Menopause A to Z.pdf - Medwords.com.au

MENOPAUSE A to Z
A TO Z
ACNE
Acne, spots, pimples, zits. It doesn’t matter what they are called, nobody likes to have them, or look at them. Acne
can vary from the annual spot, to a severe disease that may cause both skin and psychological scarring. It is generally
a curse of teenage years, but it may strike later in life too, particularly in women. Acne is usually more severe in
teenage males, but starts earlier in females. Acne affects Caucasians (whites) more than Negroes or Chinese races.
The face, upper chest, upper back and neck are most commonly affected.
Pimples are due to a blockage in the outflow of oil (known as sebum) from the thousands of tiny oil glands in the
skin. This blockage can in turn be caused by dirt (uncommon in our super-clean society), dead skin left behind during
the normal regular regeneration of the skin surface, or a thickening and excess production of the oil itself.
Once the opening of the oil duct becomes blocked, the gland becomes dilated with the thick oil, then inflamed, and
eventually infected. The result is a white head, with the surrounding red area of infection. Eventually this bursts,
sometimes leaving a scar.
The most common cause of acne is the thickening of sebum caused by the hormonal changes of puberty. The
severity of acne in a teenager will depend upon the degree of acne suffered by his/her parents, as this is a strongly
inherited characteristic. Pregnancy, premenstrual syndrome (hormonal changes before a period), menopause and the
oral contraceptive pill may all cause pimples in this way.
Stress in the patient, either psychological or caused by disease, may make pimples worsen. A simple cold, or the
onset of exams may see the number of spots increase dramatically.
If the onset of acne is after the teenage years, or recurs, the polycyctic ovarian syndrome may be responsible, and
medications such as the contraceptive pill and metformin may be helpful.
Pressure from spectacles on the bridge of the nose or tight collars, increases in skin humidity from a fringe of hair or
nylon clothing, and excessive use of cosmetics that
further block the oil duct openings, can all cause
deterioration in a person’s acne. Some chemicals or
oils that a patient may encounter in the work place are
also possible causes. Medications such as phenytoin,
lithium, isoniazid, rifampicin may also be responsible.
Treatment of asthma or other diseases with
steroids (eg. prednisone) may worsen acne. A tumour
of the pituitary gland under the brain, or the adrenal
glands on each kidney, may produce higher than
normal levels of steroids to mimic this problem.
The severity of acne also depends on hereditary
factors. There is no evidence that dark chocolate,
vitamins or herbs have any effect on acne, but there is
some new evidence that a diet high is sugar and foods
with a high glycaemic index may aggravate acne.
A number of conditions can cause a rash that looks like acne, but is not. The most common of these are rosacea
and folliculitis barbae (ingrown facial hairs caused by blunt blade when shaving or other skin damage). Rosacea is a
skin disease of the face, found most commonly in middle-aged women, that causes excessive intermittent flushing of
the face, then sores develop that are similar to a severe case of pimples.
There is no evidence that diet, vitamins or other herbs have any effect on pimples. A small number of sufferers may
find that one particular food causes a fresh crop of spots, but these people usually quickly realise this and avoid the
offending substance.
The first step in treatment involves keeping the skin clean with a mild soap and face cloth, and simple oil drying,
antiseptic and cleansing creams or lotions. Further treatment involves combinations of antibiotics (eg. tetracyclines)
that may be taken in the short term for acute flare ups or in the long term to prevent acne, skin lotions or creams
containing antibiotics and/or steroids, and changing a woman's hormonal balance by putting her on the oral
contraceptive pill or using other hormones. In rare cases it is necessary to take the very potent medication isotretinoin
(which can cause birth deformities if used during pregnancy), give steroid injections (eg. triamcinolone) into the skin
around particularly bad eruptions, and abrade away the skin around scars. The treatment of adults with maturity onset
acne is more difficult than juvenile acne.
Acne may cause both skin and psychological scarring. Picking acne spots can cause serious secondary bacterial
infections that can spread deep into the skin (cellulitis).
Although acne cannot be cured, in the majority of cases reasonable control can be achieved.
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