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Acne: The bane of existence

Acne is the most common skin disease today. In the United States alone, nearly 60 million people are infected with acne, where 85 per cent of teenagers suffer from it.

Acne is a disorder resulting from the action of hormones on the skin's oil glands (sebaceous glands), which leads to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders.

Contrary to popular belief, acne is not just a teenager’s disease. It also effects adults and can be upsetting and disfiguring in certain cases. It has a significant economic impact, as people spend a lot of money on non-prescription and prescription treatments and therapies.

Acne cases vary from mild to severely disfiguring. It ranges from comedones (blackheads and whiteheads) to nodules and cysts. Here are several acne terms that can help you better understand acne.

Lesion — a localized pathological change in a bodily organ or tissue. The lesion may be external (e.g., acne, skin cancer, psoriatic plaque, knife cut), or internal (e.g., lung cancer, arteriosclerosis in a blood vessel, cirrhosis of the liver). This means that by acne lesions we understand a change in the skin caused by the disease. Comedones (whiteheads and blackheads), nodules and cysts are all types of lesions.

Comedo (plural comedones) — A comedo is a sebaceous follicle clogged by sebum, dead cells from inside the sebaceous follicle, tiny hairs, and even bacteria. When a comedo is open at the top, it is usually called a “blackhead” because its topmost layer has a black hue. A closed comedo is usually called a “whitehead” because it appears as a skin-colored or slightly inflamed bulge with a white center. The “whitehead” has a different color than the “blackhead” because the opening of the sebaceous follicle on the skin’s surface is closed or very narrow. You should refrain from squeezing or picking open “blackheads” or “whiteheads” at all times. This is a process best left to a dermatologist and performed under sterile conditions. Tissue injured by squeezing or picking can become a gate to other infections caused by staphylococci, streptococci and other bacteria.

Papule — A papule is defined as a small (5 millimeters or less), solid, usually inflammatory elevation of the skin that does not contain pus. Groups of very small papules and micro-comedones may not be visible, but can be found by touch. A papule is caused by cellular reaction to the progress of the disease.

Pustule — A small inflamed elevation of the skin filled with pus, which is typically made of a combination of white blood cells, dead skin cells and bacteria. A pustule that forms over a sebaceous follicle usually has a hair in the center. Acne pustules that heal without progressing to cystic form leave no scars as a rule.

Macule — The macule is the simplest dermatological lesion. Those left by a healed acne/lesion are usually red or red-pink and have a well-defined border. A macule may persist for days to weeks before disappearing. When a several macules are found together at the same time, they can contribute to the "inflamed face" appearance of acne.

Nodule — The most severe form of acne lesion, a nodule is a large, deep-seated, pus-filled, often painful lump. People affected by nodules are often scarred for the rest of their lives. Nodules require treatment by a physician.

Cyst — A cyst is a closed sac or capsule, usually filled with fluid or semi-solid material, usually white blood cells, dead cells and bacteria. Cystic acne is a type of localized infection formed when oil ducts become clogged and infected. Treatment includes avoiding irritants on the face, including many cleansers and makeups, and in some severe cases steroids, antibiotics, or other medications. Systemic therapy with isotretinoin is considered to be the only effective treatment for cystic acne. Cystic acne can cause permanent scarring in severe cases.

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