Risk Factors / Triggers
1. Food / Diet
Foods such as nuts, cola, milk, cheese, fried foods and iodized salts have been implicated as triggers for common acne; However, the links between nutrition and acne have not been clearly proven because they are rarely supported by good analytical, epidemiological or experimental studies [4, 5]. In contrast, recurrent acne, as noted by Niemeier et al (2006), may be a cutaneous sign of an undernourished disorder.
A case control study by Goulden et al., As noted by Rzany et al (2006), supports a genetic context. This indicated that the risk of acne vulgaris in adults in patients with acne compared to those of patients without acne is significantly higher .
According to Rzany et al (2006), hormonal influences on acne vulgaris are indisputable, as evidenced by the higher incidence of acne in male adolescents. Premenstrual flares have also been reported to cause acne .
Smoking has also been designated as a risk factor for acne vulgaris. However, conflicting data exist regarding the link between smoking and acne. Some population-based studies found links between smoking and acne, while others did not .
Contrary to popular misconceptions of young patients and sometimes their parents, acne does not arise from bad behavior or poor hygiene. This has nothing to do with the lack of cleanliness .
Types of Acne vulgaris
There are two main types of vulgar, inflammatory and non-inflammatory acne; these can be detected in different ways,
1. Acne comedone, non-inflammatory acne
2. Papules and pustules of inflammatory acne
3. Nodular acne (inflammatory acne)
4. Inflammatory acne with hyperpigmentation (which occurs more frequently in patients with a darker complexion) 
In general, acne is limited to those parts of the body that have the most sebaceous glands. large and most abundant. like the face, neck, chest, upper back and arms. Among dermatologists, it is almost universally accepted that the clinical manifestation of acne vulgaris is the result of four essential processes described below [1, 6]
1. Increased sebum production in the pilosebaceous follicle. Sebum is the lipid secretion product of the sebaceous glands, which plays a central role in the development of acne and also provides a growth medium for Propionibacterium acnes (P acnes), an anaerobic bacterium that is a normal constituent of skin flora. Compared to unaffected people, people with acne have higher rates of sebum production. Apart from this, the severity of acne is often proportional to the amount of sebum produced [1, 6].
2. Abnormal follicular differentiation, which is the first structural change of the pilosebaceous unit in acne vulgaris .
3. Colonization of serum-rich abstract follicles with Propionibacterium acnes (P acnes). P acnes is an anaerobic bacterium that is a normal constituent of cutaneous flora and fills the androgen-stimulated sebaceous follicle [androgen is a steroid hormone such as testosterone or androsterone, that controls the development and maintenance of masculine characteristics]. Acne sufferers have higher acne counts than those without acne [1, 6].
4. Inflammation. This is the direct or indirect result of the rapid and excessive increase of acnes .
Non-inflammatory acne lesions include open and closed comedones, which are thickened secretions obstructing a cutaneous canal, especially sebaceous glands. Open comedones, also known as blackheads, "appear as flat or slightly raised black or black patches that deflect the follicular orifices." Closed comedones, also known as "whiteheads", "appear as whitish flesh papules with an apparently overlying, overlying surface" .
On the other hand, inflammatory lesions include papules, pustules and nodules; papules and pustules "result from upper or deep inflammation associated with microscopic rupture of comedones". Nodules are large, deep-washed abscesses that, when palpated, can be compressible. In addition to typical lesions of acne, other features may also be present. These include scarring and hyperpigmentation, which can lead to significant disfigurement .
Many psychological problems, such as decreased self-esteem, social exclusion, social withdrawal, depression and even unemployment, are due ;acne. However, the psychosomatic differential diagnosis indicates two serious psychological problems that may result from acne. These are,
1. Psychogenic Excoriation and
2. Body Dysmorphic Disorder (BDD)
Psychogenic excoriation, also known as neurotic excoriation, pathological or compulsive skin removal "is characterized by excessive scraping or picking of skin or normal skin with irregularities minor ". According to Niemeier et al. (2006), it is estimated that it occurs in 2% of dermatological patients. Patients with this disorder may also have psychiatric disorders such as mood disorders and anxiety, related disorders such as obsessive-compulsive disorder, substance abuse, obsessive-compulsive disorder, compulsive shopping, disorders food and personality disorders. little .
Body dysmorphic disorder (BDD) "is a condition characterized by an extreme level of dissatisfaction or concern over a normal appearance that disrupts daily functioning" . Niemeier et al (2006) have described it as "a syndrome characterized by distress, secondary to imagined or minor defects in the appearance of a person". The onset of BDD usually occurs in adolescence and also occurs in men and women. The most common areas are skin, hair and nose, with acne being one of the most common concerns in BDD patients .
According to the Diagnostic and Statistical Manual of Mental Disorders (2000), the BDD has three diagnostic criteria,
1. A concern with an imagined flaw; in the case of a slight physical anomaly, the person's concern is clearly excessive,
2. The concern causes clinically significant distress or injury in the social, occupational or other important areas of functioning,
3. The concern is not caused by another mental disorder (eg Anorexia Nervosa)
Characteristic behaviors include skin picking, mirror checking and camouflage by wearing a hat or excessive makeup. Apart from this, patients often seek to reassure themselves frequently by asking questions such as "Can you see this button?" Egypt "Is my skin all right?" Some patients also tend to consult a doctor, who basically goes from one specialist to another, looking for a dermatologist or plastic surgeon, willing to perform an intervention or to dispense a particular medicine to improve their perception of the defect [3, 5 ].
Although it is a relatively common illness, BDD is still an underdiagnosed psychiatric disorder and it is estimated that it affects 0.7 to 5% of the population General. Other psychiatric disorders associated with BDD include major depression, anxiety, and obsessive compulsive disorder. It is also associated with high rates of functional impairment and suicide attempts, high levels of perceived stress, and a poor quality of life [3, 5, 8].
Treatment of acne
1. Topical treatment, especially in people with non-inflammatory comedones or mild to moderate inflammatory acne (see types of acne vulgaris). Drugs include tretinoin (available as gels, creams and solutions), adapalene gel, salicylic acid (available as solutions, cleansers and soaps), isotretinoin gel, azelaic acid cream, benzoyl peroxide and washes), to name but a few [1, 2].
2. Oral treatment, especially against acne resistant to topical treatment or manifested by scarring or nodular lesions. Drugs include oral antibiotics (eg Tetracycline, doxycycline, minocycline, erythromycin and co-trimoxazole), oral isotretinoin and hormonal agents (eg,
3. physical or surgical treatment, sometimes useful as an adjunct to medical treatment.The methods include the extraction of comedones, intralesional injections of corticosteroids, dermabrasion, chemical peels and collagen injections, to name a few. some [1, 9].
4. Exposure to the sun, reported by up to 70% of patients, would have a beneficial effect on acne .
Light therapy, which is becoming more and more popular because of the growing demand for practical, low risk and effective therapy, as many patients do not respond appropriately to treatment or develop side effects. Acne  .The methods include the use of visible light (eg, blue light, combinations of blue / red light, yellow light and green light), laser treatment and monopolar radiofrequency . Many of these light therapy treatments can be used at home.
Recommended products for acne
1. Brown SK, Shalita AR. Acne vulgaris. Lancet 1998; 351: 1871-1876.
2. Webster GF. Acne vulgaris. Br Med J 2002; 325: 475-479.
3. Bowe WP et al. Symptoms of dysmorphic body disorder in patients with acne vulgaris. J Am Acad Dermatol 2007; DOI: 10.1016 / j.jaad.2007.03.030.
4. Rzany B, Kahl C. Epidemiology of acne vulgaris. JDDG 2006; DOI: 10.1111 / j.1610-0387.2006.05876.x
5. Niemeier V, Kupfer J, U. Gieler Acne Vulgaris-Psychosomatic Aspects. JDDG 2006; DOI: 10.1111 / j.1610-0387.2006.06110.x
6. Gollnick H. Current perspectives on the treatment of acne vulgaris and implications for future directions. Eur Acad Dermatol Venereol 2001; 15 (Suppl 3): 1-4.
7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Accessible via: BehaveNet® Clinical CapsuleTM; http://www.behavenet.com/capsules/disorders/bodydysdis.htm . Accessed: June 28, 2007.
8. Phillips KA et al. A retrospective follow-up study of the body's dysmorphic disorder. Global Psychiatry 2005; 46: 315-321.
9. Taub AF. Procedural treatments of acne vulgaris. Dermatol Surg 2007; 33: 1-22.
10. Cunliffe WJ, Goulden V. Phototherapy and acne vulgaris.Br J Dermatol 2000; 142 (5): 855-856.
11. Dierickx CC. Lasers, light and radiofrequency for the treatment of acne. Med Laser Appl 2004; 19: 196-204.
This article is for informational purposes only. It is not a medical opinion and does not replace a professional medical opinion. Please consult your doctor for all your medical concerns. Please follow the information in this article only after consulting your doctor or a qualified health professional. The author is not responsible for any arrival or damage resulting from any information obtained from this article.