacks or sports gear or any object that comes in frequent contact with the back.

Acne also tends to worsen when moist, thus sweat can also make back acne worse. Because the back is prone to frequent friction and irritation from clothing and sweat, extra steps should be taken to prevent the skin condition from getting worst.

Although we may not know the causes of back acne and acne in general, there are things we can do to prevent them from getting worse. You can carefully select clothing that do not irritate the skin, avoid tight clothing and if you are using backpacks, you may want to avoid it for the meantime to prevent friction on your back. Make sure also that you dry your back or take a shower after an activity of heavy sweating.

Diet and stress are also identified as triggering factors of acne. Heredity is also considered a contributory factor in acne breakouts, so if your parents have suffered severe acne during their teenage years, there are greater chances that you may also experience the same thing.

Back acne is most often difficult to treat, and of course, self-medication can also be difficult since it cannot be easily reached and seen, so it is always important to check your skin condition or seek dermatologist help if needed.

Carolyn Anderson has overcome severe acne in her teenage years. To learn more about natural ways of treating acne, check out Acne No More Another recommended resource is Acne Free In 3 Days a guide to eliminating acne permanently with natural cures.

Article Source: http://EzineArticles.com/?expert=Carolyn_Anderson

What Causes Back Acne?

2009-06-12T04:04:00.000-07:00

What Causes Back Acne?

By contributor1

Before looking for any type of back acne treatments and cures, it’s essential that you understand what causes back acne. If you clearly understand its causes and prevention, half of the battle is won!

Back acne is a very common skin disorder faced by people. It occurs in different forms, such as the pimples, blackheads, or pustules. Back acne can be really painful as it erupts in an area which you can’t see yourself. There are many myths related to back acne, so it is essential to clearly recognize what causes it.

Change in hormone leads occurrence of back acne:

Among the several factors that are known to cause back acne, the most important one is the change of male hormone in the body. The male hormones, also known as androgens, alter their levels in the body and this stimulates the sebaceous glands to secrete more oil. The excessive production of the oils leads to the occurrence of back acne.

As these oil glands are usually situated below the surface of the skin, the oils that are produced tend to get clogged with the dead cells to form a mass beneath the skin. Because of this, the dead cells get fixed under the skin surface and the mass blocks the hair follicle. This promotes the growth of the back acne producing bacteria in the area. Some people are prone to getting sever acne on their back. The bacteria also cause inflammation in the surrounding areas.

Things that aggravate back acne

Many things are known to worsen the back acne problem. One of them is the use of some particular clothing material. Such clothing materials when rub against the skin further aggravate the back acne. As soon as you feel that back acne has broken out, it is recommended that you consult your dermatologist.

When is a pustule formed?

In case of back acne, a pustule is usually formed if the inflammation is caused just beneath the surface of the skin. If the inflammation is caused deeper into the skin, then it forms a papule. Cystic back acne is that form of acne which is formed deepest below the skin surface. This type of back acne is the most painful one. It also tends to leave permanent back acne scars.

Back Acne Treatment

As the skin at the back is thicker than your facial skin, much stronger back acne treatments would be required to heal it. Benzoyl peroxide is used most frequently for the back acne treatments, because the medication is harsh and works well. Consult your dermatologist before it’s too late and get rid of the painful back acne.

Back Acne - Different Than Facial Acne Or Cystic Acne?

2009-06-11T11:49:00.000-07:00

Back Acne - Different Than Facial Acne Or Cystic Acne?

By Dr James Martin

Find out the difference between back acne and all the other types of acne and their differences in their treatment. If you have back acne, you may be wondering if it is different than regular facial acne or cystic acne or the eight other "types" of acne.

If you have back acne, you may be wondering if it is different than regular facial acne or cystic acne or the eight other "types" of acne.

The fact that there are so many websites I have reviewed that have great pictures of all the different "types" of acne is leading many people in their quest for a real and effective treatment to ask the wrong questions.

They look at all the pictures and compare to what their acne looks like, whether on their face, back, chest and bang! They now know what "type" of acne they have. Well, that's what I call tunnel thinking. Step back for just a few seconds and take a look at the big picture in terms of acne.

Traditional medicine has this funny way of grouping a bunch of symptoms and labeling them with some name of a condition or disease and then the person suffering with the disease or condition somehow feels better.

Needless to say, that DOESN'T mean they have a real or effective treatment or idea of even WHAT causes that condition. Medicine has one small flaw in the fact that just because you can put a label on it and tell the person they have xyz condition that that will help them.

On the contrary, then the person looks up their condition and is led down the wrong road totally...looking for a cure or treatment to a LABEL.

You have acne. It's on your back...Back Acne. Now you have your label, but I don't care and neither should you. What you SHOULD care about is...what is really causing pus to build up in all the pores all over your back making whiteheads, blackheads, cystic painful acne lesions, etc.

ALL acne is just that...ACNE. Pus emerging from inside into your skin causing zits, pimples, acne and scarring. Acne is caused my a few internal metabolic health disturbances that CAN be corrected to help you not have ANY "type" of acne.

So remember, it doesn't matter what "type" you of acne you've been labeled with or think you have. What matters is what the real underlying cause of your acne is (because it's not an acne cleanser deficiency) and how can you correct the underlying health problem that causes excessive pus and acne production and oily blocked pores.

And now I would like to offer you free access to more information on the exact cause of acne and specifics on how to eliminate it quickly and effectively at http://bestacnetreatmenttips.com and http://www.squidoo.com/BestAcneTreatmentTips from Dr. James Martin at bestacnetreatmenttips.com.

Article Source: http://EzineArticles.com/?expert=Dr_James_Martin

Acne - Back Breakouts

2009-06-05T17:44:00.000-07:00

Acne - Back Breakouts Whats The Deal With Acne On Your Back?
Back acne comes in all sizes and forms of acne, ranging from mild forms like whiteheads to serious forms of acne including cystic acne. "Bacne" as it is referred to in slang terms, can consist of pimples, pustules and blackheads as well.

Back acne affects people ranging from age ten to age forty or older yet. Understanding the causes of back acne and available treatment options, are very important is treating and preventing the condition.

Like all of the other forms of acne, there is no one thing that causes back acne. As far as the medical community stands, back acne also happens when oil glands start functioning more rapidly around puberty. The hormone group androgens, found in both females and males, get overactive which in turn causes a reaction in the oil glands, which make extra oil.

The oil glands are located just underneath the skin surface. Oil glands constantly are producing and secreting oil through the pores in the skin. When too much of the oils are produced the pores and hair follicles become clogged. The clogs obstruct the way that dead cells escape the skin, which in turn results in a mess of oil and dead cells plugging the hair follicle. This attracts bacterium, which causes the acne to be formed.

Back acne can be found on any part of the body and does not necessarily have to be on a person's back. It can be very severe with large lesions and painful cysts. Back acne may just be something that certain people are prone to or it could be caused by other things such as tight clothing or a heavy backpack.

Not having anything in contact with the back is not a logical prevention step, as we all must sit down and everyone has to wear clothing. It is easier to treat back acne than to try and prevent it because most people suffer from back acne at one time or another.

Skin on the back is much thicker and therefore allows for stronger topical treatments, such as ten percent Benzoyl peroxide. This strength of Benzoyl peroxide is not suitable for other skin that is typically thinner and will not be able to sustain itself under harsh treatment. You can get all the same types of acne, blackheads, whiteheads, papules, pustules and cysts, on your back just as you can on any other part of your body.

There are some differences in back acne and acne located elsewhere on the body however. Back acne is not caused by genetics as other acnes can be. Some severe cases of back acne may be genetically passed on but most likely it is just the individual's body type or personal genetic make up.

People all over the world suffer from back acne at some point in their lives. Unlike other acne, food does not contribute to the formation or flare up of back acne. There is absolutely no evidence that foods cooked in grease, or high in fat content contribute to back acne.

It is also known that excessive oil production and dirt build up does not have a huge impact on developing back acne. Perspiring excessively and not washing or showering immediately has been shown to not increase the chances of developing back acne. Back acne also does not seem to be affected by stress. There are some who think that facial acne is increased due to stress. However stress can cause back acne to not heal. Oftentimes, stress causes people to pick and bother the pimples, which make the condition worse.

Taking some over the counter medicines may treat breakouts of back acne in conditions that are not complex. Some skin specialists or dermatologists should treat severe forms of acne on the back, such as cystic acne. Most of the simpler forms of acne might disappear with daily washing and cleansing routines but as cystic acne goes deep into the skin and can cause permanent scarring, it should be given more serious medical attention than simple pustules or blackheads on the back.

Always speak to your healthcare provider about treatment before starting a back acne treatment program never attempt to treat severe acne on your own or with an over the counter product without consulting a professional.
Article Republished From: Liberated Press Releases

Author Resource:- Are you looking for more info on the best treatment for acne?

Acne on back psychological problems

2008-11-30T21:00:00.000-08:00

One of the psychological problems acne on back sufferers often find very difficult, is when coping the reaction of others. The first thing that we need to realise is that a person may be staring for a variety of causes, so we can’t make the assumption that a person would be staring because of the condition. One way to cope is to ask yourself, ‘Why else might they be staring? They might be staring because they like my body-build, because I look like someone they know, or because they like me.’ If you have come to the conclusion that someone is staring because of the acne on back condition, and that is making you uncomfortable regardless of the reason why, one of the best strategies is to let people know that they are staring, but to do this in the least aggressive way possible.
The first thing you do is make eye contact, and then gently smile. With this you are giving the message, ‘I’m OK with my skin condition, so you should be as well’. In many ways, one of the most important strategies is to outstare them. Look at them,
gently smile, and then look away. If you feel them looking again then do this until they stop.
There is a lot of research involving the social interactions in various types of skin conditions. It has been found that the best way to cope is by making eye contact with people to show that things are OK.

Back acne Microdermabrasion

2008-11-18T07:06:00.000-08:00

What is back microdermabrasion? Uncover a fresh new layer of skin. Learn about skin care in these free beauty videos. Got acne, acne scars, whiteheads, or blackheads? Find out if microdermabrasion can help.

How To Prevent Back Acne Outbreaks

2008-11-05T15:52:00.000-08:00

Acne on back can be irritating especially if you are an outdoors person. Sweat could make the acne on your back feel really painful and uncomfortable. In most cases, acne on back itches a lot especially when it comes into contact with sweat. Fortunately, acne on back can be prevented. To help prevent acne, here are some tips for you.

Getting Rid Of Dead Skin Cells

Some dead skin cells are shed everyday. Although some people naturally remove all their dead skin cells without much trouble, there are also some people who are not so efficient when it comes to shedding their dead skin cells. Once the dead skin cells block the pores of the skin, P.acnes bacteria start to accumulate in those blockged pores and cause some infection. Acne is one of the most common results of the build up of bacteria in the blocked skin pores.

To prevent acne, one must remove dead skin from the body by exfoliating. Exfoliating does not necessarily mean that you have to use strong chemicals. You can easily exfoliate by using a loofah or rubbing your back with a towel after taking a shower. You may also use a scrub to clean off your back while taking a bath. Note that when your skin is wet, it will be easier to peel off the dead skin cells from your back.

If you must use chemicals to exfoliate and prevent acne on back, make sure that you consult your dermatologist about this first. Always remember that the use of chemicals could cause your skin to look red and dry so make sure that you know what you are doing before you even lay your hands on those exfoliating chemicals.

Avoid Exposure To Oil

Oil is one of the primary culprits when it comes to blocking the skin pores. Studies showed that oil will make the dead skin cells adhere together and block the pores of the skin. To prevent acne on back, do not use oil to moisture your skin. If you really must use oil on your skin, use it in moderation.

Review Your Diet

If you are suffering from severe acne on back, check your diet. Make sure that you avoid fatty meals. According to experts, fatty meals will not do your skin any good. Try to eat plenty of fresh fruits and vegetables. Note that fresh fruits and vegetables will help hydrate your skin and give it a healthy glow.

Acne On Back Treatment

2008-07-17T19:22:00.000-07:00

Acne is commonly found on the back . Although not as common as our faces, acne on back is often more debilitating as it can be very difficult to treat. Acne on back has degrees of severity depending upon the number of lesions and the presence of inflammation. It can be mild, moderate, or severe. The degree of skin sensitivity also has a role in the treatment of acne. Different skin types require different treatments and may react differently to the wide variety of treatments.
Acne is the result of excess oil build up and clogged pores of our skin and in case of facial acne, is treated by a strict daily skin regimen. Treatment includes a cleanser, treated gel or lotion, and possibly a moisturizer. Often dermatologist prescribe a glycolic acid treatment. The same is true for acne on back. However, since the back skin is tougher than on the face, therefore stronger acne control products and methods of treatement is required.
The back is also in continous contact with clothing that often irritate and aggravate acne. Clothing irritates acne and synthetic fibers (such as polyester) or tight clothing in general rub against the skin and aggravate acne breakouts as well as promote sweating. (Sweat causes excess oil build-up and blocked pores which result in more breakouts.)
Determining other mechanical cauuses of acne on back is important. For example, heavy backpacks worn across the upper shoulders and covering part of the back might be contributing to acne in these areas. Switching to a pack with convenient carry handles may clear up acne on back lesions.

What are Acne causes?

2008-07-06T11:47:00.000-07:00

The three main processes contributing to acne are: increased sebum secretion; pilosebaceous duct obstruction; and inflammation.

Under the influence of local hormone metabolism, androgens stimulate an increase in the size of the sebaceous glands and, hence, more sebum is produced. These large glands themselves produce more active androgen metabolites through the activity of type 1, 5α-reductase; one effect of these metabolites is to further enlarge the sebaceous glands. Sebum acts in partnership with bacteria to produce keratinization and hence blockage of the pilosebaceous duct and comedo formation.

The principal organism responsible is Propionibacterium acnes, which increases in number during flare-ups and is important in the change from non-inflammatory to inflammatory acne. This bacterium produces many inflammatory substances, such as lipases, proteases, hyaluronidases, and chemotactic factors that play a role in producing lesions. Therapy that lowers the Propionibacterium acnes count plays a pivotal role in management, but resistance of the bacterium to some antibiotics, especially erythromycin, is an emerging problem in acne therapy.

Acne may also be drug-induced, particularly secondary to anabolic and corticosteroids, iodides, lithium, phenytoin, streptomycin, and isoniazid. Sebum consists of triglycerides, wax esters, squalene, and sterol esters. The fatty acids in sebum are inflammatory and are formed by the lysolytic enzymes of bacteria, even in healthy skin, from unsaturated 14- to 16- or 18-carbon components of the triglycerides. It is possible that acne in people living in the tropics is due to a secondary response in the rate of turnover of the follicular lining, perhaps induced by occlusion under a belt or braces in such hot environments. The acne of Cushing's disease may also be due to an increased rate of such turnover. Chlorinated hydrocarbons also cause acne. Chloracne is an important symptom of poisoning.

The exact way in which the inflammation is produced is uncertain; as the follicle contains fatty acids and bacterial proteases which activate the classical alternative pathway of complement and attract neutrophils, this may be one mechanism.

Sebaceous gland activity is regulated by hormones and, in particular, by androgens from the testes and adrenals, which stimulate, and estrogens, which seem to suppress activity. In the adult male the glands are normally maximally stimulated, leading to more severe in boys than in girls. The skin itself is a major site for androgenic conversion similar to that observed in the prostate gland and in the male genitalia. Dihydrotestosterone, rather than testosterone, may be the end-organ effector and is formed within the target cells where it stimulates lipogenesis as well as mitosis. Eunuchs do not develop acne. Estrogens reduce the size of sebaceous glands and sebum production is diminished.

Acne Scar Treatment

2008-06-25T11:50:00.000-07:00

Scar revision
Many patients are very self-conscious about the pitted and craterlike scars that remain as a permanent record of previous inflammation. Some people will endure any procedure and spare no expense to rid themselves of the minutest scar. A variety of procedures is available to remove or revise scars. A dermatologic or plastic surgeon is best equipped to perform such procedures. Dermatologic surgeons are proficient at many innovative techniques to correct all types of acne scars.
Generally, it is advisable to wait until disease activity has been low or absent for several months. Scars improve with time as they become atrophied. The color contrast is often the most troublesome aspect of acne. Inflamed lesions may leave a flat or depressed red scar that is so obvious patients mistake the mark for an active lesion. The color will fade and approach skin tones in 4 to 12 months. The following techniques are those most commonly used for scar revision.
Dermabrasion.
Dermabrasion has been practiced for years and when performed correctly is a valuable technique for decreasing the depth of pitted scars. The epidermis and part of the dermis is planed away with a high-speed, motor-driven, finely abrasive brush or wheel. A major portion of the face may be treated during a single session. Reepithelialization takes 3 to 4 weeks. The procedure may have to be repeated one or two times to obtain optimum results. Adverse effects include the creation of additional scarring and permanent loss of pigment. The creation of hypopigmented areas is a common side effect, and for this reason many surgeons advise against using this technique for patients with dark skin.
Scar excision.
Many pitted scars are too deep to be planed by dermabrasion. These deep or "ice pick" scars may be excised and closed carefully with gratifying results. Some dermatologic surgeons remove the scars with a punch biopsy. The plug is removed and the scar is separated from the subcutaneous tissue. The remaining round core of fat and dermis is replaced in the round hole and held at the surface with a Steri-strip. The autograft is rapidly fibrosed into place, and the epidermis subsequently regenerates. There are many modifications of this technique.
Gelatin matrix collagen implant (Fibrel).
Fibrel is a porcine collagen suspension that is injected intradermally to correct depressed cutaneous scars. Fibrel is composed of absorbable gelatin powder (denatured collagen types I and III) and epsilon-aminocaproic acid (EAC) in a lyophilized form. Fibrel is reconstituted with equal amounts of the patient's plasma and 0.9% sodium chloride for injection. The reconstituted Fibrel suspension forms a fibrin network within a gelatin matrix, which initially restores the skin's contour. Over a period of months, the implant is colonized by the patient's own connective tissue cells.
Scars should be distensible by manual stretching of the scar borders. A custom needle is supplied with the Fibrel kit and is used for undermining fibrotic scars prior to injection. Improvement is maintained for up to 1 year in 85% of the treated scars. "Ice pick" or extremely fibrotic scars do not respond.
Bovine dermal collagen implants (Zyderm, Zyplast).
Zyderm and Zyplast are bovine collagen suspensions indicated for the correction of scars and wrinkles. A processing technique renders collagen nonantigenic and suitable for augmenting scars in humans (see Chapter Twenty-seven). Collagen is supplied in preloaded syringes for intradermal injection. Soft, distensible lesions with smooth margins are the most amenable to correction, whereas "ice pick" acne and tiny, punched lesions do not respond as well. Zyplast, a newer cross-linked collagen product, can be placed deeper than Zyderm. The duration of correction is shorter than that of Fibrel.

ACNE SURGERY

2008-06-23T08:19:00.000-07:00

ACNE SURGERY: includes various surgical procedures used by the dermatologist or plastic surgeon for the treatment of acne and its complications.
An example of acne surgery is the manual removal of comedones and the drainage of pustules and cysts. When done correctly, acne surgery speeds resolution and rapidly enhances cosmetic appearance. Special instruments are used e.g. comedone extractors and a pointed-tip scalpel blade.
Comedones.
Removal of open comedones (blackheads) enhances the patient's appearance. By use of a special type of extractor, most comedones can easily be expressed with uniform, smooth pressure. Lesions that offer resistance are loosened and sometimes disengaged by inserting the point of a special blade into the blackhead and elevating. The orifice of the closed comedone must be enlarged before pressure can be applied. Following the angle of the follicle, the scalpel point is inserted with the sharp edge up approximately 1 mm into the tiny orifice. The blade is drawn slightly forward and up, then pressure is applied with the extractor to remove the sometimes surprisingly large quantity of soft, white material. Macrocomedones (whiteheads, microcystic acne) can also be treated with light cautery.
Pustules and cysts.
After the head of the white pustule is nicked with a special instrument, pustules are easily drained by pressing the material with the acne extractor. Cysts are preferably managed by intralesional injection because incision and drainage may cause scarring. Pustules and cysts that have a thin, effaced roof in which fluid contents are easily felt are drained through a small incision by manual pressure. To prevent scarring, a short incision (about 3 mm) should be made. After drainage, a special instrument may be inserted through the incision on the cyst in order to dislodge chunks of necrotic tissue.

Back Scrubbing

2008-06-18T16:33:00.000-07:00

Gently cleanse and refresh hard-to-reach areas of your back
One of the hardest parts about taking a bath or shower is when it comes time to wash your back. It is virtually impossible to wash your entire back without some sort of assisting device. Usually people opt for clumsy brushes or sponges on the end of a stick because they are traditionally what is used for cleansing ones back. Even with these gadgets it is difficult to do a decent job of washing, the areas cleaned are hit-or-miss, and you are also forced to do a lot of reaching.
Scrub and clean your entire back without straining
An ideal scrubber should be easy to use, clean hard-to-reach places of your back, scrubbing your entire back without contorting yourself, cleaning and exfoliating at the same time and leaving your skin feeling soft and refreshed.
Adding length and angulation to handles makes a scrubber more flexible and convenient.
Exfoliating back skin, while massaging can improve circulation.
Loofah with its natural fibres can be used to stimulate circulation, deeply cleans the pores and gently rub away dead skin. You can use your favorite body soap applied to Loofah, then rinse thoroughly and remove all soap.

Acne on back lesions

2008-06-16T09:06:00.000-07:00

Acne on back lesions
Virtually universal in the middle to late teenage years, acne on back affects both males and females, although males tend to have more severe disease. Acne is seen in all races, but it is said to be milder in people of Asian descent. Acne on back in adolescents is believed to occur as a result of physiologic hormonal variations and alterations in hair follicle maturation. The clinical features of acne may be induced or exacerbated by drugs (corticosteroids, adrenocorticotropic hormone, testosterone, gonadotropins, contraceptives, trimethadione, iodides, and bromides), occupational contactants (cutting oils, chlorinated hydrocarbons, and coal tars), and occlusive conditions such as heavy clothing and tropical climates. Some families seem to be particularly affected by acne, suggesting a heritable factor..
Acne on back is divided into noninflammatory and inflammatory types, although both may coexist. The former consists of open and closed comedones. Open comedones consist of small follicular papules containing a central black keratin plug. This color is the result of oxidation of melanin pigment (not dirt). Closed comedones are follicular papules without a visible central plug. Because the keratin plug is trapped beneath the epidermal surface, these lesions are potential sources of follicular rupture and inflammation. Inflammatory acne is characterized by erythematous papules, nodules, and pustules. Severe variants (e.g. acne conglobata) result in sinus tract formation and physical scarring, in addition to the emotional scars.

MORPHOLOGY.
Comedones form as an expanding mass of lipid (sebum) and keratin within the midportion of the hair follicle. With gradual expansion, the follicle becomes dilated and the follicular epithelium and sebaceous glands atrophy. Resultant open comedones have large, patulous orifices, whereas those of closed comedones are identifiable only microscopically. Variable lymphohistiocytic infiltrates are present in and around affected follicles, and extensive acute and chronic inflammation accompanies follicular rupture. Dermal abscesses may form in association with rupture, and gradual resolution, often with scarring, ensues.

The pathogenesis of Acne
Endocrine factors have been implicated (especially androgens) because castrated persons never develop the condition. However, these do not appear to be the sole or primary cause. It has been postulated that bacterial lipases of Propionibacterium acnes break down sebaceous oils, liberating highly irritating fatty acids resulting in the earliest inflammatory phases of acne. Inhibition of lipase production is a rationale for administration of antibiotics to patients with inflammatory acne. The synthetic vitamin A derivative 13- cis-retinoic acid (isotretinoin) has brought about remarkable clinical improvement in some cases of severe acne.

Acne Treatment, Systemic Therapy, Isotretinoin

2008-06-07T13:24:00.000-07:00

ISOTRETINOIN

The use of the oral retinoid, isotretinoin, has revolutionized the management of severe treatment-resistant acne. Isotretinoin, like vitamin A, produces side effects, which are not usually severe enough to necessitate interruption of therapy in most cases.
The remarkable aspects of isotretinoin therapy are the completeness of the remission in almost all cases and the longevity of the remission, which lasts for months to years in the great majority of patients.
Isotretinoin therapy, for all practical purposes, is always accompanied by side effects that may mimic those seen in the chronic hypervitaminosis A syndrome. Thus, side effects related to the skin and mucous membranes are most common. Cheilitis of varying degrees is found in almost all cases. Other side effects that are likely to be seen in over 50 percent of patients are dryness of the mucous membranes, xerosis, conjunctivitis, and pruritus. Side effects seen with lesser degrees of frequency include bone and joint pain; thinning of hair; headache and accompanying symptoms associated with increased intracranial pressure; palmoplantar desquamation; and nausea and vomiting.
The laboratory abnormalities that have occurred include elevations in triglycerides, erythrocyte sedimentation rate, platelet count, liver function tests, and white blood cells in the urine and decreases in red blood cell parameters, white cell counts, and high-density lipoprotein levels. The elevation of triglycerides, which is dose-related, is of particular concern because it is often accompanied by a decrease in the high-density lipoprotein levels, which may increase the risk of coronary artery disease.
There are also reports of the development of bony hyperostoses after isotretinoin therapy, but these are more likely to be seen in patients who receive the drug for longer periods of time in higher dosages for diseases of keratinization.
The issue of isotretinoin and psychiatric effects has come to the forefront. From 1982 to May 2000, 37 cases of suicide, 110 cases of hospitalized depression, suicidal ideation or suicide attempt, and 284 cases of nonhospitalized depression in patients on isotretinoin were reported to the FDA's Adverse Event Reporting System. In one population-based cohort study comparing isotretinoin users with oral antibiotic users, the relative risk for development of depression or psychosis was approximately 1.0, indicating no increased risk. Further studies are needed to resolve this issue of causality. Until then, a careful review for signs and symptoms of depression and suicidal ideation should be performed in all patients for whom isotretinoin therapy is considered, and the patients must be carefully monitored during therapy.
Studies show that some of the side effects are dosage related. These same studies demonstrate that clinical results can be obtained with dosages as low as 0.1 mg/kg per day. However, with such dosages, the incidence of relapses after therapy is greater. The recommended daily dosage of isotretinoin is in the range of 0.5 to 1 mg/kg per day. Because back and chest lesions show less of a response than facial lesions, dosages as high as 2 mg/kg per day may be necessary in those patients who have very severe trunk involvement. Patients with severe acne, particularly those with granulomatous lesions, will often develop marked flares of their disease when isotretinoin is started. Therefore, the initial dosing should be low, even below 0.5 mg/kg per day. These patients often need pretreatment for 1 to 2 weeks with prednisone (40 to 60 mg per day), which may have to be continued for the first 2 weeks of therapy. Isotretinoin is usually given for 20 weeks, but the length of the course of treatment is not absolute; in patients who have not shown an adequate response, therapy can be extended, if necessary. Some improvement is usually seen for 1 to 2 months after isotretinoin is discontinued, so that total clearing is not a necessary endpoint for determining when to discontinue therapy. Approximately 10 percent of patients treated with isotretinoin require a second course of the drug. The likelihood for repeat therapy is increased in patients younger than 16 to 17 years of age. It is best to allow at least 2 to 3 months between courses of isotretinoin. Studies suggest that the chances of inducing a long-term remission are greatest if the patient has received a total dose of 120 to 150 mg/kg of isotretinoin during a course of therapy.
Isotretinoin should be used only in those patients with severe acne. Furthermore, laboratory monitoring is indicated. It is appropriate to obtain a baseline complete blood count and liver function tests, but the greatest attention should be paid to following serum triglyceride levels. Baseline values for serum triglycerides should be obtained and repeated at 3 to 4 weeks and 6 to 8 weeks of therapy. If the values are normal at 6 to 8 weeks, there is no need to repeat the test during the remaining course of therapy unless there are risk factors. If serum triglycerides increase above 500 mg/dL, the levels should be monitored frequently. Levels above 700 to 800 mg/dL are a reason for interrupting therapy or treating the patient with a lipid-lowering drug such as gemfibrozil. Eruptive exanthemas or pancreatitis can occur at higher serum triglyceride levels. In rare instances, exuberant granulation tissue has appeared in some lesions. If this occurs, the dosage of drug may have to be decreased or the drug may have to be discontinued. Glucocorticoids may have to be administered either systemically or intralesionally to control the granulation tissue.
The greatest concern during isotretinoin therapy is the risk of the drug being administered during pregnancy and thereby inducing teratogenic effects in the fetus. The drug is not mutagenic; its effect is on organogenesis. Therefore, the production of retinoic embryopathy occurs very early in pregnancy, with a peak near the third week of gestation. Theoretically, based on animal studies and the pharmacokinetics of the drug, there should be more safety in the use of isotretinoin than either vitamin A or etretinate. However, that is not the case, and a significant number of fetal abnormalities have been reported after the use of isotretinoin. For this reason, it should be emphasized that isotretinoin should be given only to patients who have not responded to other therapy. Furthermore, women who are of childbearing age must be fully informed of the risk of pregnancy. The patient must either avoid sexual exposure totally or should employ two highly effective contraception techniques such as the use of an oral contraceptive and condoms with a spermicidal jelly. Contraception must be started at least 1 month before isotretinoin therapy. The patient must have a negative serum pregnancy test at the time when therapy is decided upon and on the second or third day of the next menstrual period or 11 days after the last unprotected intercourse in a woman who is amenorrheic. The woman must thoroughly understand the contraception techniques she is using and continue them throughout the course of isotretinoin and for 1 month after stopping treatment. No more than 1 month's supply of drug should be given to a female patient so that she can be counseled on a monthly basis on the hazards of pregnancy during isotretinoin therapy. The pregnancy test should be repeated monthly to maintain patient awareness. The manufacturer and the FDA have recently instituted a verification process requiring that authorization stickers be affixed to prescriptions to insure that pregnancy-prevention procedures are followed. As stated above, retinoic acid embryopathy results from the effect of isotretinoin on early organogenesis. Therefore, because the drug is not mutagenic, there is no risk to a fetus conceived by a male who is taking isotretinoin. Although it may seem obvious, it is important to remind men who are taking isotretinoin not to give any of their medication to female companions under any circumstances.
The mechanism of action of isotretinoin is not completely known. The drug produces profound inhibition of sebaceous gland activity, and this undoubtedly is of great importance in the initial clearing. In some patients, sebaceous gland inhibition continues for at least a year, but in the majority of patients, sebum production returns to normal after 2 to 4 months. Thus, this action of the drug cannot be used to explain the long-term remissions. The P. acnes population is also decreased during isotretinoin therapy, but this decrease is not often long lasting. Isotretinoin has no inhibitory effect on P. acnes in vitro. Therefore, the effect on the bacterial population is probably indirect, resulting from the decrease in intrafollicular lipids necessary for organism growth. Isotretinoin also has anti-inflammatory activity and probably has an effect on the pattern of follicular keratinization. Once again, it has not been demonstrated that these effects are long lasting. Thus, while the drug may influence the course of severe acne through several different mechanisms, the explanation for the long-term remissions remains obscure.

Acne Treatment, Systemic Therapy, Hormonal

2008-06-07T13:16:00.000-07:00

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.

Acne Treatment, Systemic Therapy, Antibiotics

2008-06-05T22:14:00.000-07:00

SYSTEMIC THERAPY Over the years, many different agents have been used systemically. The major systemic modalities that are currently being used include antibiotics and antibacterial agents, hormones, and an oral synthetic retinoid.

Antibiotics and antibacterial agents

Currently, the broad-spectrum antibiotics are widely used in the treatment of acne. Although the oral administration of tetracycline does not alter sebum production, it does decrease the concentration of free fatty acids while the esterified fatty acid content increases. This decrease in free fatty acids is seen with dosages ranging from 250 mg/day to 1 g/day. The free fatty acids are probably not the major irritants in sebum, but their level is an indication of the metabolic activity of the organism and its secretion of other proinflammatory products. The decrease in free fatty acids may take several weeks to become evident. This, in turn, is reflected in the clinical course of the disease during antibiotic therapy, as several weeks are often required for maximal clinical benefit. The effect, then, is one of prevention; the individual lesions require their usual time to undergo resolution. However, the fact that a decrease in free fatty acids does occur strengthens the rationale for the use of tetracycline. Tetracycline may act through direct suppression of the number of P. acnes, but part of its action may also be due to its anti-inflammatory activity. Decreases in free fatty acid formation also have been reported with erythromycin, demethylchlortetracycline, clindamycin, and minocycline. Most studies support the efficacy of tetracycline and its derivatives in the treatment of acne. In clinical practice, tetracycline is usually given initially in dosages of 500 mg/day to 1000 mg/day. While the dose is often decreased as improvement occurs and may be continued at a level of 250 mg/day or less, there is increasing concern that this may generate resistant strains. Tetracycline should be taken on an empty stomach to promote absorption. Erythromycin has been used in the past in patients who have difficulty in taking tetracycline on an empty stomach, but there is increasing evidence of the development of erythromycin-resistant strains of P. acnes from both the topical and systemic use of erythromycin. Therefore, it is wise to limit the use of oral erythromycin to those cases where tetracyclines are contraindicated, that is, in pregnant women and young children. Increasingly, doxycycline and minocycline are being used as alternatives for tetracycline or in tetracycline-unresponsive cases. These two drugs appear to be more effective than tetracycline, and drug resistance is less likely to occur, especially with minocycline. Doxycycline should be administered in dosages of 50 to 100 mg twice daily. The major disadvantage of the use of doxycycline is that it can produce photosensitivity reactions, and patients should be switched to another antibiotic, if possible, during the summer months. Minocycline is given in divided dosages at a level of 100 mg/day to 200 mg/day. Patients on minocycline should be monitored carefully as the drug can cause blue-black pigmentation, especially in the acne scars, as well as the hard palate, alveolar ridge, and anterior shins. Minocycline-induced autoimmune hepatitis and a systemic lupus erythematosus-like syndrome have been reported during minocycline therapy, but to date, these side effects are very rare. Oral clindamycin has been used in the past, but because of the potential of pseudomembranous colitis, it is now rarely used for acne. Although long-term, low-dosage antibiotic therapy is often continued for many months, very few side effects have been observed. Tetracyclines have an affinity for rapidly mineralizing tissues and are deposited in developing teeth, where they may cause irreversible yellow-brown staining; also, tetracyclines have been reported to inhibit skeletal growth in the fetus. Therefore, they should not be administered to pregnant women, especially after the fourth month of gestation, or to babies. The tetracyclines also should not be given to children younger than 8 years of age. The only safe antibiotic to administer to pregnant women or children is erythromycin. A rare complication, but one that can easily be missed, is the development of a gram-negative folliculitis. With prolonged antibiotic therapy, gram-negative organisms may proliferate in the anterior nares and spread out onto the surrounding skin. The physician should be alerted to this diagnosis if there is a sudden flare with pustules or nodules in a patient who is otherwise improving. Two types of lesions are seen. Most commonly there are multiple pustules with an intense inflammatory areola. This type of lesion is often caused by Enterobacter or Klebsiella. The patient may also have deep indolent nodules from which Proteus organisms are most often isolated. Culture confirmation is necessary, and antibiotic therapy should be governed by the results of sensitivity studies. Ampicillin is often the antibiotic of choice. Patients who do not show a response to antibiotics should be treated with a full course of isotretinoin . Tetracycline in dosages ranging from 1500 mg/day to 3500 mg/day has been used in patients with very severe acne. The results of this form of therapy are encouraging, particularly because the treated patients have otherwise been resistant to therapy. Patients under treatment with high-dose tetracycline should be carefully monitored with frequent laboratory evaluation. Trimethoprim-sulfamethoxazole combinations are also effective in acne. In general, because the potential for side effects is greater with their use, they should be used only in patients with severe acne who do not respond to other antibiotics. If trimethoprim-sulfamethoxazole is used, the patient must be monitored for potential hematologic suppression approximately monthly.

Acne Treatment : Local Procedures

2008-06-05T10:10:00.000-07:00

ACNE SURGERY This modality, used for the removal of comedones and superficial pustules, aids in bringing about involution of individual acne lesions. Acne surgery was a mainstay of therapy in the past. However, with the advent of comedolytic agents such as topical vitamin A acid, it is not needed as often. Its use is primarily restricted to those patients who do not respond to comedolytic agents. Even in those patients, the comedones are removed with greater ease and less trauma if the patient is treated first with topical vitamin A acid or a similar topical agent for 3 to 4 weeks. This pretreatment should be done in all patients who are going to undergo mechanical comedo removal. Acne surgery is helpful only when properly done, and inaccurate placement of the comedo extractor may serve only to push the inflammatory material further into the skin. Therefore, it is inadvisable to have the patient do acne surgery at home. The Unna type of comedo extractor, which has a broad flat plate and no narrow sharp edges, is preferable. The removal of open comedones does not materially influence the course of the disease because these lesions do not become inflammatory. However, it is desirable to remove them for cosmetic purposes. In contrast, closed comedones should be removed to prevent their rupture. Unfortunately, the orifice of closed comedones is often very small, and usually the material contained within the comedo can be removed only after the orifice is gently enlarged with a no. 25 needle or other suitable sharply pointed instrument.
INTRALESIONAL GLUCOCORTICOIDS Intralesional injection of glucocorticoids, either by the use of a syringe or by the use of an automatic needleless injector, usually dramatically decreases the size of deep nodular lesions. The injection of 0.05 to 0.25 mL per lesion of a triamcinolone acetate suspension (2.5 to 10 mg/mL) is recommended as the anti-inflammatory agent. This is a very useful form of therapy in the patient with nodular acne, but it often has to be repeated every 2 to 3 weeks. A major advantage is that it can be done without incising or draining the lesions, thus avoiding the possibility of scar formation.

Acne Treatment : local therapy

2008-06-05T09:56:00.000-07:00

LOCAL THERAPY

Cleansing
There is no evidence that either surface sebum or surface bacteria aggravates acne. Therefore, in order for a soap or topical antibacterial agent to be of aid in the therapy of acne, the topical agent would have to remove the lipids or the bacteria (or both) from within the follicle. Certainly, the action of a soap will not remove open or closed comedones. Any dermatologist can readily describe cases of acne that he or she has seen in compulsive washers. It would appear that washing as a therapeutic measure is often overemphasized, but many acne patients do not have a pronounced seborrhea, and washing or cleansing to remove this excessive oil, if not overdone, provides subjective benefit.

Topical agents
Topical therapy of acne has undergone periodic change. Many years ago, empirical reliance was placed on the use of sulfur- and resorcinol-containing products, and to a degree, they are still used in the over-the-counter market. Their mechanism of action has not been defined. Products containing salicylic acid, a keratolytic agent, have also enjoyed some popularity. However, the major topical agents now in use are retinoids and antimicrobials such as benzoyl peroxide and topical antibiotics.

Topical retinoids, such as tretinoin and tazarotene, and agents with retinoid activity, such as adapalene, are used extensively for their comedolytic activity. These agents can be irritants; in general, the order of irritancy increases as one progresses from the use of cream preparations to gels to the solution. Most patients can use low-potency tretinoin or adapalene cream daily without developing an irritant reaction. Patients must also be cautioned about sun exposure, because an exaggerated burn may follow what previously was an easily tolerated sun exposure. Unlike tretinoin, adapalene and tazarotene are specific for a subset of retinoic acid receptors (RARs). These two drugs selectively activate RAR-ß and RAR-, but not RAR-a receptors. The binding of these agents to nuclear retinoic acid receptors affects the expression of genes involved in cell proliferation, cell differentiation, and inflammation. At the cellular level, the result may be a modification of several acne pathogenic factors, including corneocyte accumulation and cohesion, and inflammation. Topical retinoids are comedolytic, and reversal of the altered pattern of follicular keratinization has been seen at an ultrastructural level. Epidermal cell turnover is increased in comedones.

Salicylic acid is also comedolytic but is not as effective as topical retinoids.

Benzoyl peroxide preparations are among the most common topical medications prescribed by dermatologists, and benzoyl peroxide is a major therapeutic agent in the over-the-counter acne market. Benzoyl peroxide is a powerful antibacterial agent, and its effect is probably related to a decrease in the bacterial population and an accompanying decrease in the hydrolysis of triglycerides. Benzoyl peroxide preparations are available in both lotion and gel forms, the latter generally being considered more active. The compound can produce significant dryness and irritation, and allergic contact dermatitis has occurred, but this is an uncommon event.

Topical antibiotics are also used for the treatment of acne, the most popular preparations containing erythromycin or clindamycin. These two agents have also been used in combination preparations with benzoyl peroxide. Increased levels of P. acnes resistance have been reported in patients who are being treated with antibiotics. However, the development of resistance is less likely in patients who are treated with a combination of benzoyl peroxide/erythromycin or clindamycin, these combination products are preferable over topical antibiotics alone. Another topical agent is a cream containing 20% azelaic acid.

Azelaic acid is a naturally occurring dicarboxylic acid found in cereal grains. It is available as a topical cream, which is effective in inflammatory and comedonal acne. The activity of azelaic acid against inflammatory lesions may be greater than its activity against comedones. Azelaic acid is applied twice daily and its use is reported to have fewer local side effects than topical retinoids. In addition, it may help to lighten postinflammatory hyperpigmentation. Because comedolytic agents, such as topical retinoids or salicylic acid, and antimicrobial agents, such as benzoyl peroxide or antibiotics, have different modes of action, they are often used together in an individual patient. However, they should be applied at separate times.

Acne Treatment

2008-06-05T09:46:00.000-07:00

Acne Treatment
The determination of the therapeutic efficacy of medications used in acne is not a simple task, and it is possible to find many favorable therapeutic reports for agents that are obviously of little value in the treatment of acne. In this post, no attempt is made to be all-inclusive; only the more commonly used or useful modalities are discussed.
In general, there are four major principles governing the therapy of acne, and the individual therapeutic modalities listed below are related to these principles, where possible. These principles are: (1) correct the altered pattern of follicular keratinization; (2) decrease sebaceous gland activity; (3) decrease the follicular bacterial population, particularly the P. acnes population, and inhibit the production of extracellular inflammatory products (either directly or indirectly) by inhibiting the bacterial organisms; and (4) produce an anti-inflammatory effect. The first of these treatment principles, namely, changing the altered pattern of follicular keratinization, should be the primary form of therapy in noninflammatory acne; the rest of the modalities are primarily designed for use in inflammatory acne. Nonetheless, because altered follicular keratinization is the starting point for the development of inflammatory acne, therapy directed at this abnormality also should be of value in inflammatory acne.

What is Acne?

2008-03-11T14:58:00.000-07:00

Acne is a chronic inflammatory condition of pilosebaceous units and manifests itself as comedones, papules, pustules and eventually scarring.

Epidemiology
Acne vulgaris is a common disease affecting around 40% of 16-18-year-olds. Minor degrees are an almost universal finding throughout puberty in both sexes. All races may be affected, although there is a lower incidence in Asians and blacks.

Pathology
The etiology of acne involves abnormal keratinization, hormonal activity, bacterial growth and immune hypersensitivity. The disease is limited to the pilosebaceous units of the head and upper trunk. The primary lesion arises from a change in the keratinization of the hair follicle and results in a micro-comedone due to impaction and distension of the follicle with improperly desquamated keratinocytes and sebum.
At puberty, androgens stimulate sebaceous glands to produce larger amounts of sebum, and pre-existing comedones become filled with lipids and enlarge. Propionibacterium acnes, a usually harmless commensal bacterium in the pilosebaceous units, contains bacterial lipases that convert lipid into fatty acids. Together with sebum, it causes an inflammatory response in the pilosebaceous unit resulting in the hyperkeratinization and plugging of the follicle.
The enlarging follicular lumen that contains keratin and lipid debris is known as a whitehead (closed comedone). A follicle with a port of entry at the skin with oxidized sebum forming a black tip is known as a blackhead (open comedone). The distended follicle may rupture releasing its contents into the dermis. This provokes a foreign body response resulting in papules, pustules or nodules. Scarring can follow this intense inflammation.

Clinical features
The lesions of acne vulgaris almost always occur on the face. The upper back and chest are involved in approximately 70%. The main skin lesions are comedones, both open and closed. Papules, pustules and nodules may also be present . Nodulocystic acne is a variant consisting of large tender nodules and cysts, which eventually form deep scars. It is important to recognize and treat this form of acne early in life before extensive scarring has occurred. The severity of disease can be assessed using a pictorial grading approach which looks at the extent of inflammation, range and size of inflamed lesions, and associated erythema.
A number of factors, including endocrine disorders and drugs, can exacerbate acne vulgaris.

Initial investigations
Acne is a clinical diagnosis.

Further investigations
Investigations may be required to rule out underlying causes such as hyperandrogenism and polycystic ovary syndrome.
Testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH) and dehydroepiandrosterone sulphate (DHEA-S) levels
In the overwhelming majority of acne patients, hormone levels are normal and, unless clinically indicated, do not need to be checked. Raised free testosterone and DHEA-S levels indicate hyperandrogenism. In polycystic ovary syndrome, the ratio of LH to FSH is increased and the levels of testosterone, oestradiol and androstenedione are raised.

Medical management
Treatment should be commenced early to prevent scarring. The choice of treatment depends on whether the acne is predominantly comedonal or inflammatory, and its severity.

Patient education
The psychological impact of acne should be assessed in each patient and therapy modified accordingly. Patients should be warned that an improvement might not be seen for at least a couple of months.

Topical preparations
Benzoyl peroxide is effective in mild to moderate acne and can be used for both comedones and inflamed lesions. Adverse effects include local skin irritation, particularly when treatment is initiated. Azelaic acid has both antimicrobial and anticomedonal properties. It is less likely to cause local irritation and may be an alternative to benzoyl peroxide.

Topical antibacterials
For mild-moderate inflammatory acne, topical antibacterials such as erythromycin and clindamycin can be used together with benzoyl peroxide. This treatment should be continued for at least 6 months before its benefits can be fully assessed. Antibacterial resistance of P. acnes has increased over the last 20 years. Failure to respond to topical treatment after 8 weeks should prompt a change of treatment.

Topical retinoids
Tretinoin and isotretinoin are effective in comedonal and inflammatory acne. Patients should be warned that some redness and peeling might occur but will settle with time. Improvement occurs over a period of months but may take longer for non-inflamed comedones.

Oral antibiotics
Systemic antibacterial treatment should be considered for all cases of moderate-severe inflammatory acne, and in cases of mild-moderate inflammatory acne where topical treatments used over a period of 3-6 months have been ineffective. Anticomedonal treatment such as benzoyl peroxide or topical retinoids can be used in conjunction with oral antibiotics. Oxytetracycline or tetracycline 500 mg twice a day is usually used. If there is no response after the first 3 months another oral antibiotic should be given. Maximum benefit usually occurs after 4-6 months. Doxycycline and minocycline both at 100 mg daily are alternative antibiotics. Erythromycin can also be used; however, there are now widespread resistant propionibacterium strains and so the response is often poor.

Hormone treatment
Co-cyprindiol (cyproterone acetate with ethinylestradiol) contains an antiandrogen that decreases sebum secretion. It is useful in women who need treatment for acne and also wish to receive oral contraception.

Oral retinoids
Isotretinoin is a synthetic retinoid that inhibits sebaceous gland function and keratinization, and also has some anti-inflammatory activity. It is extremely effective treatment for severe acne (including nodulocystic acne) and disease which has not responded to an adequate course of a systemic antibacterial. Isotretinoin, 0.5-1 mg/kg, is given for about 16 weeks. Although it has revolutionized the management of acne, it is a toxic drug that is prescribed only by, or under the supervision of, a consultant dermatologist. The drug is teratogenic and must not be given to women of child-bearing age unless they practise effective contraception. Pre-treatment tests should include a lipid profile, liver function tests, full blood count and, in the case of women, a negative pregnancy test. These tests should be repeated at 1 month and then every 3 months until the treatment is completed. Concerns have been raised that oral isotretinoin may occasionally cause depression, psychotic symptoms and rarely suicide attempts. However, retrospective studies have failed to demonstrate a relationship. Nevertheless, particular care needs to be taken in patients with a history of depression.
After successful control of disease, maintenance treatment with topical agents is essential with reintroduction of oral antibiotics if acne recurs.

Prognosis
Most cases of acne clear spontaneously by the early twenties but around 5% of cases may persist into the third decade. With the appropriate treatment 90% of patients show a 50% improvement in 3 months and an 80% improvement within 6 months, but continuous treatment may be necessary for many years.

Why should Acne on back be managed by a dermatologist?

2008-01-05T07:53:00.000-08:00

How could the acne on back sufferer be sure that it is acne and not another disease?

How could he/she tell about the response to treatment?
Acne on back should be managed by a dermatologist because of diagnostic and follow up difficulties.

There's an inherent inability to precisely recognize back lesions and follow up their progress during the course of disease or its treatment.
Failure to recognize lesions on back would hinder perception of their exact nature and extent. This particularly applies to changes in appearance or density especially of deep lesions or those raised above the skin surface such as nodules and cysts.
Consequently, the discovery and follow up of the progress of abnormalities and complications as well as judgment by the back acne sufferer upon resolution or response to treatment is not practical. As the sufferer is always oriented with acne, because it's a common disease and because of the limitations in perception, these lesions are either neglected or misinterpreted as an acne lesion.

Why is Acne on back difficult to prevent?

2008-01-03T21:24:00.000-08:00

A special back scrubber

With the large surface area of the back, extra effort is required to accomplish cleansing and scrubbing i.e, difficulties associated with the personal hygienic approaches to the back.
The remote back or the area farthest from the front is partially beyond the the range of movements of the upper limb and the reach of the fingers--------> Failure of proper ordinary scrubbing during regular wash and the need for a special back scrubber.
Unlike the face, it's not practical to wash the back many times a day especially when the acne on back sufferer is in outdoor site during day time to prevent the effects of the sweaty covered back.

Inevitable daily activities

Why are Acne on back lesions lately discovered?

2008-01-01T20:18:00.000-08:00

The back is beyond the limits of the normal human visual field and therefore, any changes in its appearance as caused by disease are not recognizable. That also means, whenever an abnormality develops in the back, it is not detected and is not complained of as a symptom.
That particularly applies to changes in appearance of the skin surface of the back and to add most of the abnormalities resulting from acne i.e. comedones which are only visually detected. Accordingly acne on back projects into consciousness mainly, when pain and or itching is associated with the inflammatory lesions.
The back is hidden from the public eye due to clothing, consequently, it's not noticed by others especially family members who would direct the back acne sufferer's attention to these lesions.
The consequences of this simple fact are:
Late discovery of the lesions of acne on back (usually when severe or complicated).

Why is Acne on back difficult to treat?

2007-12-29T19:30:00.000-08:00

There are many factors responsible for difficulties in treatment of acne on back.
These are related to either the acne on back sufferer or to the disease itself.
Factors related to the disease are either quantitative or qualitative.
Quantitative factors are considered in association with: large pores, large surface area with increased skin thickness and toughness and the extent of lesions.
The large pores of sebaceous glands on the human back are responsible for the more severe-looking appearance of some back acne lesions and its need for more treatment.
The skin of the back is thicker than anywhere else in the body; accordingly ducts of sebaceous glands need to penetrate it for a longer distance to reach the pores located at the skin surface. This feature promotes relative stagnation and clogging of the sebum inside the ducts. Since the back has much tougher skin than the face, commonly available topical treatments used for facial acne are not sufficient, it would therefore need stronger solutions of up to10% benzoyl peroxide. At times it is more resistant to treatment and some dermatologists may recommend using benzoyl peroxide in conjunction with another form of back acne treatment, such as glycolic acid or salicylic acid.
The late discovery of acne lesions is usually associated with their widespread distribution all over the back.
Qualitative factors include: type of lesions; mostly nodulocystic, prevalence of bacteria; secondary to increased humidity and the relatively diminished blood supply of the back which reduces the rate of healing.
Increased thickness of back skin favors the development of nodules and the deeply seated cysts commonly encountered in acne on back. The nodulocystic form is known to be more difficult to control than comedones.
The bacterial element (p.acnes), a normal inhabitant of the skin surface and known to contribute to the disease process is also enhanced; simply due to the large surface area, the humidity resulting from sweating. This fact has its implications on antibiotic therapy of acne lesions.
The healing process also entails adequate blood supply for repair and renewal of exfoliated skin. This point explains why acne on back takes more time for healing in comparison to facial acne.

Factors related to the acne on back sufferer are: late discovery of lesions, difficulty to apply topical medications specified for acne on back lesions, and clothing factors.
The invisible back hinders perception of acne lesions. Late discovery of the lesions of acne on back (usually when severe or complicated) and therefore difficulties in its treatment.
The remote back is partially beyond the the range of movements of the upper limb and the reach of the fingers. The main disadvantage of the remote back is the difficulty or inability to apply topical medications specified for acne on back lesions. The sufferer is always in need for the help of a family member and that is a drawback in both treatment and patient compliance.
Back coverage and the necessity of clothing may be associated with staining due to contact with medications, deprivation of the beneficial drying effect of sunlight and in severe cases preventing from going out as the sufferer is unable to keep clothing on the body.
Many acne medications contain benzoyl peroxide, which is very effective for fighting acne. Using benzoyl peroxide may stain clothing, much like bleach. This upsets the emotionally fragile sufferer and adds to the psychological impact.
Back coverage hinders moderate exposure to ultraviolet rays of sunlight which helps in drying of acne on back lesions.
In severe cases of back acne, it might even make it difficult for the person to keep clothing on the body and this might make the person’s movement handicapped.
All these patient relate factors reduce compliance of the acne on back sufferer and contribute to difficulty in treatment.

What are the implications of acne on back? (part1)

2007-11-27T14:04:00.000-08:00

The invisible and inaccessible back

The back is that part of the body behind the chest or the posterior portion of the trunk region between the neck and the pelvis.
In the dictionary the back as a noun is also defined as the part opposite to or behind that adapted for view or use and the part or area farthest from the front. As an adjective the term back is used to describe the part distant from a center of activity; remote. In technical terms, it may also be a synonym to the unseen or the less important part of a structure or an object.
All these meanings have their relevance when acne on back is to be considered.
The most important of these descriptive terms that concerns our subject are the unseen and the remote back.
As the back is the part opposite to that adapted for view or use, it is practically invisible and inaccessible.
When we recall the definition of a symptom i.e. the visual perception of a change in the perceived appearance of a normal structure; we immediately grasp the idea. The back is beyond the limits of the normal human visual field and therefore, any changes in its appearance as caused by disease are not recognizable. That also means, whenever an abnormality develops in the back, it is not detected and is not complained of as a symptom.
That particularly applies to changes in appearance of the skin surface of the back and to add most of the abnormalities resulting from acne i.e. comedones which are only visually detected. Accordingly acne on back projects into consciousness mainly, when pain and or itching is associated with the comedones.
The consequences of this simple fact are:
Late discovery of the lesions of acne on back (usually when severe or complicated) and therefore its treatment.
Inability of the sufferer to precisely recognize the progress of lesions or follow them up during the course of disease or its treatment.
This also applies to other lesions which are either neglected or misinterpreted as an acne lesion.
The remote back or the area farthest from the front is partially beyond the the range of movements of the upper limb and the reach of the fingers. Our hands are anatomically configured to perform visually monitored manipulations that are therefore in front of the body. Such a functional organization has its own significance. Failure to touch lesions of acne on back would hinder perception of changes in their density or their being raised above the skin surface as in nodules and cysts, again late discovery of abnormalities and complications.
The other disadvantage of the remote back is the difficulty or inability to apply topical medications specified for acne on back lesions. The sufferer is always in need for the help of a family member and that is a drawback in both treatment and compliance.
To mention, one good point for the inaccessible back is preventing the sufferer from picking or squeezing lesions of acne on back. That mechanical hindrance is a favorable factor in the course of disease as it diminishes the complications of such a bad habit practiced by most acne sufferers.

What are the implications of acne on back? (part2)

2007-11-27T14:03:00.000-08:00

Biological characteristics of the back skin

The back skin, has certain biological characteristics that have many implications upon the causation, course, presentation and treatment of acne on back.
With the large surface area of the back having thousands of sebaceous glands with their pores producing an oily substance called sebum; there is a higher risk of blockage of these pores.
Such a predisposition, is augmented when coupled with the same quantitative factor of the anatomically associated increased sweat glands and the fact that increased perspiration is important in the causation of acne on back.
The skin of the back is thicker than anywhere else in the body; accordingly ducts of sebaceous glands need to penetrate it for a longer distance to reach the pores located at the skin surface.
This feature promotes relative stagnation and clogging of the sebum inside the ducts. It also favors the development of nodules and deeply seated cysts commonly encountered in acne on back.
The bacterial element (p.acnes), a normal inhabitant of the skin surface and known to contribute to the disease process is also enhanced; simply due to the large surface area, the humidity resulting from sweating and the difficulties associated with the personal hygienic approaches to the back.
Another factor is that blood supply of the back region is relatively diminished in comparison to the face, consequently acne lesions on the face heal better than those on the back.
It is well known that stress does not worsen acne on back, again this feature would be linked to the differences in blood supply of back in comparison to the face; as the chemical mediators of stress mainly corticosteroid hormones which aggravate acne reach their receptors in sebaceous glands via circulation and that means more steroids will be delivered to the face which has a much better blood supply. The back is also unseen and judgment by the back acne sufferer upon any response to stress is not practical.
This rule applies also to changes of back acne in relation to certain diets.
It has been suggested that hereditary contribution in the development of acne operates through the genetically determined size of pores in different individuals; some having relatively smaller pores would have the problem just as their parents did. Since the pores on the human back are larger than the face, such a hereditary role is not played in the causation of acne on back.
The large pores of sebaceous glands on the human back are also responsible for the more severe-looking appearance of some back acne lesions.
Since the back has much tougher skin than the face, topical treatment used for facial acne may not be sufficient, it can therefore tolerate stronger solutions of up to10 percent benzoyl peroxide.
At times it is more resistant to treatment and some dermatologists may recommend using benzoyl peroxide 2.5% in conjunction with another form of back acne treatment, such as glycolic acid or salicylic acid.

What are the implications of acne on back? (part3)

2007-11-27T14:01:00.000-08:00

The covered back

There are two general issues related to the consequences of back coverage. The first, though less important is that it hinders moderate exposure to ultraviolet rays of sunlight which helps in drying of acne on back lesions.
The second and most important, is concerned with the sweaty covered back.
In contrast to the face, the back is not exposed as it is always covered up with clothes. This fact is coupled with the inherent abundance of sweat glands and their excessive sweating activity in the back region. Consequently, sweat is not cleared up and allowed to stay on the back for periods of time. There are many factors related to the sweaty back that are also considerable. These anatomical factors include: 1- The flat regular surface area of the back which favors Spreadability of sweat. 2- The presence of hair in the back region, which further increases the back's surface area and the entanglement of sweat favors the readily deposition of its salts.
In addition to these factors is the fact that the back has lots of oil glands which produce a large amount of oil on the back. As a result of that, sweat with its content of excreted salts is entrapped between clothes and skin surface especially in hairy backs where it can get deposited easily. The interaction between the increased amount of oil, being mixed with excessive sweat and allowed to stay on the back for periods of time, increases the chance that pores of hair follicles will become blocked producing acne.
The situation is further complicated by the humidity medium associated with sweating that favors invasion of pores with p.acnes bacteria.
Another factor related to the sweaty covered back is the practical inconvenience to wash the back many times a day especially when the acne on back sufferer is in outdoor site during day time.

Clothing factors
Everyone has to wear clothing and the clothes we wear could be important factors in the causation of acne on back. There are many mechanisms involved in the injurious effects of clothing acting upon the regular large surface area of the back with its abundant sweat and sebaceous glands. This interaction may further contribute to the initiation or worsening of acne on back.
The following mechanisms are significant:
Direct effects (primary) related to clothing, which are either organic skin damage or functional stimulation of sweat gland activity.
Indirect effects (secondary) related to the increased production of sweat and its entrapment between the clothing and skin. The causes of trapping sweat in between clothing and skin are either failure of the absorptive capacitance of the clothes or failure of its evaporation due to the barrier effect of clothing.
Consequences of these events (tertiary effects), including excessive oil production by the skin as a protective mechanism in response to the retained sweat and clogging of pores as a result of mixing sweat, sebum and debris. This eventually results in acne breakouts on the back.
The triggers of there effects are:
* Direct contact of clothing to the skin and lesions which may be associated with mechanical, thermal and electrostatic effects producing: 1. direct trauma, 2. increased sweat secretion and 3. eroding and oozing of lesions.
* Direct contact of the skin to retained harmful irritants such as sweat, skin debris and pus i.e. factors related to failure of absorption and evaporation of these irritants.

The sequence of events would be simplified as follows:
* Increased sweat secretion: local heat produced by clothing stimulates the increased production of sweat.
* Direct trauma: clothing rubs against the skin of the back and cause skin irritation and shedding of its superficial surface layers in the form of debris especially when the skin is rinsed in sweat for a long time.
* Eroding and oozing of existing acne lesions: mechanical irritation resulting from the rubbing of clothes against acne lesions may induce ulceration of these lesions and release of pus.
---------> accumulation of Sweat, Debris and Pus.
* Trapping of these harmful irritants due to to clothing related failure of absorption and evaporation of these substances: in between clothing and skin for a long time.
--------->
* Excessive oil (sebum) production by the skin: as a protective mechanism in response to prolonged contact with these retained irritants.
--------->
* Clogging of pores: as a result of the mixing of Sweat, Debris, Pus and Sebum.
--------->
* This eventually results in new acne breakouts on the back.
Specific clothing effects:
Tight clothing:
The wearing of tight clothing, especially on hot days, has increased mechanical damaging effect and heat retention with increased sweating. Clothes that fit close to the body can result in significant rubbing and leads to irritation or even excoriation of the skin. Tightness also favors mixing of the retained harmful substances and forcing them into the pores resulting in their clogging and the formation of new acne lesions.
Athletic gear, bra straps and tight fitting uniforms are known examples of tight clothing.
Rough clothing:
Rough clothing is more injurious and traumatic to the skin of the back. It can irritate existing acne and cause new breakouts.
Thick clothing:
By virtue of its weight: it has more mechanical effect producing direct damage and injuring lesions, it also increases sweat secretion.
By acting as a barrier: it prevents evaporation of sweat.
By virtue of its absorptive capacitance: it retains a lot of harmful irritants and if unchanged for a longer interval it becomes soaked with sweat, debris, pus and sebum and maintains them in contact with the skin.
Polyester clothing:
These fabrics may be associated with mechanical and electrostatic effects producing direct trauma and increased sweat secretion. They have no absorptive capacitance, and have an insulating barrier effect preventing evaporation of sweat, consequently trapping sweat and other irritants in between clothing and skin. These features are in contrast with cotton and other natural fibers which help to clear up perspiration away from the body.
The ideal solution is to wear undershirts that are made with "moisture-wicking" fabric, that keep the sweat away from the skin or to quickly change out the sweat-soaked shirt immediately after working out.

Benzoyl peroxide bleaches clothing
Many acne medications contain benzoyl peroxide, which is very effective for fighting acne. Using benzoyl peroxide may stain clothing, much like bleach.
Wearing white is advised immediately after applying Benzoyl peroxide for the treatment of acne. Another option is to use benzoyl peroxide 2.5% in conjunction with another form such as glycolic acid of salicylic acid.
A good practice is to allow the medication to fully absorb and dry before putting on any clothes. Another alternative is using other acne treatments that are formulated with salicylic acid, which does not stain clothes.

Some good , Some bad news
The back is hidden from the public eye due to clothing, consequently, back acne cause less worry.
In general, it's not quite so serious as getting facial acne because it's usually not as visible.
It's much easier to hide back pimples under the clothing we wear most of the time. Of course, the exceptions are the times one is in a bathing suit or being shirtless. Under these conditions acne on back can be as much of a cosmetic problem as the facial variety of acne.
For a female the decision that involves choosing between a dress with a low back or one that comes to the neckline, is obvious. Acne sufferers are usually terrified of having to wear a low-backed dress.
The fact that back acne limits wearing a special dress, changing in the locker room or spending the summer in your bathing suit has its own psychological consequences .
In severe cases of back acne, it might even make it difficult for the person to keep clothing on the body and this might make the person’s movement handicapped.
It is also noteworthy that overexposure to the sun dries out the skin activating the sebaceous glands to produce more sebum. Covering the back would thus be a favorable protection especially in hot climates.

What are the implications of acne on back? (part4)

2007-11-27T13:57:00.000-08:00

The mechanically stressed back

There are many daily activities that would aggravate acne on back. These practices are considered irritative as they inflict local repetitive minor trauma to the back on a daily basis. Examples of these mechanical stresses include: sitting in a chair for a long time, such as when driving or while working. Also when carrying a heavy backpack, the straps of which would cause friction by rubbing the back region therefore contributing to the condition of back acne.
The back is also in constant contact with clothes and especially when tight, might irritate the skin, which can further aggravate the condition. Tight clothing badly interact with the mechanics of breathing in such a way that when the chest expands involuntarily against the tight non expanding especially synthetic clothes, it results in friction that irritates the back and initiates outbreaks of acne.
Some of these factors are inevitable because we all must sit down such as sitting while working or driving. However, such measures as changing posture and moving around to avoid prolonged sitting and driving for short distances and having some rest before resuming driving in long journeys would help. Another non preventable factor is the effect of contact with clothing as everyone has to wear clothing, this can be diminished by avoiding tight or heavy clothing or wearing a cotton T-shirt underneath. It's clear that all these factors comprise reasons for why acne on back is more difficult to treat than facial acne.
Other alternatives for carrying heavy packs include trying a hand held bag or a shoulder bag.
This type of acne on back caused by these friction mechanisms is sometimes called acne mechanica.

Privacy Policy for acne-on-back.blogspot.com

2007-07-06T12:04:00.000-07:00

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