American Medical Association Family Medical Guide - American Medical Association [758]
Topical treatments for psoriasis include over-the-counter or prescription coal tar or salicylic acid preparations, corticosteroid medications, a synthetic form of vitamin D called calcipotriene, a potent vitamin A derivative called tazarotene, and a medication called anthralin. The immune-suppressing medications cyclosporine and methotrexate (which slow cell division) and retinoid medications (vitamin A-like drugs) may be taken orally or injected to treat severe forms of psoriasis.
Medications that dampen the errant immune response that may cause psoriasis are given in injections to people whose psoriasis has not responded to treatment with other medications.
Acne
Acne is a common skin condition that results from inflammation of the hair follicles and sebaceous glands. Sebaceous glands produce an oily substance called sebum that lubricates the skin. If your body produces too much sebum and it becomes trapped in follicles, blemishes called blackheads and whiteheads form. Bacteria that are normally present on the skin can invade the blocked follicle and multiply quickly, causing red, pus-filled lumps called pimples (see page 121). Acne is most common during puberty and adolescence because the level of male hormones rises in both boys and girls at this time, stimulating the sebaceous glands to increase sebum production. Acne usually clears up in the late teens or early 20s, although many people develop acne later in life.
Symptoms
Acne blemishes are usually concentrated on the face, but may appear on the neck, back, chest, buttocks, and sometimes the upper arms and thighs. As some blemishes heal, others appear. Pimples may leave dark, purplish marks on the skin, which usually fade. Severely inflamed pimples may take weeks to clear and can leave scars.
Acne blemishes
An acne blemish can form when sebum and dead skin cells block the opening of a hair follicle. Blackheads (top) are blockages in which the collection of sebum turns dark because of oxidation and the presence of the skin pigment melanin. A blackhead can turn into a pimple (bottom) if the sebum that is unable to escape builds up along with bacteria and dead skin cells in the hair follicle, producing pus.
Treatment
If you have mild acne, keep your skin clean but don’t scrub or pick it. Wash your skin with a mild, antibacterial soap twice a day. Try not to wash it more often unless it is very dirty or oily. Don’t use moisturizers unless absolutely necessary, and then use only those recommended by your doctor—and only use them sparingly. Avoid wearing foundation makeup—if you feel you must, use a water-based makeup and always remove it completely. If you have oily skin, wash your hair with a dandruff or detergent shampoo, and don’t use oily hair-care products.
Acne treatments work in one or more of the following ways—by reducing the production of sebum, by killing the harmful bacteria on the skin, or by speeding up the rate at which skin cells are shed (by removing keratin, the main component of the outer layer of skin). These treatments have made severe acne and scarring less common. Ask your doctor to recommend an over-the-counter acne preparation that contains salicylic acid (which loosens and helps remove the keratin blocking the pores) or benzoyl peroxide (an antibacterial medication that induces skin peeling).
Your doctor may refer you to a dermatologist (a doctor who specializes in disorders of the skin). The dermatologist may prescribe topical treatments such as a light chemical peel to loosen blackheads and prevent new blemishes, antibiotics (such as erythromycin, clindamycin, tetracycline, or sulfonamide) to kill the bacteria, medications that decrease bacteria (such as azelaic acid), or nicotinamide (a B vitamin that makes antibiotics more effective). He or she may prescribe stronger acne medications called retinoids (such as tretinoin, isotretinoin, adapalene, and tazarotene), which are derived from vitamin A. Retinoids have an antibacterial effect