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"Acne is a common ailment for teenagers but can persist well into middle age. Although the formation of comedones in hair follicles is quite well understood, the actual causes initiating the process are less well so. Many theories have been forwarded, from hormones through cleanliness to diet, none of which fully explain the condition. Indeed the variation in presentation and classification (there are three acnes) can make precise diagnosis troublesome. It is likely the causes are multifactorial, and evidence is accruing for all the above contributors.Many books have focused on the straightforward pathophysiological processes of hormones and cleanliness but have neglected the contribution of diet as a possible guide to prevention and other medical approaches to treatment. This book will take more catholic view, with a practical focus on all the possible modes of treatment based on current pathophysiological knowledge.The aim of the book is to assemble the pieces of the jigsaw puzzle so that the resultingpicture will be comprehensible to physicians and other caregivers, and identify what is known and what needs more investigation"--Provided by publisher.
List of contents
Preface ix
Practical acne therapy xii
Genetics xii
Diet xii
Hormones xii
Stress xiii
Comedones (plugs in pores) xiii
Blemishes--a brief catalogue xiv
Nodules xv
Scars and sinuses xvi
Support xvii
Introduction xviii
Nomenclature xix
The three acnes and grading xx
Acne vulgaris xx
Acne rosacea xxii
Acne inversa (hidradenitis suppurativa) xxiii
Grading the three acnes xxvi
Acne vulgaris xxvi
Acne rosacea xxvi
Acne inversa (hidradenitis suppurativa) xxvi
1 The three acnes and their impact 1
1.1 Acne vulgaris 1
1.1.1 Terminology 1
1.1.2 The starting point 3
1.2 Acne rosacea 3
1.2.1 The "pimply" part 4
1.2.2 The "redness" part 4
1.2.3 The third part the firm fibrosis 6
1.2.4 Part four--ocular rosacea 7
1.2.5 Putting it all together 7
1.2.6 The inflammatory epiphenomena in acne rosacea 8
1.2.7 The "acne rosacea" versus "rosacea" controversy 12
1.2.8 Summary 12
1.3 Acne inversa (formerly hidradenitis suppurativa) 12
1.3.1 Before the rupture where and why? 15
1.3.2 After the rupture what next? 15
1.3.3 So what invaders are important in acne inversa? 15
1.3.4 What makes this disease behave so much worse than acne vulgaris? 18
1.3.5 So what can one possibly do to settle down all this inflammation? 21
1.3.6 So how do you get rid of all this material? 25
1.3.7 What does the future offer? 25
1.4 The psychology of acne 26
1.4.1 Acne as a stress 26
1.4.2 Acne and self-image 27
1.4.3 Isotretinoin therapy and the psyche 27
1.4.4 The isotretinoin-depression question 28
1.4.5 Isotretinoin in perspective 29
2 The folliculopilosebaceous unit--the normal FPSU 31
2.1 Anatomy 31
2.2 Genetics 31
2.2.1 Acne vulgaris 31
2.2.2 Acne rosacea 34
2.2.3 Acne inversa/hidradenitis suppurativa (AI/HS) 34
2.2.4 The scottish twins 34
2.3 Epigenetics 35
2.3.1 The farmer's boys 36
2.4 Embryology 36
2.5 Histology 38
2.5.1 Onwards and downwards 38
2.5.2 What is going on inside the FPSU? 40
2.6 Physiology 42
2.6.1 Hair first 42
2.6.2 Oil second 42
2.6.3 Last but definitely not least: the follicle 43
2.6.4 Looking deeper 44
2.7 Biochemistry 44
2.8 Hormones enzymes receptors and the intracrine system 45
2.8.1 The intracrine system 48
2.9 FoxO1 and mTORC1 49
2.9.1 The next step 50
2.9.2 The broad view 51
3 Pathogenetic mechanisms summarized 54
3.1 Acne vulgaris 54
3.2 Acne rosacea 56
3.3 Acne inversa/hidradenitis suppurativa (AI/HS) 57
3.4 Other variants 60
3.4.1 Malassezia folliculitis 60
3.4.2 Eosinophilic pustular folliculitis (ofuji's disease) 62
3.4.3 Dissecting terminal folliculitis 63
3.4.4 Acne keloidalis 63
3.4.5 Epidermal growth factor receptor (EGFR) inhibitor eruption 64
3.4.6 Acné excoriée des jeunes filles 65
4 The acne hormones 67
4.1 The endogenous hormones 67
4.1.1 Androgens and their sources 67
4.1.2 Estrogens and their sources 68
4.1.3 Progesterone and the progesteroids 68
4.1.4 Insulin 69
4.1.5 Growth hormone and insul
About the author
F. William Danby, MD, FRCPC is Adjunct Assistant Professor of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Summary
Learn to accurately diagnose, prevent and treat all three acnes using both traditional and novel approaches to understanding the causes and selecting the most effective treatments. Acne vulgaris is an extremely common condition. It is troublesome to manage, often persisting into middle age.
