Definition:
Acne is derived from the word”Akme” which means the highest point.It is a chronic inflammatory disorder of the pilosebaceous glands and is the most common dermatological condition in the adolescent age clinically characterized by comedones which may be secondarily infected resulting in papules, pustules, nodules, cysts and scars.
Epidemiology
Adolescent age group.
Severe in females of 16-17 yrs
Males 17-19 yr.
Most of the lesions completely resolve by 25 yrs of age.
Sometimes seen in 30-40 years of age in both the sexes.
Atieopathogenesis:
Increased sebum production (seborrhoea),
Pilosebaceous duct hypercornification
(comedogenesis),
Colonization of the duct with P.acne,
Inflammation.
COMPOSITION OF SEBUM
Triglycerides – 60 %
Wax esters – 25 %
Squalene – 10 %
Others – 5 %
(Diglycerides, free fatty acids, free sterols and
phospholipids
Pathogenesis of Acne
Androgens lead to thickening of epidermis and sebaceous gland overactivity in susceptible individuals.This results in obstruction of pilosebaceous duct with blackheads or whiteheads(open or closed comedones),secondary infection by P.acnes or Staph,epidermis that forms the normal flora of skin surface leads to papules and pustules with inflammation.
Depending on conditions
Non-inflammatory
open/closed
comedones
Inflammatory papule/
pustule/nodule.
Factors Aggravating Acne
Occlusive
Cosmetics/Hair
Halogenated
Hydrocarbons
Heat/Humidity
Excessive/Vigorous
Washing
Friction/Pressure
Manipulation of
Lesions
Exogenous
Medications (OCP,
Lithium,
Topical Steroids, Oral
Steroids, INH, etc)
Endocrine
Abnormalities.
Types & Variants
Acne vulgaris
Cystic or acne conglobata
Neonatal acne
Pomade and cosmetic acne
Occupational acne (oils and tars)
Drug-induced acne.
GRADING OF ACNE
Grade I (Mild) – comedones. few lesions on face.No scars.
Grade II (Moderate) – comedones, papules,more than 15-20
lesions on the face and body with mild scarring
Grade III (Moderately severe) – Comedones, papules,
pustules, numerous lesions with moderate scarring
Grade IV (severe) – Nodules, cysts, sinuses and
wide spread scarring.
Terms/Definitions
Microcomedone:
hyperkeratotic plug made of sebum and keratin in follicular canal.
Therapy
Goals of therapy:
Relieving discomfort
Preventing pitting or scarring
Limiting psychosocial distress.
Patient Education
Maintain good skin hygiene by daily cleansing with warm water and a mild non-medicated soap to remove excess sebum.Violent washing of skin washings will worsen the skin by inducing inflammatory lesions.Do not squeez or pick the lesions.Avoid excess oil application on scalp and affected skin.
skin care management formulated to treat skin inside outHOMOEOPATHIC TREATMENT: what outcome can a patient expect?
Based on the patients age, Personal and Family History, His/her dynamics at home, school, workplace a totality is formed with respect to his social, economic, physical and financial status.
Also understanding psychodynamics one can clearly see suppressed anger as the major cause of the disease pertaining to the different conflicts at various levels that the patient is undergoing.
Understanding this as a whole along with the personality of the patient, a Homoeopathic Physician can offer the best results with no re- occurrence ever.
A case of Acne:
A 30-year-old married female came with complaint of severe acne on face and boils all over the body. which are very painful and itching, patient sounded very irritated and frustrated with her condition. It is increasing since 15 days with burning, please help me and cure as fast as you can as I can’t bear to look at myself. On observation I saw that the acne was not so severe as projected, but the patient was saying oh no doctor they grow really fast.
Her husband pointed out that she is taking excessive precautions with respect to her diet and skin care. She is avoiding all fatty and junk food. She has become overanxious about her face and practically avoids everything that she doubts will cause her acne to increase. Husband was dancing to her tune and the patient was just obsessed with her skin and troubling everyone around her with her exaggerated expressions.
Rubrics selected:
Mind;Communicative
Impatience.
Fear poisoned of being
Irritability
Narrow minded
Obstinate;resists the wishes of others.
REMEDY SELECTED:
ALUMINA 200 3 DOSES STAT, there was a drastic change in all her eruptions which reduced but above all the patient became very relaxed and calm.