Pathology and treatment of pimples

'Pimples' is one thing which almost every teenager is worried about though the severity varies. It is the hot topic of teenagers not just because it is found mainly in that age due to hormones but the increased concern for their looks due to the attraction towards the opposite gender which is again due to the same hormones. Hence pimples are exaggerated as a disease and responsible for the inferiority complex developed by the pubertal age group.

A teenage girl with pimples

pathology

Pimples(scientifically called Acne vulgaris are formed due to the blockage of sebaceous ducts which arise from sebaceous glands (modified sweat glands which secrete a fluid called sebum. When this duct gets blocked, germs (bacteria) proliferate and infection occurs which eventually leads to pus formation and then scarring. The main bacteria responsible for pimples/acne is Propionibacterium acnes

The blockage may be due to dead cells or thick sebum (due to the increased ratio of oil to water in its composition). This oily-ness is due to the effects of hormones called androgens e.g. Testosterone. That is the reason pimples appear at puberty and males are more effected.

I say that fat consumption has no relation with pimple formation, because it is not a rule for obese persons to have pimples and you often find thin persons with pimples. So it is only the oily sebum that is responsible rather the fatness of the person. Hence it is a misconception.

Treatment

conservative

* It is very important to wash your face daily for 3-5 times depending on the oily-ness 0f your skin with a mild soap or plane water. It removes the dead cells and excess oil from the skin. Apply gently a piece of cloth to take away water. Use a clean cloth.

* Drink 2-3 liters of water a day and even more in summer. It dilutes your sebum and increases sweat.

* Make your body sweat by playing sports or athletics so that pores are cleared and wash the face immediately after the exercise.

* Take nutritious food which include vitamins and minerals especially Zinc,which can boost your immunity. You can get those from fresh fruits, vegetables and milk.

* Facial pack with multani mitti
or 'fullers earth' helps to clear the pores.

* You can apply lemon juice to face which contains anti-oxidants and some fruits and vegetables also help.

Medical treatment

It is required in cases failed to respond to conservative management.

1) Benzoyl peroxide(2.5-5%) ointment- apply before you sleep. It is an anti-oxidant and removes dead cells.

2) Topical retinoids in the form of tretinoin & adapalene. It should be applied in the night or when you don't go out to reduce the photo-sensitivity.

3) Topical antibiotics like clindamycin & erythromycin

4) Azaleic acid (10-20%)

Severe acne(pimples)

1) Oral isoretinoin:

used in cystic,conglobate acne. This drug is avoided in pregnants as it is teratogenic(harmful to the foetus). Hence in young girls it is to be given after a negative pregnancy test and advising contraception till 3 months after stopping the drug.

Dosage: 0.5-1 mg/kg body weight for 2 weeks is enough

Side effects : dry skin, chelitis, and dry eyes.Liver function tests and lipid profile are to be monitored.

*Cyproterone acetate in boys

*It is combined with oestrogens used cyclically in girls with P.C.O.D.

Physical modalities

:

For stubborn cysts modalities like

1) intra-lesional injections of steroids

For scar treatment modalities like

2) Laser therapy

3) Cryotherapy

4) Dermabrasion

5) collagen injection