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Acne is
driven by sebaceous gland secretions, most common in teenagers,
but it can also occur in adults and in the first few weeks of life
(transplacental hormone influences) and occasionally starts
at age 8 or 9. The face, chest and upper back are the most commonly
affected sites although acne may be present on the shoulders,
arms, underarms, groin and scalp. Acne may induce lifelong scarring
and thereby affect a person's self-esteem. Acne is as a general
rule quite curable, excluding those regions in which scarring
has been so severe as to cause cyst formations. Even advanced
cases can usually benefit tremendously from dermatologic management,
from the simple topical home remedies to the most elaborate
scar revisions which may include scar subcision, soft-tissue
augmentation and skin resurfacing (the latter involving peels,
lasers and abrasive techniques). In some cases, entire face
lifting as well as botox may be necessary to control the damage
to the patient's sense of esthetic self-esteem.
Acne is generally earlier in onset and most severe
in young men, where as women suffer from a long, slow acne development
process. Biologically speaking, acne is driven by androgenic
sex hormones, testosterone and androstenedione. Androgen sensitive
hair follicles contain the sebaceous glands which thicken the skin of the face, scalp, ears, neck, upper back, chest shoulders and arms. Ensuing sebaceous secretions
overwhelm clogged hair follicle outlets (pores). Acne is not
typically caused by infection, but it does set the stage for secondary
infections. Sebacous glands reflect nature's attempts to provide
protection from the elements that primitive man encountered.
At ages 12-14, boys and girls were expected to make their own
way and catch their own food so nature provided them with the
hormone of aggression, testosterone. In general, estrogens decrease
sebaceous gland activity and androgens increase it. In women,
androgens are produced by the ovaries (markedly so in polycystic
ovary disease), the placenta and adrenals, and in men by the
testes and adrenals. While males experience a peak in testosterone
at age 18, female testosterone peaks at 31. Birth control pills
by their estrogenic effects have a mild effect on acne. It is
occasionally noticed that some of the more androgenic preparations
may aggravate acne and even produce mild hirsutism. A certain
amount of trial and error for each individual is therefore necessary
to pick out the best contraceptive.
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