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Acne is a common inflammatory disease in areas where
sebaceous glands are largest , most numerous, and most
active. The process begins about the base of the follicle
and is characterized, in order of increasing severity, by
comedones, pustules, papules, inflamed nodules, infected
cysts, and, in extreme cases, canalizing inflamed and
infected sacs. 

Acne is attributable to the effect of androgenic hormones
on the pilosebaceous apparatus. Acne is so common at
puberty that it may almost be considered a physiologic
disturbance; it affects more than 80% of teenagers. 

comes in various grades. Grade I acne is an evanescent disorder leaving few residual sign except possibly dilated pores. The lesion consists of a lipokeratinous plug, commonly known as a blackhead. In Grade II acne, the sebaceous duct ruptures and the sebum spills into the skin. The sebum may irritate the surrounding tissue which reacts by isolating and containing it in the form of a superficial or deep noninflammatory cyst. Simultaneously, a superficial pustule usually develops around the orifice. If extension of the inflammation is prevented, atrophy and scarring usually do not follow. In Grade III acne, bacterial and chemical irritation of the tissues, destruction and displacement of epidermal cells, and scarring occur. In Grade IV acne, the lesions are extensive, involving the shoulders, trunk, and upper arms. Certain foods appear to aggravate acne in some patients. Chocolate, nuts, cola drinks, and less frequently, milk in large quantities have been implicated. However, prohibition of essential foods can lead to a deficient diet, especially for growing active adolescents. Suspected foods should therefore be eliminated, one at a time, for 3 week trial periods. Clumsy manual attempts to extrude blackheads or superficial cysts, constant fondling or pinching of lesions, and scratching of ruptured lesions before a crust forms - all promote residual scars. Though it is important to keep the skin hygienically clean, too vigorous or too frequent washing should be avoided. Exacerbation of acne is often noted during the winter with improvement during the summer. However, excessively humid and hot weather frequently produces a flare-up. Disfiguring acne may induce severe psychic trauma, particularly in girls. The tension mayincrease facial flushing and possibly seborrhea; it leads to trauma, new lesions, and excoriation of old ones. The adolescent is likely to use the acne as an excuse to avoid difficult personal adjustments and may become withdrawn and self-pitying. Such individuals find the explanation that their acne is but a passing annoyance difficult to accept, and may need psychotherapy. Tension may bring out and aggravate suppressed intra-family antagonisms, particularly between mother and daughter. Treatment varies according to severity. In Grade I or II acne, treatment should be simple, since a stringent regimen exaggerates the importance of the eruption for some. The affected areas should be washed witha type of soap containing an antibacterial agent. a soft complexion brush or a slightly abrasive soap help to eliminate blackheads, but may be harmful if the lesions are inflamed. In mild acne, large comedones may be removed carefully once or twice a week, preferably with the Schamberg loop extractor, which a responsible member of the family may be taught to use. Warm towels applied for 10 to 15 minutes facilitates removal. Inflammatory lesions should not be opened until they have pointed in a pustule, since too early incision leads to extension of the inflammation and scarring. Picking the crust covering an opened lesion may delay healing for several weeks and produce a pitted scar. In Grades III and IV acne, therapy aims to decrease the output of the sebaceous glands and to control inflammation and cyst formation. Systemic administration of a broad spectrum antibiotic may improve severe acne. Since relapse ordinarily follows short periods of treatment, therapy must be continued for weeks to months, though small daily doses may suffice. Any broad-spectrum antibiotic (e.g. tetracycline, crythromycin) may be given in the usual therapeutic doses for 2 weeks. If it is effective, dosage is continued for an additional 2 to 4 weeks; then the dose is decreased at 2 week intervals. Abrupt cessation of treatment is usually followed by relapse. If, after an initial 4 week trial, one antibiotic has not resulted in improvement, another may be tried. The risks of antibiotic treatment and the emergence of antibiotic-resistant staphylococci must be weighed against the severity of the disease. The results of antibiotic therapy are erratic, as are all topical treatments. Residual scarring may be decreased appreciably by dermabrasion. The skin is ground down to the level of the dermal papillae; the epidermal cells of the interpapillary ridges then regenerate a smoother epidermal layer. The patients who may be helped must be selected by a specialist since not all types of acne scarring are improved.   


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