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Health Guide
Compiled by Shanika Sriyananda

What you should know about acne

by Dr. Sharnika Abeyakirthi

What is acne?

Acne (or pimples) is an inflammatory disease of the pilosebaceous unit. This unit consists of the sebum or oil secreting gland and a hair follicle.

Acne is an extremely common condition affecting almost 80 per cent of adolescents and young adults. It usually starts in adolescence and frequently resolves by mid twenties. Acne develops earlier in girls than boys. A peak in severity occurs between 14-17 yrs in girls and 16-19 yrs in boys.

Thereafter the acne resolves slowly. Although most people are free of acne there are few unfortunate ones in late twenties who still suffer. At the age of 40 significant lesions are still present in one per cent of males and five per cent of females.

What causes acne?

There are four main factors contributing to the formation of acne.

1) Increased sebum production

In patients with acne, the sebum producing glands (glands producing only secretions on the skin) are larger and more responsive to different stimuli than normal people. Hence they produce more sebum (only secretions) than others.

2) Abnormal proliferation and shedding of cells at the opening of the pilosebaceous gland.

Because of this the follicular opening is blocked and various substances accumulate within the gland and form a microcomedone. Later these microcomedones turn into closed and open comedones which are also known as white heads and black heads respectively. These comedones are the ones that later become acne.

3) Bacterial proliferation

A bacteria called Propionibacterium acne plays a role in the formation of acne. But it is important to remember that acne is not infectious.

4) Inflammatory mediators

P.acne act on the various substances within the blocked follicle and produce inflammatory mediators. The follicles rupture and these mediators are released causing acne.

What other factors influence the formation of acne?

Genetic factors

This means that the tendency for you to get acne is influenced by, whether one or both your parents have acne or not. Not only that, the severity of acne, their distribution, scarring, response to treatment and the age at which their acne resolved could all be genetically determined. So if you have a parent who had severe scarring acne which persisted even at forty you should be extra cautious about your own acne.

Hormones

Androgen is the main hormone that causes acne. Increase androgens causes, increased sebum secretion which leads to the formation of comedones and thereby causes acne. In addition, growth hormones and progesterone can also exacerbate acne.

Premenstrual flare

About 70 per cent of women complain of a flare of their acne 2-7 days before their periods. This is partly due to the effect of hormones. On the other hand due to the fluid retention during this time, the follicles get blocked and cause exacerbation of acne.

Sweating

Acne can get worse during periods of excessive sweating. This is especially seen in people who live or work in hot humid environments.

Occupation

Certain occupations are linked with formation of acne. Eg. Cooks can get acne due to working in hot environment. People dealing with oil can develop a special form of acne.

Smoking

There are certain studies that have shown a relationship between acne and the number of cigarettes you smoke daily.

Drugs

Certain drugs can aggravate acne. These include steroids, androgens, certain contraceptive pills, antiepileptic drugs, iodides, lithium etc.

What about diet?

It is very common to hear that certain foods like chocolates, fatty foods are blamed for exacerbating acne. But scientific proof for this is lacking. There are some trials that have shown that western civilization food habits give a high blood glucose index which triggers your insulin secretion and thereby influence androgen secretion.

This in turn can cause acne. The best advise you can give an acne patient is, that they can eat anything they want in moderate amounts. 'Eat sensibly' contain all the advice that should be given.

How does acne present itself?

Acne can present itself in a number of different ways. The initial presentation is with multiple comedones (what we commonly call white heads and black heads). These lesions become inflamed and cause papules, pustules and in some people nodules.

Nodules are common in males. Acne not only affects your face, but chest, back and upper arms as well.

What are the different types of acne?

Chloracne

These patients present with multiple comedones. This is due to exposure to certain toxics, chlorinated hydrocarbons etc.

Cosmetic acne

This type of acne is seen in females, especially those who had acne in their adolescence and have used cosmetics for a long time. Sometimes when you start using a newer cosmetic which is comedogenic, you will notice a flare up acne.

Pomade acne

Greasy preparations used to defreeze curly hair can cause acne specially comedones around the forehead.

Mechanical acne

This type of acne occurs at the site of physical trauma. Eg. At the chin of violin players, due to the friction of head bands, tight bra straps.

If you have acne together with excessive hair on your face. In this context you should consult a doctor, especially if you are abnormally fat or have menstrual irregularities, because you may be having an underlying endocrine disorder.

Acne mimics

There are certain diseases that can mimic acne. Eg. Rosacea

Your doctor will be able to differentiate these conditions.

Why you should take acne seriously and seek treatment early?

Because it is no longer a natural thing that can occur to most of us during adolescence. It is a disease that can end up with permanent disfigurement due to pigmentation, scarring and keloid formation. If you seek treatment early the disease can be cured and can prevent complications. So you should not hesitate to go to a doctor for treatment early because there are a number of treatment modalities available for acne now.

Some myths about acne

Acne is infectious

Some people believe that by kissing a person who has acne or by sharing the same towel can cause acne. This is not true. Although acne is caused by a bacteria and it is not infectious.

Eating oily food can cause acne

Increased sebum or oil secretion by sebaceous glands cause acne. But oily foods only increase your blood lipid levels and these lipids do not pass into the sebaceuous glands.

So oily foods cannot cause acne.

Acne patients need to wash their skin thoroughly and frequently. Many people believe that acne is related to poor hygiene. So they wash their face excessively and frequently. But there is no evidence that lack of washing is associated with acne or frequent washing improves the condition. But of course if you wear make-up it is important to wash it off as soon as possible.

Dr. Sharnika Abeyakirthi, is the senior Registrar, Dermatology Unit, National Hospital of Sri Lanka.

Managing acne - next week

Newborn weight linked to obesity

Latest US research has found that newborn babies who gain weight rapidly, in the first week are more likely to become obese later on. They found that for every 100g (3.5oz) gained, the risk of being overweight as an adult rose by 10 per cent.

All 653 people who took part in the study were formula fed when they were born in the 1970s and 1980s, and as such were more likely to put on weight than breastfed babies.

According to researchers, the weight gain in the first week was crucial in determining future levels of obesity. Size, diet and weight gain seem to be very important in determining the future growth and risks of cardiovascular and possibly other diseases.

And it is estimated that one in 10 six-year-olds are obese - three times higher than 20 years ago.

"During the first week of life, however, a too-rapid gain in weight may increase the risk of figure weight problems", said Dr. Nicholas Stettler who heads the research. He added no specific recommendation could be made about what level of weight gain was best, but he said exclusively breast-feeding in the first few months could lower the risk of obesity later in life.

Meanwhile, several past studies had shown breast-feeding helped reduced the risk of obesity. "It may be that babies pull off when they have had enough, whereas there is a tendency to encourage a baby to finish a bottle and thereby get them used to taking more", he said.

BBC news

Is your child at risk of high Cholesterol?

by Dr. Rani Goonewardene

Do you know that adult heart disease starts in childhood?

Clinical evidence, epidemiological and post-mortem studies show that build up of cholesterol plaques (atherosclerosis) begin in childhood. It is documented that in Sri Lanka about 30 per cent of patients suffering from heart ailments are less than 50 years.

The risk factors of heart disease and stroke in adults show up in childhood, it is crucial that parents and health carers take action to diagnose it early.

Most parents do not know their children's cholesterol levels. This is partly due to the fact that parents are not aware that cholesterol; build up in the blood vessels starts as early as 2 years, and also due to the less importance given by health carers for the build up of childhood cholesterol.

Studies show nearly half of the children with high cholesterol will have normal cholesterol as adults. Therefore screening is necessary only for "children at risk".

Parents should worry about children's cholesterol levels by the age of eleven-twelve years or even as early as preschool.

The children at risk are, those with a family history of high cholesterol or if parent suffered from Coronary heart disease at the age of 55 or less.

A family history of High Lipids levels (Hyperlipidaemia),and children whose parents blood cholesterol levels are more then 200mg/dl (more than 90 per cent of children with high cholesterol have parents with high cholesterol).

Other causes of high cholesterol are: smoking, alcohol, physical inactivity, high blood pressure, diabetes and hypothyroidism, renal disease. Studies show that family and life style issues such as obesity, diet rich in bad fats, and physical inactivity, are linked to high cholesterol in children.

Unfortunately childhood is not free of worries and health problems because most of the cardio vascular diseases start in childhood.

Studies show that it is safe to lower high cholesterol in children, whose LDL 90mg/dl or with a family history of high cholesterol.

High childhood LDL will lead to clogging of carotid artery the main blood vessel supplying the brain due to the (IMT) intimal thickening of the wall in young adults.

With proper treatment, the high cholesterol levels can be lowered. Diet plays an important role in lowering cholesterol in children.

Diet rich in good fats and low in bad fats which will reduce the LDL low density lipoproteins (bad fat).

This will not interfere, or adversely affect the development. Seek advice from the doctor and dietician to obtain optimal results.

Adapting life-style changes, like stopping smoking, alcohol and increasing daily physical activity.

Another method of lowering cholesterol can be achieved as a "family affair". The family can monitor the diet and regular exercise programme, which are the key issues in lowering bad cholesterol.

By explaining the increase in cholesterol to a child in an appropriate way, one can minimise the mental trauma. Discuss it with your doctor, and also by not presenting it as a treatment for a disease.

You and your baby

The three trimesters

Proper antenatal care has helped achieve a remarkable drop in infant as well as prenatal mortality. Tests carried out during pregnancy have helped detect adverse development in mothers and abnormalities of the foetus.

First trimester

Your baby: This is the period that the baby starts to grow and acquire a distinctive identity. Nature carves the eyes, nose, nerves, central nervous system, brain, kidneys, liver and lungs of the tiny embryo. By the end of the first trimester your baby will be 8 to 8.5 cm long and weight just 14 grams. If you take an ultra sound scan you can see her arms and legs movements.

You: Complications will slowly occur and you will lose your apetite. You may feel the first symptoms of morning sickness, caused by the amount of pregnancy hormones in your body. Vomiting will continue. Some may gain 1 to 2 kilograms of weight during this period and some may loose weight. But if you lose several kilos, consult your doctor.

Second trimester

Your Baby: Your baby is growing fast and is now around 20 cms long-bigger than the length of your pen. The face is now prominent, the eye lashes and hair are growing fast and start to darken. Her heart beats at 120 to 140 beats per minute. Her sex organs mature and the scan can clearly tell whether the baby is a boy or a girl.

You: This is the time you may begin experiencing 'quickening', which means the baby's first movement. This is a very important movement, especially if you have doubts about your dates. So the first sign of quickening will help you and your doctors fix a correct date for your baby's birth. Remember, to wear very comfortable clothes.

You will gain four to six kilos and feel heavy. You may have swollen achy feet. It is not necessary to maintain the same weight but if you are overweight, it should be reduced by avoiding oily/fatty food. It is advisable to eat more vegetables, green leaves and fruits during these months. Most mothers to be worry about weight loss but as long as your baby is growing there is nothing to worry.

Third trimester

Your baby: Your baby is growing fast and there is very little room for her to move in your womb. She is 14 inches long and is gaining about 14 grams weight now. She is ready to see the world outside. Only three per cent babies arrive on their due date but most of them arrive before two weeks.

You: The tummy is becoming large and you feel uncomfortable. Tightening pain will occur during the later part of this trimester. If the tightening pain is progressive see your doctor immediately.

So during these three trimesters it is important to closely monitor yourself and your baby's movement.

With Dr. Hemantha Dodampahala, Consultant Gynaecologist and Obstetrician

Holistic healing

Fundamentals in Ayurveda : Realising the Basic Principles

by Dr. Daniter L. Perera

To stay healthy, you must live in harmony with nature, without destroying the natural balance. To practise this art of living in natural balance one has to first understand himself. According to Ayurveda every individual has a different constitution. Once you know about your personal Ayurvedic constitution, you can select your diet, life style, daily routine and other activities according to that.

So to maintain your health and also to cure the diseases, it is very important to know the personal Ayurvedic constitution.

It is simple. Everyone can do it. Many times we may be on a diet or doing an activity which is not suitable to our constitution and thus creating an imbalance in our body which is the cause of disease. More specifically, there are a number of important factors for maintaining good health which are related to food. This includes food items, time difference between two meals, mixing of different foods, cleanliness, proper eating and eating according to the digestive power.

Proper regulated sleep is equally important to maintain a balance of the various functions in the body. Early to bed and early to rise is the key to good health. For an average person six hours of sleep is sufficient.

Sleeping longer is a cause of disease. Regular exercise according to your constitution is very beneficial for good health. Yoga is advised as the best type of exercise as it takes care of the physical, mental and spiritual health. Yoga and Ayurveda go hand in hand as the aim of both the sciences is to give perfect health and attain salvation or liberation through God consciousness.

Even after strictly following the above mentioned precautions it is natural that some toxins accumulate in the body as a result of various metabolic activities. It is necessary to eliminate these toxins from the body, which the body is doing to a great extent. But some toxins still remain in the body and are causing many diseases when their quantity increases beyond a certain limit.

To maintain proper functioning of different body systems and to stay healthy a regular elimination of these toxins is required. Ayurveda gives an elimination therapy called Pancha karma.

Another important factor for maintaining good health and staying active even in old age is called rejuvenation therapy. So a healthy person should take rejuvenating preparations to maintain good health and stay young. There are many such Ayurvedic preparations available which can be taken according to the season and your personal constitution.

Good social conduct, morality, good manners and good character are some other factors which are necessary to stay away from disease. Thus Ayurveda approaches the complete individual, while giving instructions about maintaining health. Overall, this seems to be an easy way to stay healthy! Change your habits from now and I assure you, from tomorrow you will start feeling better and of course saving a lot of money. It's great! No medical bills.

According to Ayurveda the body comprises three primary life forces or humors. In Ayurvedic terminology they are called doshas. The state of balance or equilibrium between these three doshas in the body is called health and the state of imbalance or disequilibrium is disease. The imbalance may be due to an increase or decrease in one, two or all the three doshas.

For example excess of vata causes arthritis and excess of pitta causes acidity, ulcers and liver disorders.

www.Pathmaconstruction.com

www.ceylincoproperties.com

www.millenniumcitysl.com

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