* Plewig, Gerd; Kligman, Albert M. (2000). Acne and rosacea (3rd ed. ed.). New York: Springer-Verlag. ISBN 3-540-66751-2.
* Cunliffe, William J.; Gollnick, Harald P. M. (2001). Acne : diagnosis and management. London: Martin Dunitz. ISBN 1-85317-206-5.
* Thiboutot, Diane M.; Strauss, John S. (2003). "Diseases of the sebaceous glands". in Burns, Tony; Breathnach, Stephen; Cox, Neil; Griffiths, Christopher. Fitzpatrick's dermatology in general medicine (6th ed. ed.). New York: McGraw-Hill. pp. 672–87. ISBN 0-07-138076-0.
* Zaenglein, Andrea L.; Thiboutot, Diane M. (2003). "Acne vulgaris". in Bolognia, Jean L.; Jorizzo, Joseph L.; Rapini, Ronald P. (eds.). Dermatology. London: Mosby. pp. 531–44. ISBN 0-32302-4092.
* Habif, Thomas P. (2004). "Acne, rosacea, and related disorders". Clinical dermatology : a color guide to diagnosis and therapy (4th ed. ed.). Edinburgh: Mosby. pp. 162–208. ISBN 0-323-01319-8.
* Simpson, Nicholas B.; Cunliffe, William J. (2004). "Disorders of the sebaceous glands". in Burns, Tony; Breathnach, Stephen; Cox, Neil; Griffiths, Christopher. Rook's textbook of dermatology (7th ed. ed.). Malden, Mass.: Blackwell Science. pp. 43.1–75. ISBN 0-632-06429-3.
* James, William D.; Berger, Timothy G.; Elston, Dirk M. (2006). "Acne". Andrews' diseases of the skin : clinical dermatology (10th ed. ed.). Philadelphia: Saunders Elsevier. pp. 231–50. ISBN 0-7216-2921-0.
Monday, February 2, 2009
Grading scale
There are multiple grading scales for grading the severity of acne vulgaris,[67] three of these being: Leeds acne grading technique: Counts and categorises lesions into inflammatory and non-inflammatory (ranges from 0-10.0). 'Cook's acne grading scale: Uses photographs to grade severity from 0 to 8 (0 being the least severe and 8 being the most severe). Pillsbury scale: Simply classifies the severity of the acne from 1 (least severe) to 4 (most severe).
Pigmentation
Pigmented scars is a slightly misleading term as it suggests a change in the skin's pigmentation and that they are true scars; however, neither is true. Pigmented scars are usually the result of nodular or cystic acne (the painful 'bumps' lying under the skin). They often leave behind an inflamed red mark. Often, the pigmentation scars can be avoided simply by avoiding aggravation of the nodule or cyst. When sufferers try to 'pop' cysts or nodules, pigmentation scarring becomes significantly worse, and may even bruise the affected area. Pigmentation scars nearly always fade with time taking between 3 months to two years to do so, although rarely can persist.
On the other hand, some people—particularly those with naturally tanned skin—do develop brown hyperpigmentation scars due to increased production of the pigment melanin. These too typically fade over time.
On the other hand, some people—particularly those with naturally tanned skin—do develop brown hyperpigmentation scars due to increased production of the pigment melanin. These too typically fade over time.
Acne scars
See Acne scarring.
Acne often leaves small scars where the skin gets a "volcanic" shape.
Physical acne scars are often referred to as "Icepick" scars. This is because the scars tend to cause an indentation in the skin's surface. There are a range of treatments available. Although quite rare, the medical condition Atrophia Maculosa Varioliformis Cutis results in "acne like" depressed scars on the face.
Ice pick scars - Deep pits, that are the most common and a classic sign of acne scarring.
Box car scars - Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
Rolling scars - Scars that give the skin a wave-like appearance.
Hypertrophic scars - Thickened, or keloid scars.
Acne often leaves small scars where the skin gets a "volcanic" shape.
Physical acne scars are often referred to as "Icepick" scars. This is because the scars tend to cause an indentation in the skin's surface. There are a range of treatments available. Although quite rare, the medical condition Atrophia Maculosa Varioliformis Cutis results in "acne like" depressed scars on the face.
Ice pick scars - Deep pits, that are the most common and a classic sign of acne scarring.
Box car scars - Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
Rolling scars - Scars that give the skin a wave-like appearance.
Hypertrophic scars - Thickened, or keloid scars.
Preferred treatments by types of acne vulgaris
* Comedonal (non-inflammatory) acne: local treatment with azelaic acid, salicylic acid, topical retinoids, benzoyl peroxide.
* Mild papulo-pustular (inflammatory) acne: benzoyl peroxide or topical retinoids, topical antibiotics (such as erythromycin).
* Moderate inflammatory acne: benzoyl peroxide or topical retinoids combined with oral antibiotics (tetracyclines). Isotretinoin is an option.
* Severe inflammatory acne, nodular acne, acne resistant to the above treatments: isotretinoin also known as Accutane, can be prescribed by a doctor, or contraceptive pills with cyproterone for females with virilization or drospirenone.
* Mild papulo-pustular (inflammatory) acne: benzoyl peroxide or topical retinoids, topical antibiotics (such as erythromycin).
* Moderate inflammatory acne: benzoyl peroxide or topical retinoids combined with oral antibiotics (tetracyclines). Isotretinoin is an option.
* Severe inflammatory acne, nodular acne, acne resistant to the above treatments: isotretinoin also known as Accutane, can be prescribed by a doctor, or contraceptive pills with cyproterone for females with virilization or drospirenone.
Future treatments
A vaccine against inflammatory acne has been tested successfully in mice, but it is not certain that it would work similarly in humans.[65] A 2007 microbiology article reporting the first genome sequencing of a Propionibacterium acnes bacteriophage (PA6) said this "should greatly enhance the development of a potential bacteriophage therapy to treat acne and therefore overcome the significant problems associated with long-term antibiotic therapy and bacterial resistance."[66]
History of some acne treatments
The history of acne reaches back to the dawn of recorded history. In Ancient Egypt, it is recorded that several pharaohs were acne sufferers[citation needed]. From Ancient Greece comes the English word 'acne' (meaning 'point' or 'peak'). Acne treatments are also of considerable antiquity:
* Ancient Rome[citation needed]: bathing in hot, and often sulfurous, mineral water was one of the few available acne treatments. One of the earliest texts to mention skin problems is De Medicina by the Roman writer Celsus.
* 1800s: Nineteenth century dermatologists used sulphur in the treatment of acne. It was believed to dry the skin.
* 1920s: Benzoyl Peroxide is used
* 1930s: Laxatives were used as a cure for what were known as 'chastity pimples'. Radiation also was used.
* 1950s: When antibiotics became available, it was discovered that they had beneficial effects on acne. They were taken orally to begin with. Much of the benefit was not from killing bacteria but from the anti-inflammatory effects of tetracycline and its relatives. Topical antibiotics became available later.
* 1970s: Tretinoin (original Trade Name Retin A) was found effective for acne.[61] This preceded the development of oral isotretinoin (sold as Accutane and Roaccutane) in 1980.[62]
* 1980s: Accutane is introduced in the United States, and later found to be a teratogen, highly likely to cause birth defects if taken during pregnancy. In the United States more than 2,000 women became pregnant while taking the drug between 1982 and 2003, with most pregnancies ending in abortion or miscarriage. About 160 babies with birth defects were born.[63] [64]
* 1990s: Laser treatment introduced
* 2000s: Blue/red light therapy
* Ancient Rome[citation needed]: bathing in hot, and often sulfurous, mineral water was one of the few available acne treatments. One of the earliest texts to mention skin problems is De Medicina by the Roman writer Celsus.
* 1800s: Nineteenth century dermatologists used sulphur in the treatment of acne. It was believed to dry the skin.
* 1920s: Benzoyl Peroxide is used
* 1930s: Laxatives were used as a cure for what were known as 'chastity pimples'. Radiation also was used.
* 1950s: When antibiotics became available, it was discovered that they had beneficial effects on acne. They were taken orally to begin with. Much of the benefit was not from killing bacteria but from the anti-inflammatory effects of tetracycline and its relatives. Topical antibiotics became available later.
* 1970s: Tretinoin (original Trade Name Retin A) was found effective for acne.[61] This preceded the development of oral isotretinoin (sold as Accutane and Roaccutane) in 1980.[62]
* 1980s: Accutane is introduced in the United States, and later found to be a teratogen, highly likely to cause birth defects if taken during pregnancy. In the United States more than 2,000 women became pregnant while taking the drug between 1982 and 2003, with most pregnancies ending in abortion or miscarriage. About 160 babies with birth defects were born.[63] [64]
* 1990s: Laser treatment introduced
* 2000s: Blue/red light therapy
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