mediviews.com» Dermatology

Dr. Jaggi Rao: Laser Resurfacing

vsuresh — Tue, 19 Jul 2011 08:17:30 +0000

Questions answered in this video include:

How does the laser work to reduce the size of pores?
How do you know how deep you need to go in order to vaporize the right skin cells?
Are there any other potential side effects or risks to the procedure?
What steps are required to ensure quick healing after the procedure?
Does the resurfacing laser have any other applications besides minimizing pore size?

More about Dr. Jaggi Rao:

Dr. Jaggi Rao is a board-certified dermatologist licensed in both Canada and the United States. Immediately after completing his dermatology training, Dr. Rao became the first Canadian physician to be accepted to the prestigious American Academy of Cosmetic Surgery Fellowship Training Program. For a full-year, Dr. Rao was immersed in the art and science of various fields of cosmetic medicine in the heart of southern California. During this time, he was taught by and worked alongside some of the most famous names in cosmetic and laser surgery. With his love for dermatology, physics and technology, Dr. Rao distinguished himself as a reputable researcher, author, teacher, presenter, technician and skilled cosmetic specialist. Dr. Rao was privileged to be an investigator for numerous medical and device trials, exposing him to almost every new laser system and cosmetic technology, advanced uses for Botox, filling substances and novel topical agents, as well as cutting-edge advances in liposculpture, sclerotherapy and cosmetic surgery.

At this early point in his career, Dr. Rao has already earned several achievements. These include having authored over 30 scientific articles and textbook chapters, presented at over 20 medical meetings, mentoring countless physicians of various disciplines, serving as a peer reviewer for prominent medical journals including Dermatologic Surgery and The Journal of Cosmetic Dermatology, and acting as a consultant for various laser, technological and pharmaceutical companies. He has won awards for his research and presentations, and was recently appointed as a Faculty Member of the prestigious Hugh Greenway Superficial Anatomy and Cutaneous Surgery course, the gold standard course in dermatologic and cosmetic surgery hosted annually by some of the top leaders in the field.

Dr. Janice Liao: Male Pattern Baldness

pkuzel — Fri, 29 Apr 2011 03:50:38 +0000

Notes on Dr. Janice Liao:

Dr. Janice Liao is a dermatologist specializing in hair transplantation, with over 25 years of experience in the field. Dr. Liao is the past president of the Alberta Society of Dermatology and board member of both the Canadian Dermatology Association and Canadian Society of Dermatological Surgery.

Background Information – Androgenic Alopecia:

Alopecia (balding) is a very common problem in both males and females. At age 50, about 50% of the male population will be affected by it. In females, around 30% of the population will experience balding to some degree by age 40. The exact amount of money spent yearly on treating alopecia is unclear, but figures suggest that it is a multibillion dollar industry. Alopecia can be caused by genetic factors, medication (e.g. chemotherapy), and nutritional deficiencies such as a lack of iron. Many types of alopecia occur in humans, such as traction alopecia, alopecia areata, scarring alopecia and androgenic alopecia. Androgenic alopecia, commonly known as male pattern baldness, contributes to the vast majority of hair loss seen in both males and females and is caused predominantly by genetic factors.

Pathophysiology:

Male pattern baldness (MPB) typically begins with a receding hairline, slowly becoming an “M” shape, sometimes referred to as a widow’s peak. The hair on the crown then begins to thin out, along with other existing hair at the frontal hairline. Depending on the severity, the top of the head may eventually become completely bald, leaving a horseshoe-shaped bald patch. Characteristically, MPB spares the lateral aspects of the scalp, leaving a ring of hair follicles resistant to hair loss along the sides of the head. This is due to a lack of receptors on these hair follicles to the androgen DHT, which causes hair loss in hairs at the back and side of the head.

This loss of hair is a completely physiological process, although it can commonly result in adverse psychological effects in an affected individual.

Male pattern baldness has been studied extensively, and it is evident that it is predominantly dictated by a few hormones and enzymes, the most influential of which is dihydrotestosterone, or DHT. This substance is created from another hormone called testosterone, of which approximately 5% is reduced by an enzyme called 5-alpha-reductase to produce dihydrotestosterone. DHT facilitates pubic and body hair growth during puberty, and a lack of this hormone can lead to a deficiency of body hair or more serious developmental abnormalities during normal male development. However, despite promoting hair growth and the development of male secondary sexual characteristics earlier in life, the role of DHT can curiously reverse and begin to promote hair loss in individuals with a genetic susceptibility and/or sensitivity to this hormone. The extent to which hair follicles on the scalp are sensitive to DHT determines the total extent of hair loss an individual will experience.

Thus, the genes that dictate the hormonal receptor’s response to DHT play a central role in the onset of androgenic alopecia. Studies had shown that a certain variant of androgen receptor is needed for male pattern baldness to occur. The genes responsible for this type of receptor are recessive (meaning one copy of the gene from each parent is required for it to work), and are located on the X chromosome.

Treatments:

One of the most widely used treatments for androgenic alopecia is a drug called finasteride (Propecia^TM, Proscar^TM). It is a synthetic substance that inhibits 5-alpha-reductase, the enzyme that converts testosterone to DHT. Studies have shown that this treatment can prevent further hair loss in up to 90% of the individuals, while a certain percentage of people may in fact experience hair regrowth. However, the effect of finasteride lasts only as long as it is taken, and therefore the pill must be taken long-term and on a daily basis for optimal results. Hairs grown or maintained through the use of finasteride are at risk of being lost within 6-12 months after treatment stops. Since this drug inhibits the production of DHT, a male sex hormone, adverse side effects may include erectile or ejaculatory dysfunction and decreased libido. A few European agencies have warned of permanent sexual dysfunction, and this warning is included on the European product label but not North America warning label. Importantly, this drug should also not to be handled or ingested by pregnant and breastfeeding women, or by women planning on becoming pregnant soon. Additionally, it is recommended that males who intend to try to conceive a child with their partner should cease taking finasteride for a period of at least 3 months. In all, though, this medication is very well tolerated by the majority of patients, and it is the most effective medical treatment option currently available for MPB.

Minoxidil (or Rogaine^TM) is another popular treatment option for androgenic alopecia. Originally developed for high blood pressure, the side effect of increased hair growth in patients soon led to its adoption as a hair loss treatment option. Topical minoxidil is made specifically for treating hair loss. It often comes in the form of a liquid or foam in both a 2% and 5% concentration, and is directly applied to the scalp once or twice each day. The exact mechanism of how minoxidil works is still unknown, but its effect is thought to be related to increased blood flow and oxygenation to the scalp. As with finasteride, treatment should be maintained long-term for optimal results, as hair loss will resume after minoxidil is discontinued. Minoxidil can be used to treat male pattern baldness in both men and women, and can in fact produce more pronounced results in the latter. The side effects of minoxidil may include local skin irritation and flaking, although in general this medication is very well tolerated by patients. A sometimes bothersome secondary side-effect is the unsightly flaking of the liquid preparation of this medication when applied to the scalp. In this circumstance, flaking can often be minimized by switching to the foam preparation.

For individuals who have failed medical therapy for MPB and in those patients for whom hair loss is particularly psychologically distressing, the next and most definitive treatment option is hair transplant surgery. This surgery involves transplanting small areas of hair follicle-containing skin, harvested from the peripheral areas of the scalp where follicles tend to be resistant to hair loss, to areas of the scalp where hair loss has occurred. Though the transplanted hair will not be as dense as it was prior to when hair loss first occurred, a properly done re-distribution of resistant scalp hair can significantly reduce the effects of MPB on a patient’s overall cosmesis. Side effects may include continued thinning of hair, scarring, and a small risk of skin infection. Importantly, it is important that patients maintain a strict regimen of additional hair loss-prevention measures (namely minoxidil and/or finasteride therapy) after the procedure has been completed, to prevent continual loss of non-resistant hair follicles.

Research:

Currently, there are several exciting avenues of research being explored in the field of male pattern hair loss. Of these, the most cutting-edge and potentially most promising is the harvesting and growth of stem cells into new, fully functional hair follicles, which would then be surgically implanted into the scalp in much the same manner as hair transplant are currently conducted. If this technology is brought to fruition, stem cell-based hair transplantation would mitigate the limiting factor affecting our current transplant technology, namely the availability of viable, resistant hair follicles.

Dr. Taher: Nonmelanoma Skin Cancer

pkuzel — Wed, 23 Mar 2011 20:48:32 +0000

Questions answered in this video include:

What is skin cancer?
How does a skin tumor develop, and what processes are involved?
Are there different forms of skin cancer?
What are some specific types of Non-melanoma skin cancers (NMSC’s)?
How common are NMSC’s in society?
Of the BCC and SCC, which is more commonly found?
Do certain segments of the population have a higher risk of developing NMSC’s?
Do artificial tanning beds increase your risk of developing skin cancer?
Can people from any age group develop an NMSC, or are certain ages more prone?
What features or aspects of the skin might lead a specialist to suspect a BCC or SCC?
Are there warning signs that allow skin cancers to be detected early?
What are some potential consequences of a BCC that goes unchecked for a long period?
What are some dangers of leaving a SCC unchecked for a long period?
Is there anything patients can do to prevent these types of skin cancers?
What treatment options are available to someone who is diagnosed with an NMSC?
What is Mohs Micrographic Surgery?
How does Mohs Micgrographic Surgery differ from regular surgical excisions?
After receiving treatment for a BCC or SCC, what are the chances of the tumor reappearing or recurring?
Are there any other long-term complications that can arise after treatment?

About Dr. Taher

Dr. Taher completed his dermatology training at the University of Alberta. Prior to this, he underwent fellowship training in Moh’s micrographic surgery in Dermatologic surgery in Los Angeles and Santa Monica, California. While in the United States, he was on faculty at USC and also lectured at UCLA. Dr. Taher has an interest in general medical dermatology and cutaneous oncology and provides advanced skin cancer surgery skills to his patients.

Read about Dr. Taher’s innovative skin cancer screening and treatment clinic for organ transplant patients

Keystone Dermatology Institute

Nonmelanoma Skin Cancer – Backgrounf Information

Skin cancers are abnormal growths of the skin that have many possible etiological factors and varying degrees of severity. There are two major categories of skin cancer, namely melanoma and non-melanoma skin cancers (NMSCs). Of the non-melanoma skin cancers, the two most common types are squamous cell and basal cell carcinoma. Together, they make up about three quarters of all NMSCs, and are the most commonly diagnosed of all human cancers. The squamous and basal cells are cells that make up the epidermis, or the outmost layer, of the skin. The squamous cells are the mature cells that gradually move toward the surface of the skin, and basal cells are the infant stage cells being constantly produced deeper in the epidermis, pushing the squamous cells upwards.

Pathophysiology:

Basal cell carcinoma (BCC) is most commonly found on skin that’s been exposed to the sun, with 80% occurring on patients’ face and neck. It usually has the appearance of a smooth, shiny bump on the skin. Sometimes the bump is translucent in nature, and blood vessels can be seen. Some types of basal cell cancers can resemble a thickening of skin or scar tissue. It should also be noted that it is difficult to differentiate between basal cell carcinoma and acne scars, amongst other skin conditions. This type of carcinoma is the most common type of skin cancer, with a person’s lifetime risk of developing BCC around 30%. Luckily, BCC is one of the most treatable forms of skin cancer, with metastasis or death occurring in only extremely rare instances. Nevertheless, uncontrolled proliferation of BCC has the potential to cause substantial local tissue destruction, and thus prompt treatment and careful follow-up is very important.

There are a few primary etiological factors which have been identified that lead to the development of basal cell carcinoma. It has been observed that certain genetic traits, namely Caucasian traits, such as light colored skin, blue or green eyes, and blonde or ginger hair can elevate the risk for basal cell skin cancer. Also, overexposure to strong radiations such as ultra violet and X-ray radiation also increases the risk for this type of skin cancer. As with all cancers, genetic pre-disposition is also a major factor. Early signs and symptoms that may indicate the presence of basal cell carcinoma includes a sore on the surface of skin that bleeds easily and refuses to heal, or the emergence of a scar-like sore in an area that has not previously been injured.

Squamous cell carcinoma (SCC) occurs less commonly than basal cell carcinoma, although it does still make up a significant proportion of the overall skin cancer burden. It appears as a growing bump that may take on different textures and colors. Commonly, it presents as a reddish, scaly papule which may have a rough of crusty surface. It is also most prevalent in areas on the face or neck, as well as other areas that are exposed to the sun. Patients commonly describe SCC as having a sore which doesn’t seem to heal. This type of cancer can also occur in organs other than the skin, including lung, liver, prostate, cervix, etc. Appearances and symptoms of the cancer may vary with the organ.

Squamous cell carcinoma can be caused by a variety of different environmental factors. It tends to appear in individuals with lighter skin and those who have been overexposed to X-ray and ultra violet radiation. Risks for this cancer are also higher in individuals who have had contact with environmental toxins such as arsenic. Old age is itself a risk factor for SCC development. Finally, another important risk factor for the development of SCC is immunosuppression, such as is the case with organ transplant recipients who receive lifelong immunosuppressive therapy to lower the chances of tissue rejection. Thus, patients such as this require close monitoring and regular skin check-ups performed by a dermatologist.

Treatments:

To determine whether the case is indeed skin cancer, a biopsy will is usually performed in which a small piece of skin tissue is removed for further examination in a laboratory. Basal cell skin cancers are relatively easy to treat, and the rate of recurrence is under 10%; squamous cell skin cancer can be cured with a high success rate if discovered and treated promptly. However, compared to BCC, SCC is somewhat more likely to recur locally and is also associated with a slightly higher chance of distant metastasis.

Many treatments are currently used to treat skin cancers. These include surgical excision, Mohs micrographic surgery, curettage and electrodesiccation, radiation therapy, and skin creams. Doctors will recommend and employ different treatment methods depending on the size and location of the tumor, age of the patient, and other factors which may result in a specific treatment modality being indicated.

Surgical excision, including Mohs micrographic surgery, is the preferred method in dealing with most skin cancers. This method results in removal of the tumor and results in the lowest rates of local recurrence and metastasis. Due to the limitations of conventional surgical removal in cosmetically sensitive or high risk areas such as the face, Mohs smicrographic surgery is often the preferred choice. This type of surgery removes a thin layer of skin cancer, which is immediately examined under a microscope to check for cancer cells. The base and side of the sample is specifically assessed, and the surgeon will then continue to remove layers of skin until the sample observed is free of cancer cells. This method allows for maximal tissue sparing, lower recurrence rates and a higher degree of confidence that all of the cancer has been removed.

The curettage and electrodesiccation method is often used for tumors of smaller size and in non-cosmetically sensitive areas. This method uses a curette to scrape away the tumor, before an electric current is applied to further eliminate any remaining cancer cells. The cure rate is highly varied and depends on the size and type of the tumor.

Radiation therapy (RT) involves utilizing damaging radiation to destroy cancer cells. The normal tissues around the tumor are also be affected to some degree, and thus a recovery period is needed in between treatments to allow for healing. The resting period does not allow the cancer to recover much since the cancer cells are not as apt at restoring themselves. Radiation therapy is used when cancer has spread to other organs or lymph nodes and surgical removal would be difficult. Fragile areas that are difficult to reconstruct (i.e. nostril rim) are also sometimes treated by radiation therapy. RT is also used for elderly patients that are not well-suited for surgery. It takes multiple visits to complete the treatment, and can require anywhere from 5 to 25 visits. Radiation therapy can deliver a high success rate in curing tumors, although the exact cure rate depends on the type of tumor in question as well as its stage of progression.

Skin cream that contains imiquimod or 5-fluorouracil is used to treat superficial skin cancers. It is reported that such treatment is very effective in reducing and even removing the tumor, although marked inflammation often occurs as a side effect when using this treatment. This method is often used in conjunction with Mohs surgery to ensure the complete removal of the tumor.

Research:

A synthetic inhibitor of the Hedgehog Pathway that is known to induce tumor growth is currently under active investigation. This inhibitor is known as GDC0449, developed by the Curis Inc. and is currently under clinical trials by the Genetech company. It has been shown to slow or even stop the development of tumors, and can cause existing tumors to shrink. It does not only work on skin, but other organs such the esophagus and cervix as well.

References:

Canadian Cancer Society

http://www.cancer.ca

National Library of Medicine

http://www.nlm.nih.gov

Dr. Jaggi Rao: Tattoo Removal

vsuresh — Wed, 23 Mar 2011 20:47:39 +0000

Questions asked in this interview include:

What is a tattoo?
How does a tattoo remain permanent given that the skin is constantly shedding?
What are the options for tattoo removal?
How are lasers used to remove the tattoos?
Are certain colours of tattoos easier to remove than others?
How much does the laser treatment hurt the individual?
Is tattoo removal covered by health insurance coverage?
What are the costs associated with laser tattoo removal?
How many laser treatments are required to remove a tattoo?
How does the skin heal after tattoo removal? Is there noticeable scarring?
Does the skin revert back to its pre-tattoo state?
Are there risks involved with laser tattoo removal?
What advice would you give to somebody to insure proper tattoo removal?
Are there differences to having tattoos removed in a hospital (clinic) versus a tattoo parlor?

Notes on Dr. Jaggi Rao:

Dr. Rao is a board certified dermatologist licensed in both Canada and the United States. He is also a clinical professor of Dermatology and a coordinator of the residency training program at University of Alberta. After completing his dermatology training, Dr. Rao was the first Canadian physician to be accepted to the prestigious American Academy of Cosmetic Surgery Fellowship program.

Tattoo Removal:

Tattoos represent an ancient form of art, and has been an important means of self-expression for many millenia. In fact, archeological evidence suggests that the use of tatttoos dates back to 4-5000 B.C. Tattooing involves inserting indelible ink into a layer of the skin called the dermis, which is the layer found below the epidermis. This process results in permanent skin markings, removable only by very invasive, painful procedures. The most effective and safe of all removal strategies is laser tatto removal. In this video, footage showing an actual laser tattoo removal session is featured, together with an explanation of the procedure by an experienced laser tattoo removal expert.

Background Information

Overview:

Tattoo removal probably has a history as long as the art of tattoo itself. In fact, statistics show that a large proportion of people who choose to get tattoos later end up regretting their decision. Early forms of tattoo removal consisted of applying or injecting substances such as garlic or lime into the skin, as a way of mechanically extracting the tattoo ink. More modern techniques include invasive medical procedures such as cryosurgery as well as surgical excision. Probably the most cutting-edge form of tattoo removal, often considered to be the gold standard, is the laser tattoo removal method. This method makes use of Q-switch lasers—lasers capable of producing high-power laser pulses—to remove a tattoo. This method rarely results in scars, and is also non-invasive, reducing the chance of adverse side effects.

Methods:

One of the older methods of tattoo removal uses specialized gel to drive the ink into the deeper skin layer up to the surface layer, eventually to be shed along with the surface skins. More invasive methods include surgery akin to that of skin transplant or skin grafting Due to the high rate of scarring, unpredictable results, and potential for infection, invasive methods to remove tattoos are no longer very popular. The newest laser tattoo removal method makes use of a phenomenon termed selective photothermolysis, which uses high energy laser beams to target a specific structure, producing sufficient heat to destroy the target. In this case, the targeted structure is the ink in the tattoo, which, after being fragmented by heat, will be broken down and removed by the body.

Laser Tattoo Removal:

As the name implies, the laser tattoo removal method uses laser to remove the tattoo’s coloration of the skin. The laser used must be able to provide enough energy (upwards of gigawatts) to shatter the color pigments of the dye, and Q-switched lasers are one of the only commercially available lasers capable of delivering such enormous amounts of energy. However, due to the nature of lasers—namely they will be absorbed differently by different colors—removal of multicolored tattoos often require many different lasers of different wavelengths to work together.

There are a few types of lasers used for tattoo removal: Q-switched Ruby Laser, Q-switched Nd:YAG, Q-switched Alexandrite Laser, and Flashlamp-Pumped Pulsed Dye Laser. The Ruby Laser is effective on most tattoo ink colors except for red and yellow; the Nd:YAG laser works well on red and orange tattoos, and also works better on individual with darker skin; the Alexandrite Laser works great on green colored tattoo. And all three work most effectively on the darker colored tattoos. The Flashlamp-Pumped Pulsed Laser works best on more brightly colored tattoos, but has the disadvantage of being unable to reach tattoos deeper in the skin.

The procedure of laser tattoo removal is quite simple. Most of the time, a topical anesthetic cream is applied to the tattoo area to help ease the pain, which has been described as comparable to snapping a rubber band against the skin. The doctor will then target the tattoo with a pulsing laser and cover the entire tattoo area with the appropriate type of laser. The procedure itself usually takes under an hour to complete, depending on the size of the tattoo. The fragmented ink will then be broken down and processed by the body. In order for the tattoo to completely disappear, however, multiple treatments are required. Due to the blistering and scabs that will follow the treatment (the laser will heat the skin as well), a resting period of about 4-8 weeks is often required before the next treatment. Most of the tattoo will be removed after 5 to 15 treatments, but the exact number of treatments needed varies greatly between individuals, depending on how fast the body processes the ink fragments, the skin tone, and the tattoo itself. Generally speaking, darker tattoos (black tattoos, for instance) are easier to remove than light colored ones (such as green tattoos). Also, tattoos using professional and more permanent ink, and tattoos with multiple layers are harder to remove.

The cost of each procedure varies depending on the size, type, and the surgeon. However, the typical cost per visit ranges from roughly $100 to $500. Taking into consideration the number of treatments needed, the total cost of removing a tattoo via laser tattoo removal can be anywhere from several hundred to a few thousand dollars.

Risks and Side Effects:

Mechanical tattoo removal has a high risk for scarring and ink retention. Change in pigmentation of the skin is also a probable side effect.

Laser tattoo removal sometimes causes changes in the skin pigmentation; however, in most cases the altered pigmentation goes away within a year or so, with a few rare cases being permanent. Blistering and scabs will often form post-treatment, and any tampering with these will raise the risk of scarring. Textural changes have also been known to occur, and in most cases subside within a few months. Hyperpigmentation of the skin, particularly in dark-skinned individuals is another potential side-effect, especially of care is not given to select the appropriate type of laser for the skin-tone of the patient. It has also been noted that bulla, large fluid-filled vesicles on the surface of the skin akin to blisters, can rarely develop. But if treated quickly by the practitioner, long-term consequences are unlikely to ensue.

Procedure Video: Laser Tattoo Removal

vsuresh — Tue, 08 Mar 2011 06:20:21 +0000

Background Information

Overview:

Methods:

Laser Tattoo Removal:

Risks and Side Effects:

Mechanical tattoo removal has a high risk for scarring and ink retention. Change in pigmentation of the skin is also a probable side effect.

Dr. Jaggi Rao: Psoriasis

pkuzel — Thu, 04 Nov 2010 05:34:15 +0000

Questions answered in this video include:

What is psoriasis?
How common is psoriasis?
Who can develop psoriasis?
Can dry weather trigger psoriasis?
What are some other trigger factors for psoriasis flare-ups?
Does psoriasis have any other symptoms besides skin rash?
What does a psoriatic skin rash look like?
What are the most effective treatment options for psoriasis?
Do these treatments help with symptoms other than the skin rash?
Are all topical treatments steroid-based?

Dr. Jaggi Rao is a board certified dermatologist, licensed in both Canada and the United States. He is also a clinical professor of Dermatology and coordinator of the residency training program at the University of Alberta. After completing his dermatology training, Dr. Rao became the first Canadian physician to be accepted to the prestigious American Academy of Cosmetic Surgery fellowship training program. He has authored a large body of scientific articles and textbook chapters, has presented at countless medical meetings, and has served as a peer reviewer for prominent medical journals, including Dermatologic Surgery.

Dr. Jaggi Rao: Acne

pkuzel — Thu, 04 Nov 2010 04:54:39 +0000

Questions answered in this video include:

What is acne?
How does acne come about?
How common is acne?
What are the trigger factors for acne breakouts?
Are there effective treatment options for acne?
Are there any limitations to who can take accutane?
Are there any effective over-the-counter treatments for acne?
Can anything be done to treat/diminish acne scars?
What is dermabrasion?
What are some ways by which one can prevent the development of acne scars?

General notes about Dr. Jaggi Rao

Background Information

Overview

Acne is a common disease of the skin which leads to the development of pimples. These pimples form as a result of hair follicles found underneath the surface of your skin getting clogged up and becoming inflamed. Common areas on the body where pimples tend to form include the face, back, neck, shoulders and chest. Although anyone can get acne, it is common in adolescents and young adults. Although acne usually does not lead to serious health consequences, if left untreated some people may suffer serious psychological distress or develop unsitely scarring as a result of this skin condition.

The exact cause of acne is not known, although several theories do exist. For one, hormonal changes such as those during the teenage years and pregnancy, are thought to play a role. Because of our general lack of insight into the exact causes or triggers of this disease, many myths regarding the cause of acne exist. For example, chocolate and greasy foods are often blamed, despite there being little evidence that foods of any type have much effect on the development of acne. Another common myth is that acne is caused by dirty skin. In fact, blackheads and pimples are not caused by dirt or grease found on the skin surface. Although stress is also not a direct cause of acne, it is thought that stress can make acne worse.

If you or a loved one suffers with acne, some practical tips to follow would be to clean your skin gently with a mild facial soap, try your best not to touch your skin so as to not spread bacteria from the environment to the skin surface, and avoid the sun as much as practically possible, as this has been shown to exacerbate the symptoms of acne.

There are many effective treatments currently available for acne, which can broadly be divided into oral medicines as well as topical creams.

Acne

Acne is a skin disease which primarily affects oil glands found on the surface of the skin called sebaceous glands. These glands produce an oily substance called sebum. Small holes in your skin called pores connect to these oil glands underneath the skin, to allow sebum to be expeled to the surface. A tiny canal called a follicle acts as the piece which connects the sebaceous gland and the pore found on the skin surface. Inside the follicles, sebum carries dead skin cells to the surface of the skin. Also, a thin hair grows through the follicle and out to the surface. When this follicle connecting a sebaceous gland to the pore clogs up, it results in the formation of a pimple. These follicles can become plugged in many way. Usually, it is the result of hair, sebum, and the dead skin cells clumping together and plugging the follicle, sort of like a traffic jam. Once bacteria enters the follicle, it causes swelling in the area of the plug. Once the contents of the plug begin to breakdown within this inflamed follicle, a pimple develops.

Pimples come in all shapes and sizes, and are generally classified as follows:

Whiteheads are pimples caused by a complete blockage of a follicle, trapping all of the products of the plug-breakdown (pus) that stay under the surface of the skin.
Blackheads are pimples in which the contents of the plug have risen to the skin’s surface, giving the pimple its characteristic black appearance. It is important to note that the black color is not the result of dirt.
Papules are small pink bumps which are often tender.
Pustules are pimples that have a wheel of red at the base, with pus on top.
Nodules are painful, large, solid pimples which are found deeper in the skin.
Cysts are deep, painful, pus-filled pimples can cause scars.

Demographics

Acne is the most common of all skin diseases, affecting people of all ages and races. However, it is most common in adolescents and young adults. Some estimates suggest that up to 80% of all people between the ages of 11-30 have acne outbreaks at some point in their lives. It is not uncommon for people to develop acne later in life either, with later-stage acne sometimes being a sign of some other underlying medical condition, particularly in women.

Causes

Although the cause of acne is unknown, there are certain factors which likely contribute to its pathogenesis. For one, the hormonal changes seen in the teenage years can result in excess sebum production, causing the follicles to plug up more often. By the same mechanism, hormonal changes during pregnancy can also lead to the development of acne. because birth control pills also contain high doses of progesterone +/- estrogen, two of the main hormones which icnrease during pregnancy and during adolescence in females, starting or stopping these pills can again trigger increases in acne symptoms. Some researchers have suggested that acne may be a hereditary condition, meaning that it may run in families. If this is in fact true, it would suggest that our genes may play a role in the development of acne. Other types of medicine besides birth control pills, such as certain psychiatric medications and testosterone derivatives, can exacerbate acne. Finally, certain makeups, moisturizers, sun tanning creams and other similar prodcuts may contribute to the development of acne, particularly if these products have a large amount of grease in them, as this may in turn clog the follicles in the skin.

Treatments

Acne is typically treated either by general practitioners or else physicians who specialize in the treatment of skin disorders (dermatologists). The goals of treatment are four-fold, and include attempting to heal all existing pimples, prevent new pimples from forming, avert the formation of acne scarring and lastly to reduce the psychological effects which this condition can have of individuals, especially teenagers.

In terms of preventing scars, the most important thing is to begin treatment as early as possible. This may be done using several methods. In less severe cases, your doctor may suggest the use of over-the-counter medications applied topically to the surface of the skin. Examples of such products include facial cleansers, spot treatments for pimples and alcohol-based toners. For serious cases of acne, a physician may opt to use prescription strength medications, of which there is a wide variety. Again, topical agents such as antibacterial or retinoid based creams may be used. Conversely, orally ingested agents such as antibiotics or isotretinoic acid may be used, to name but a few of the available acne-figthing medications.

Routine Acne Skin Care

There are several skin care practical tips which everyone can follow in order to help minimize the chances of developing acne. Most importantly, people should wash their face daily with a gentle facial cleanser so as to remove the excess contaminants picked up during the course of the day, including bacteria, grease and environmental pollutants. This will help to prevent such material from contributing to clogged pores. Cleansing can be done in the morning, evening and/or after a heavy workout. Keep in mind that scrubbing the face too firmly will not only not prevent acne, but may in fact make the problem worse! Secondly, try not to touch your skin, as this may lead to the transfer of unwanted bacteria from your hands to your face. Furthermore, people who attempt to pinch, pick or squeeze their pimples may either make the problem worse, or else may end up inadvertently causing acne scars or hyperpigmentation of the skin. Another practical tip for men is to be careful when shaving. Try to use both manual and electric shavers, in order to establish which method works best and leaves you with the least amount of razor burn and acne. It is important to always use a sharp blade, and only shave when necessary. It is also a great idea to soten your beard with soap and warm water prior to shaving. Besides increasing the amount of wrinkles you have and predisposing you to skin cancer, excessive sun exposure should also be avoided due to the risk of increasing the symptoms of acne. Furthermore, many of the medications used in the treatment of acne sensitize patients to the sun, causing them to burn more readily. It is also very important to choose makeup as well as any products you may want to apply to your face carefully. In particular, always look for the word “NONCOMEDOGENIC” on the label. This means that the product will not clog your pores, and it is highly recommended that people who suffer with acne avoid puting any product on their face which does not have this label. Finally, it is a important to shampoo your hair regularly, especially if you have oily hair, in which case you may want to shampoo your hair daily.

Acne Triggers

As already mentioned, there are several factors which have been identified which can lead to the worsening of acne. Of these, fluctuating hormone levels is likely the most significant factor. Examples of situations in which this may be an issue are during adolescence, pregnancy, when starting or stopping birth control and between 2 to 7 days before the start of a woman’s period. Pressure from tight-fitting sports equipment such as bike helmets, backpacks or even tight collars has been implicated as a trigger for acne. Similarly, pollution as well as climates with a high humidity are two environmental factors linked to acne exacerbation. As discussed, it is never a good idea to squeeze or pinch existing pimples, as this can not only worsen acne but may in fact lead to scarring and hyperpigmentation. Finally, always be gentle when washing your face, as hard scrubbing may increase acne symptoms.

Acne Research

Scientists are looking at new ways to treat acne. Current research includes working on new drugs to treat acne, including new topical antibiotics. In addition, more is being learned about the bacteria found on the skin surface which leads to the development of acne. Another strategy scientists are using is to look at ways in which to prevent the plugs which cause comedones to form. Finally, others are looking at ways to stop the hormone testosterone from causing acne.

All of the cutting-edge research being done to ultimately enhance our ability to treat acne has resulted in many exciting new developments recently. For one, a vaccine which could protect its recipients from the onset of acne during adolescence has already been successfully tested on mice. Secondly, the genome for the primary bacteria responsible for acne has been sequenced, potentially expediting the process of developing new antimicrobial weapons in the fight against acne!