Figure-1 Blackhead

Figure-2 Whitehead

Body acne, back acne, adult acne and hormonal acne: - Acne is common on the back, chest, shoulders, and even buttocks of many people. Acne on the back, often referred to as acne is often more severe, sometimes with many nodules and cysts⁵. Acne by its very nature can be considered a hormonal disease. Hormones are responsible for the maturation of the oil glands in our skin. This is why children do not experience acne⁵.

Acne Myths:- In addition to the potential causes of acne, there are also many myths about what causes acne. Chocolate and greasy foods are often blamed, but research has shown that foods seem to have little effect on the development and course of acne in most people. Another myth is that dirty skin causes acne; however, blackheads and other forms of acne lesions are not caused by dirt⁵.

Disregard the Myths: - You’ve heard your mother say, "Don't eat that chocolate! It will cause your face to break out!" But is this really true or merely a misperception? There are numerous myths regarding the causes of acne. Read below to learn more about these common misperceptions.

· Acne is caused by not washing your face often enough.

· Acne is caused by the foods you eat.

· Acne is caused by stress.

Epidermiology:

Acne is an extremely common condition, experienced by approximately 80% of female and 90% of male teenagers. Despite the high prevalence of acne and the availability of effective treatments, only 16% of teenagers seek a physician's advice regarding skin care⁶. In United States Acne vulgaris affects 85-100% of people at some time during their lives.

Mortality/Morbidity:- Acne can cause physical pain and psychosocial suffering.Acne can lead to scarring. A severe inflammatory variant of acne, acne fulminans, can be associated with fever, arthritis, and other systemic symptoms.

Sex:-Acne vulgaris is more common in males than in females during adolescence. It is more common in women than in men during adulthood.

Etiology:

The exact cause of acne is not known, however, several risk factors have been identified.

· Age:- Because of the effect of sex hormones, teenagers are quite likely to develop acne.

· Cosmetics:- Make-up and hair sprays that contain oils can make acne worse.

· Diet:-Acne is not caused by diet, but some foods can make the disease more serious.

· Disease:- Hormonal disorders can increase the severity of acne problems in girls.

· Drugs:- Acne can develop as a result of using certain drugs, such as tranquilizers, antibiotics, oral contraceptives, and anabolic steroids. Steroids are synthetic hormones that may sometimes be abused by athletes to increase the size of their muscles^7-8.

· Environment:- Acne can become worse as a result of exposure to oils, greases, and polluted air. Sweating in hot weather can also make the condition worse.

· Gender:- Boys are more likely to develop acne and tend to have more serious cases than girls.

· Heredity: - Acne is more common in some families than in others.

· Hormonal changes. Acne can flare up during menstruation, pregnancy, and menopause. Menopause is the period in a woman's life when her body stops producing certain hormones.

· Personal hygiene. Strong soaps, hard scrubbing, and picking at pimples can make acne worse.

· Stress. Emotional stress can contribute to acne⁹.

Acne Causes:

The exact cause of acne is unknown, but physicians believe it results from several related factors.

Potential causes include:

· Role of androgens (hormones)

· Propionibacterium acnes (P. acnes)

· Sebum production

· Follicle growth^9.

Causes of acne vulgaris:

Acne occurs when pilosebaceous units become obstructed with plugs of sebum and desquamated keratinocytes, then colonized and sometimes infected with the normal skin anaerobe Propionibacterium acnes. Manifestations differ depending on whether P. acnes stimulate inflammation in the follicle; acne can be noninflammatory or inflammatory¹⁰.

Figure-3 Causes of acne vulgaris

Causes of acne vulgaris:

Causes of acne Rosacea: - Rosacea flushing is commonly triggered by the intake of acidic foods and drinks, acids produced by the body due to stress or exercise, and lack of proper sleep. Commonly used acidic foods and drinks are cheese, bread, coffee, and alcohol. All of these triggers may be "normal" activities encountered in your everyday life, but the acids they produce must be buffered or neutralized by alkaline-producing foods, drinks, and activities. Another cause of rosacea flushing is a lack of facial exercise. The arteries in the face must be stimulated to evacuate acidic byproducts such as plaque and cholesterol¹¹.

What causes the trapping of sebum?

· Hormones cause the sebaceous glands to enlarge, and acne may develop from the over-stimulation of these glands. In women, acne flare-ups may coincide with the hormonal changes associated with the menstrual cycle.

· Changes inside the follicle occur as a result of increased hormone production and enlarged sebaceous glands. The cells of the inner lining of the hair follicle shed more rapidly during puberty, and tend to stick together and block the follicle when they mix with sebum.

· Bacteria which are normally present on the skin multiply rapidly in the clogged gland and can cause inflammation of the area and rupture of the gland^11.

Figure-4 Causes of acne

Causes of acne:

Acne commonly starts in the early teen years, when the oil glands in the body start making more sebum (oil). Some people also have too many "sticky" skin cells. In people who have acne, these cells mix with the oil and plug up the hair follicles in the skin.A "whitehead" results when the hair follicle is plugged with oil and skin cells. If this plug reaches the surface of the skin and the air touches it, it turns black and is called a "blackhead." A blackhead isn't caused by dirt.If the wall of a plugged follicle breaks, the area swells and turns into a red bump. If the follicle wall breaks near the skin surface, the bump usually becomes a pimple. If the wall breaks deep in the skin, acne nodules or cysts can form. This is called "cystic acne."¹¹.

Classification:

Types of Acne: - Acne vulgaris

· Mild to Moderate acne vulgaris consists of the following types of acne spots:

Figure-5 Whiteheads Figure-6 Blackheads

Whiteheads: Whiteheads result when a pore is completely blocked, trapping sebum (oil), bacteria, and dead skin cells, causing a white appearance on the surface.

Blackheads: Blackheads result when a pore is only partially blocked, allowing some of the trapped sebum (oil), bacteria, and dead skin cells to slowly drain to the surface.

Acne rosacea

Acne Rosacea can look similar to the aforementioned acne vulgaris, and the two types of acne are sometimes confused for one another. Rosacea affects millions of people, most of who are over the age of 30. It appears as a red rash which is normally confined to the cheeks, nose, forehead and chin. Other types of acne are acne conglobata, acne fulminans etc ^12-13.

Mild acne: According to the various grading systems used by various dermatologists, acne is considered to be mild when there are up to 3 dozen comedones and/or scattered papules, no big permanent lesions and lesions which are not visible from 2.5m away, on your skin.

Moderate Acne: You are said to be suffering from moderate acne when you have inflamed red lesions, numerous comedones and pustules, which are as large as 1-2cm and inflammatory or non-inflammatory lesions visible at a distance of 2.5m also. It can be found in anybody ranging from infants to people in their old age. It can be found anywhere on the skin, that is, the face, arms, back, thighs, chest or shoulders¹³.

Pathophysiology:

Acne lesions develop in the oil-producing structures of the skin called pilosebaceous follicles. These follicles are present in large numbers on the face, chest, shoulders and upper back. Each follicle consists of a hair follicle and sebaceous gland. The glands secrete an oily mixture called sebum which normally passes through the hair follicle to the skin surface. Acne occurs when the normal route of sebum to the skin surface is blocked by dead skin cells, bacteria, hormones and extra oil protection. The obstruction leads to swelling and the development of blackheads, whiteheads, papules and pustules¹⁴.

Pathophysiology of Acne vulgaris: - Acne vulgaris is a common cutaneous disorder of the pilosebaceous follicle, affecting more than 45 million people in the United States alone. The pathogenesis of acne is multifactorial, involving abnormal hyperkeratinization, increased sebum production, hormones, cutaneous microbes, and immunological mechanisms. Many of the immunological processes that contribute to the formation of acne lesions take place at the very site of disease, the skin.

Figure-7 Pathophysiology of acne

Other troublesome acne lesions can develop, including the following:

· Papules-inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch

· Pustules (pimples)-papules topped by pus-filled lesions that may be red at the base

· Nodules-large, painful, solid lesions that are lodged deep within the skin

· Cysts-deep, painful, pus-filled lesions that can cause scarring¹⁵.

Figure-8 Papules

Figure-9 Pustules

Pathophysiology of acne Rosacea:

· Acne vulgaris is a chronic disease of the pilosebaceous unit.

· The primary alteration is desquamation of follicular coenocytes into the sebaceous follicle ducts, forming a plug.When present for a prolonged period, the plug can be seen clinically as Comedones.

· Acne patients tend to have larger sebaceous glands and produce more sebum than do persons without acne. However, patients with very dry skin also may have a great deal of acne activity.

· Nevertheless, the free fatty acid portion of sebum may be a contributing cause of inflammation.

· The anaerobic diphtheria Propionibacterium acnes, which is found in hair follicles, is important in inducing inflammation through chemo tactic factors and host response.Androgenic stimulation is important in both men and women because it drives sebaceous gland secretion.

· Other hormonal influences also may play a role; women often have exacerbations of acne activity in the premenstrual period.

· Emotional stressors appear to play a role in acute acne exacerbations but not in chronic acne vulgaris¹⁷.

Types of lesions:

Figure-10 Microcomedo

Figure-11 Open comedo

Figure-12 Closed comedo

Stages of Acne:

Nodules and cysts:- These form when the tissue around a follicle is damaged by a severely ruptured sebaceous gland. Scarring may also result¹⁸.

In a nutshell, here's how the stages of acne are graded:

· Stage 0: white- and blackheads (really nothing to worry about)

· Stage 2: papules (small red bumps; we can still call this mild.)

· Stage 4: pustules (full-blown pimple; Yes, it has a ripe, yellow centre and is completely unwanted, but it is usually still in the superficial layers of the skin and can heal without leaving any permanent scars).

· Stage 6: nodules and cysts in the deeper layers of the skin (Things are getting bad. If you haven't been to a dermatologist, consult one asp. If not, chances are you will end up with permanent acne scars).

· Stage 8: scars. (Even if you are left with acne scars, treatments can help¹⁸.

Stage 1 Stage 2

Stage 3 Stage 4

Stage 1:- Mainly Comedones, topical retinoid, maybe a benzoyl peroxide product.

Stage 2:- A combination of retinoid and benzoyl peroxide, maybe a topical antibiotic.

Stage 3:- We need a systemic antibiotic.

Stage 4:- Try everything, but don't be surprised if you end up on either a birth control in a female, or Acutance in a male or a female.

Mild Acne: - Acne is defined as the inflammation of the sebaceous glands and hair follicles of the skin due to which pimples or pustules are produced. All of us are prone to acne. Studies have found that acne has left deep psychological and social scars on individuals, who have suffered from it. It is a dermatological condition that requires immediate medical attention. Acne can be found in three different stages- mild, moderate and severe¹⁹.

Moderate Acne: - Acne or Acne Vulgaris is a disorder in which the oil glands found in your hair follicles are stimulated to produce extra oil called sebum. This sebum, the hair and the dead cells on your skin cause bacteria to develop in your follicles, which in turn causes the skin to inflame. This inflammation is referred to as acne. Acne can be found in three different stages-mild, moderate. Other stage is severe²⁰.

Signs and Symptoms:

Acne vulgaris primarily occurs on the face and, to a lesser extent, on the torso including the back, chest, and shoulders. Most acne patients have increased sebum production, seen clinically as "oily skin." Noninflammatory acne lesions include closed Comedones (whiteheads) and open Comedones (blackheads)²¹. Inflammatory lesions can be superficial erythematous papules and pustules or deep-seated pustules and "cystic" nodules. Inflammatory lesions and areas that have been traumatized often heal with residual erythematic or pageantry change that may persist for months after the initial acne lesions have cleared. Permanent scarring also can occur, especially with larger inflammatory lesions. The most common permanent scarring is the "ice-pick" variety that occurs on the cheeks²².

· Grade 1—primarily Comedones

· Grade 2—inflammatory papules and pustules

· Grade 3—nodules/cysts

· Grade 4—severe scarring

· Grade 5—acne conglobata with sinus tracts²³

Symptoms of Acne vulgaris:

Acne of an older teenager.The most common form of acne is known as “acne vulgaris”, meaning “common acne.” Many teenagers get this type of acne. Excessive secretion of oils form the sebaceous glands accompanies the plugging of the pores with naturally occurring dead skin cells (coenocytes) blocking hair follicles. The accumulation of these corneocytes in the duct appears to be due to a failure of the normal keratinization process in the skin which usually leads to shedding of skin cells lining the pores. Oil secretions are said to build up beneath pore, providing a perfect environment for the skin bacteria Propionibacterium acnes and the lipophilic (oil/lipid-loving) yeast Malassezia multiply uncontrollably²⁴.

Symptoms of acne Rosacea:

Signs and symptoms vary from person to person and are often intermittent. If you or someone you know exhibits any of the following, it is best to consult a dermatologist. Rosacea can be treated and controlled if medical advice is sought in the early stages. When left untreated, Rosacea often gets worse and then becomes more difficult to treat²⁵.

Non-inflammatory Lesions:

1. Blackheads or open comedones. Blackheads result when sebum (oil) and skin cells become clogged in the sebaceous hair follicle. They appear to be black in color.

2. Whiteheads or closed comedones. Whiteheads result when the sebaceous follicle is completely clogged with sebum and skin cells. They appear to be either white or skin colored, hence the name "whiteheads." Whiteheads can form as small bumps on top of the skin or under the skin.

Inflammatory Lesions:

1. Papules are small, firm, red-colored lesions. Although they may contain pus, is not easily seen because of the redness. Papules often continue to grow in size and become pustules.

2. Pustules are small papules but they are round, red, swollen, and contain pus. Although they contain pus, they generally don't have a lot of bacteria inside.

3. Nodules also referred to as cysts. Oftentimes, nodules are very red, swollen, and contain a large amount of pus. They develop deep in the skin and may be painful. Unlike the other types of lesions, upon healing, nodules generally leave scars.

Based on the type and number of lesions present, a doctor or dermatologist can classify acne as mild, moderate or severe.

You should see your doctor or dermatologist if any of the following apply to you:

· A lesion or nodule becomes infected, turns purple in color, increases in size, becomes painful, or does not get better with self treatment

· A scar develops following healing

· Acne interferes with your normal daily routine or makes you feel embarrassed or depressed

· Acne leads to dark patches on the skin (this is more common in people with dark skin)²⁵.

Diagnosis:

People with acne are often treated by family doctors. More serious cases are referred to a dermatologist (a specialist in skin disorders) or an endocrinologist (a specialist in hormonal disorders)²⁶.

Diagnosis of acne vulgaris:

Diagnosis is by examination. Differential diagnosis includes rosacea (in which no Comedones are seen), corticosteroid-induced acne (which lack Comedones and in which pustules are usually in the same stage of development), perioral dermatitis, and acne form drug eruptions. Acne severity is graded mild, moderate, or severe based on the number and type of lesions; a standardized system is outlined in Table 1: Acne and Related Disorders: Classification of Acne Severity²⁸.

Classification of Acne Severity:

Severity: Mild - <20 Comedones, or <15 inflammatory lesions, or <30 total lesions.

Moderate- 20 to 100 Comedones, or 15 to 50 inflammatory lesions, or 30 to 125 total lesions.

Severe- > 5 cysts, or total comedo count >100, or total inflammatory count >50, or >125 total

lesions²⁸.

Prevention:

Prevention is better than cure is an old adage very much applicable in this condition. Some ways to prevent formation of acne is as follows.

a) Avoid exposure to harsh sun and usage of sun block creams and gels is important to prevent loss of moisture.

b) Remove black heads early and prevent them from developing into pimples. Blackheads can be removed at home or by a professional and should not be left to fester especially in oily skin and in teenagers.

c) For a skin prone to acne, it is important to deep cleanse and moisturize the skin every night before going to sleep.

d) Switch to a low salt, healthy non fried diet. Fresh fruits, raw salads, sprouted grains and pulses and yogurt can go a long way in reducing oil formation in oily skins.

There are no sure ways to prevent acne. However, the following steps tend to reduce flare-ups of the condition:

a) Gently wash—do not scrub—the affected areas once or twice every day.

b) Avoid rough cleansers.

c) Use makeup and skin moisturizers that do not produce comedos.

d) Shampoo often and wear hair away from the face.

e) Eat a well-balanced diet and avoid foods that trigger flare-ups.

f) Give dry pimples a limited amount of sun exposure unless otherwise directed by

Your doctor

g) Do not pick or squeeze pimples.

h) Reduce stress³⁰.

Other Treatments:

Several surgical or medical treatments may be used to reduce acne or the scars caused by the disease.

a) Chemical peel. A chemical known as glycolic acid is first applied to the skin. When it dries, it is peeled off, taking the top layer of skin with it. This treatment helps reduce scarring.

b) Collagen injection. Shallow scars are filled in by injecting collagen, a skin protein, beneath the scars.

c) Comedo extraction. A special tool is used to remove a comedo from a pore.

d) Dermabrasion. The affected skin is first frozen with a chemical spray. Then it is removed with a brush or sandpaper-like instrument.

e) Intraregional injection. Anti-inflammatory drugs are injected directly into inflamed pimples.

f) Punch grafting. Deep scars are removed and the area repaired with small skin grafts³⁰.

Prevention of acne:

Clean Skin Gently, Choose Cosmetics Carefully, Shave Carefully, Avoid a Sunburn or Suntan, and Avoid Frequent Handling of the Skin³¹.

Treatment:

· Non-prescription

· Topical antibiotics

· Topical retinoid

· Oral antibiotic

· Topical Drugs

· Oral Drugs

· Topical Acne Products:- Benzoyl Peroxide, Azelaic Acid, Sulfur, Sodium Sulfacetamide and Salicylic Acid, Topical Antibiotics, Tretinoin, Adapalene, Tazarotene.

· Oral Acne Products:- Oral Antibiotics, Isotretinoin, Spironolactone, Oral Contraceptives³².

Vulgaris for Acne Treatments:

Treatments are directed at reducing sebum production, Comedones formation, inflammation, and infection. Selection of treatment is generally based on severity; options are summarized Affected areas should be cleansed daily, but extra washing, use of antibacterial soaps, and scrubbing confer no added benefit. Changes in diet are also unnecessary and ineffective. Peeling agents such as sulfur, salicylic acid, and resorcinol are minor therapeutic adjuncts³³.

Resources for Acne Treatment:

There are many different types of acne treatment that people can use. Just about everyone you know has some kind of magical remedy. But where did they obtain their information? It is little wonder that there is a lot of misunderstanding on the subject. Acne is generally placed into one of three categories; mild, moderate or severe. The management for each of these stages varies significantly. Acne is a health condition and needs to be treated as such. Acne is moderate when pimples (blackheads, whitehead, and Comedones) cover approximately half of the face. If you have moderate acne, consult a dermatologist in order to quickly get a handle on your situation³³.

Figure-13 Treating acne

Treatment for mild acne:

Mild acne can be treated with topicals gels, solutions and lotions or other medicines available over the counter (OTC). Wash the acne affected area will not rid you of your acne. So, do not overdo it. And do not use a hard soap³³.

Treatment for moderate acne:

Patients with moderate to severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination. Acne or zits is a skin condition also known as pimples that occurs when sebaceous glands become blocked or inflamed to varying degrees. The blocked oil glands often become infects causing puss to build under the skin. Here are some useful facts about acne³³.

Medication:

Top Ten Therapeutic Drug Categories,

1. External applications- antibacterial and antibiotics: this includes clindamycin, sulfamycin, azelaic acid and erythromycin.

2. Retinoid: rentin-A is available from years and its preparations come in milder and gentle forms. Newest ones include: adapalene, tazarotene. It does come with side effects and it includes irritation, sensitivity to sun.

3. Oral antibiotics: most of the doctors go starting with tetracycline or other cyclines. Other oral antibiotics which are good with acne are ceadroxil, sulfa drugs and amoxicillin. Some side effects are associated to these drugs which are gastrointestinal upset and sun sensitivity or increased affinity for sunburn. These drugs can also make you less immune so you get prone to other diseases. While recent studies have shown that you also have increased risk for developing breast cancer.

4. Oral contraceptives: these drugs are designed to produce low estrogen and so these have effects on acne.

5. Spironolocatone: this works by blocking androgen receptors so it may cause sensitive breasts, irregular menstruations and increased levels for potassium in blood stream. It can help some women against resistant acne.

6. Cortisone injections: they are injected when you need to flat out cysts and pimples fast.

7. Isotretinonin: this is an excellent treatment for resistant pimples and millions of patients have tilled now used this and gave come up with satisfying results. But it is to be mentioned in here that this medication is not a good choice for those who are having moderate and very few pimples. Here are few things needed to be mentioned about this composition of medicines.

· If used properly they are safe and can produce very few side effects. It is prescribed for only few weeks say five to six week duration. It is coupled with blood tests to monitor any sort of disorder.

· It has long lasting effects and even after its use is discontinued it remains in blood and have its effects shown for long time.

· It is forbidden to use while you are pregnant as it makes you at risk for giving birth to a deformed baby.

· It can also cause a sort of psychological disorder like depression and a number of time suicides have been observed with the patients of this medications.

8. Laser treatment: acne from last few years is also been treated by laser and such devices. These treatments however are safe and very effective but success effects and long lost effects are not known.

9. Chemical peels: chemical peels are also very supportive and are of course beneficial.

10. Treatment of scars: with those patients who have their acne gone leaving away scars have a number of options to have them also gone. Such options are:

· surgical procedures

· laser resurfacing

· creams

· and other medications

· Messaging also counts.

11. Proton Pump Inhibitors: Gastro-intestinal drugs used to treat conditions where a reduction of gastric acid secretion is required. (I.e. Ulcer)

12 Antipsychotic Agents: Drugs used in treatment of schizophrenia and other psychotic disorders such as agitation, confusion, delusion, tension and anxiety³⁶.

13. Home remedies of acne:

Orange peel pounded well with water. Applied to affected acne areas.

1. Cucumber leaves or grated pieces. Apply to area for acne cure.

2. Rub the pimple (acne) with a fresh cut clove of garlic.

3. Drinking at least 1 liter of water a day to impart a healthy glow to the skin.

4. Clove based face mask or a paste of fenugreek (methi) leaves applied overnight on acne and washed off next morning.

5. Garlic also reduces acne. A piece can be rubbed and then washed off.

6. For strong acne, one can make a paste of methi seeds (fenugreek) and apply it overnight. It can be washed the next morning. Even a clove face pack works as well.

7. Using turmeric (haldi paste) is also effective³⁷.

Medications for mild acne:

1. Antiseptic washes or any of your mild daily skin washes.

2. Mild acne washes containing salicylic acid. This would help exfoliate and unplug the hair follicles.

3. Creams containing benzoyl peroxide.

4. Stabilized cream containing hydrogen peroxide.

Medication for moderate acne:

5. Oral medicines including antibiotics like tetracycline, minocycline, Doxycycline or erythromycin.

6. Females can use oestrogens and anti-androgens.

7. Some acne sufferers take non-steroidal anti-inflammatory agents such as ibuprofen.

8. Some dermatologists also recommend oral Isotretinoin for persistent acne³⁷.

Table-1 Drugs used in acne

Brand Name(Generic Name)	Possible Common Side Effects Include
Accutane(Isotretinoin)	Dry Skin, dry mouth, conjunctivitis
Cleo in T (Clindamycin Phosphate)	Dry skin
Desquamate-E (benzoyl peroxide)	Itching, red and peeling skin
Erythromycin topical (A/T/S, erycette, t-stat)	Birning, dry skin, hives, red and peeling skin
Minocin (Minocycline hydrochloride)	Headache, hives, diarrhea, vomiting

Therapeutic strategies for Acne Vulgaris:

· Isotretinoin: - Accutane® is a retinoid which when administered in pharmacologic dosages of .5 to 1 mg/kg/day inhibits sebaceous gland function and keratinization. Clinical improvement in nodular acne patients occurs in association with a reduction in sebum secretion. In addition to Accutane®, Isotretinoin may also be sold under the names of Amnesteem®, Claravis™, or Sotret®³⁸.

· Antibiotics:- For patients who suffer from moderate to severe acne, doctors may prescribe a combination of topical remedies and oral antibiotics. The most common oral medications used to treat acne are tetracycline, minocycline, Doxycycline and erythromycin³⁹.

· Benzoyl peroxide: - One of the most commonly used ingredients; Benzoyl Peroxide can be very effective in treating mild cases of non-inflammatory acne. It’s safe for children as well as adults, and may combine with other topical or oral treatments³⁹.

· Blue light therapy: - Light wave therapy uses a high-intensity blue light that is passed over the skin. Blue light therapy has been available for approximately three years, and was originally approved by the Food and Drug Administration as a cancer treatment. It is not approved to fight acne, but studies are currently under way⁴¹.

· Laser therapy: - Lasers currently in use for acne are in the investigational phase: studies are inconclusive and the efficacy of this treatment is questionable. Overall, this therapy needs long-term follow-up and more in-depth studies with larger control groups. The bottom line is that more research is needed before this laser can be recommended to the public for the treatment of acne⁴¹.

· Hormonal therapy:- The antiandrogenic agents most frequently used in acne treatment are all systemic and are especially useful in the presence of other signs of peripheral hyperandrogenism, in extensive acne and in any type of acne resistant to conventional treatments. However, they can only be used in women, contraception is essential, they are only suppressive and recurrence occurs after treatment is stopped, and they may cause side effects and drug interactions. Other therapy is available in hospital like cosmetics surgery and gene therapy⁴¹.

Diet in Acne:

1. Vegetarian, low fat diet andAcne, 2.Essential Fatty Acidsand Acne, 3. Vitamin A and Acne, 4. Zinc andAcne, 5. Vitamin B₆ andAcne 6. Chromium and Acne, 7. Selenium and Acne, 8. Diet treatment:- We ate much less grains, especially whole grains. Whole grains are high in hydrates and fiber, which can interfere with mineral absorption, including zinc. Refined grains don't seem to be any better for those with acne either.

a) We ate more foods high in zinc, especially red meat.

b) We avoided eating too much of foods that contain zinc antagonists. Minerals such as calcium, copper and iron taken in high amounts may interfere with zinc absorption.

c) I avoid caffeine. I've noticed that anything with caffeine, especially chocolate,

d) Eating a lot of sugary foods seems to make my face

e) I usually don't consume many dairy products break out^43-45.

CONCLUSION

The development of new drugs for the treatment of acne has dramatically altered our approach to the treatment of acne. Now the majority of patients can be completely cured of this physically and emotionally scaring illness.

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Received on 31.12.2010

Accepted on 17.01.2011

Research J. Pharmacology and Pharmacodynamics. 3(2): March –April, 2011, 48-57