Medicine for acne pictures

Each diagram illustrates commonly used medicines. Oral and topical forms are included together with dosages and side effects.

Acne tips

• Essentials of Diagnosis
• Often occurs at puberty, though onset may be delayed until the third or fourth decade
• Open and closed comedones the hallmarks
• Severity varies from comedonal to papular or pustular inflammatory acne to cysts or nodules
• Face, neck, upper chest, and back may be affected
• Pigmentary changes and severe scarring can occur
• Differential Diagnosis
• Acne rosacea, perioral dermatitis, folliculitis, and tinea.
• Trunk lesions may be confused with folliculitis or miliaria.
• May be induced by topical, inhaled, or systemic steroids, oily topical products, and anabolic steroids.
• Foods neither cause nor exacerbate acne.
• In women with resistant acne, hyperandrogenism should be considered; may be accompanied by hirsutism and irregular menses.
• Treatment
• Improvement usually requires 4--6 weeks
• Topical retinoids very effective for comedonal acne but usefulness limited by irritation
• Topical benzoyl peroxide agents
• Topical antibiotics (erythromycin combined with benzoyl peroxide, clindamycin) effective against comedones and mild inflammatory acne
• Oral antibiotics (tetracycline, doxycycline, minocycline) for moderate inflammatory acne; erythromycin is an alternative when tetracyclines contraindicated
• Low-dose oral contraceptives containing a nonandrogenic progestin can be effective in women
• Diluted intralesional corticosteroids effective in reducing highly inflammatory papules and cysts
• Oral isotretinoin useful in some who fail antibiotic therapy; pregnancy prevention and monitoring essential
• Surgical and laser techniques available to treat scarring
• Advice:
Don't waste time continuing failing therapies in scarring acne; treat
aggressively if needed to prevent further scars.

What is acne?

Acne
Acne is a common inflammatory disease of a sebaceous gland associated with a hair follicle, called the pilosebaceous unit. There are two types of acne: inflammatory and non-inflammatory. Both types of acne are characterized by excessive sebum production. The excess sebum accumulates in the follicle, causing the follicle to swell.
In inflammatory acne, the follicle becomes blocked by the sebum and a type of acne-specific bacterium, Propionibacterium acnes, proliferates in the canal. Eventually, the follicle ruptures and the sebum and bacteria are released into the dermis, causing inflammation of the dermal tissue. In non-inflammatory acne, the follicle does not burst but remains dilated. The sebum either moves to the skin surface (a blackhead) or the canal remains blocked (a whitehead).
Acne is commonly seen in teenagers and young adults, beginning with the onset of puberty. Although both boys and girls suffer from acne, it is especially severe and common in boys. Adults, especially women, may have a recurrence of acne.
Causes of Acne
Sebum production is stimulated by androgens, especially testosterone. The sharp increase in androgens seen in both girls and boys during puberty is largely responsible for the onset and severity of acne. There is little research support for traditional biases that diet or lack of facial cleansing contributes to acne, although P. acne infection of the obstructed follicle may be worsened by poor nutrition. Instead, there is a strong genetic influence over the development of acne that may be related to oversensitivity of the sebaceous glands to androgen or the presence of an environment favorable to the proliferation of bacteria. Other contributors to acne may be important and vary for any given individual. Protective against acne is estrogen, which opposes the action of androgen on the sebaceous glands and reduces the development of acne. In adult women, the development of acne may be related to other systemic conditions or
may occur as the level of testosterone relative to estrogen begins to rise in the early perimenopausal years.
Acne rosacea is a condition of the skin that develops in middle-aged adults of both sexes and is characterized by redness (erythema), papules, and pustules, especially on the forehead, nose, cheeks, and chin. Although no specific cause of acne rosacea has been identified, it is associated with heightened sensitivity to the sun. The condition may come and go and is typically exacerbated by hot drinks and alcohol. It may result in hypertrophy of the sebaceous glands, with thickening of the nose (rhinophyma), a permanent development. Eye irritation, including conjunctivitis, may be present. There is also a genetic tendency to develop rosacea, with light-skinned populations especially susceptible.
Clinical Manifestations
Acne may present with a variety of lesions on one individual. Lesions can include blackheads, whiteheads, nodules, pustules, cysts, and scars. Lesions are commonly over the face, back, and shoulders.
In women, acne may increase before or during the menstrual period when estrogen levels are lowest.
With rosacea, the face may turn bright red with even limited sun or alcohol exposure, and papules and pustules may develop.
Complications
Scarring may occur in severe cases of acne.
Self-esteem may be affected even with less severe conditions.
Rhinophyma may occur with rosacea.
Treatment
Topical agents such as benzoyl peroxide and retinoic acid (vitamin A, Retin A) are used to dry and to peel the skin. This effect increases cell turnover and opens the follicles and facilitates the movement of sebum to the skin. Benzoyl peroxide also works to eliminate P. acnes. Retin A may lead to excessive drying and redness of the skin, and individuals using Retin A must avoid unprotected sun exposure. Pregnant women are advised to avoid using Retin A.
Antibacterial soap may reduce bacterial contamination of the skin.
Topically applied antibiotics, often in combination with benzoyl peroxide, may be prescribed for use once or twice a day. Topical antibiotics, usually tetracycline, erythromycin, or clindamycin, work to reduce P. acnes proliferation. Treatment with this regimen typically takes at least 4 weeks to induce notable improvement.
Oral low-dose antibiotic therapy (e.g., tetracycline, doxycycline) may be administered to reduce bacterial proliferation in the follicle. Antibiotic therapy requires several weeks to be effective and may induce photosensitivity. Oral tetracycline damages developing teeth; therefore, it is
contraindicated in pregnant women or women planning to get pregnant. Tetracycline is also a drug of choice for rosacea.
Birth-control pills containing estrogen can reduce sebum production. They may be used to treat acne in girls and women.
Systemic 13-cis-retinoic acid (isotretinoin) may be used for severe nodular cystic acne. This drug can cause severe birth defects and should not be used by young women who are or may get pregnant. Males likewise should avoid impregnating a partner while on isotretinoin