Acne at its Worst - Uncommon Forms Which Can Disfigure

Severe acne can cause physical as well as emotional scars. Although most people stress out over the occasional zit, acne can deliver serious blows to an individual's sense of confidence and self-perception. Acne can cause a person to experience consistently blemished skin that may include pimples, papules, abscesses, cysts, blackheads, whiteheads, and other painful inflammations of the skin. Moreover, acne can be a whole body problem. While most people are seriously afflicted primarily in the facial area, many people also experience considerable blemishing across their back, chest, neck, and other areas of the body.

While most people experience the brunt of acne during the difficult adolescent years, imagine the agony of living with acne well into your middle years. With the stress of modern day living and increased exposure to environmental pollutants, adult acne is becoming a fact of life for many adults. Although most people will only have to deal with transient acne, some will experience far worse. Here is a quick run-down of the most serious forms of acne.

Acne Conglobata (AC) This is a very uncommon form of acne that can produce significant disfiguration. Acne conglobata is characterized by the development of burrows in the skin, along with papules, abscesses, keloidal and atrophic facial scars. Individuals with AC often develop blemishes that appear in clusters of two or three. Cysts are often present that are filled with pus. Nodules may also be present, especially in the area of the back and chest.

Who is more susceptible to acne conglobata? In general, males are more likely to experience AC. Onset of AC usually occurs at a young age, between the ages of 18 and 30. Although no one knows the exact cause of AC, some believe it is caused by a mutation in the XXY karyotype chromosomes. A person with AC may experience extensive scarring and subsequent disfigurement. Because the effects of AC can often be dramatic, individuals afflicted with the skin disorder may be at greater risk of suffering from self-esteem issues, depression, anxiety, and they may feel stigmatized.

Acne Fulminans (AF): Acne fulminans, sometimes referred to as acne maligna, was originally thought to be acne conglobata (AC).

The major characteristics of acne fulminans include sudden onset of ulcerating acne, which may be accompanied by fever and symptoms of polyarthritis. Usually, AF does not respond well to conventional acne treatment, such as antibacterial therapy. The most successful treatments appear to be debridement used in conjunction with steroid therapy.

What causes AF? It appears that acne fulminans is caused by a weakened immune system and increased levels of testosterone and certain anabolic steroids. These high levels of hormones cause an increase in the production and excretion of sebum and the acne-inducing bacteria known as propionibacterium acnes (P acnes). Some skin professionals believe that isotretinoin may also precipitate an eruption of AF.

How can you tell the difference between acne conglobata and acne fulminans? Although the physical symptoms may at first appear identical, AF is usually characterized by the presence of more physical pain. Patients with AF may describe feelings of bone or facial pain, migraines, and fever. Acne conglobata and acne fulminans also differ in the way they are treated. While AC may be treated with conventional anti-acne oral and topical agents, AF typically does not respond well to such treatments. AF responds better to steroid treatments.

Gram-Negative Folliculitis: Gram-negative folliculitis refers to an infection of gram-negative rods that usually occurs after an extended period of antibiotic therapy. Scientists use the word "gram" to describe the blue stain that is used in laboratories. This is often used to locate microscopic organisms. The bacteria that cause gram-negative folliculitis does not stain blue, thus the term 'gram-negative.' The most common forms of bacteria that are believed to cause gram-negative folliculitis include E. coli, serratia marcesoens, pseudomonas aeruginosa, and bacteria's from the proteus and klebsiella species.

How does gram-negative folliculitis differ from regular acne vulgaris? Most cases of gram-negative folliculitis produce less papules and comedones than acne vulgaris. Treatment of gram-negative folliculitis is fortunately much easier to treat than other severe types of acne. In most cases, conventional antibiotic therapy will help clear up gram-negative folliculitis. Isotretinoin may also help clear up this condition.

Acne and Diet - Insulin, Insulin Resistance, and Hormones

Diet, though not a direct cause of acne, does have an indirect effect on acne. That is why so many 'acne cures' recommend dietary changes in conjunction with whatever else they are advocating.

Because diet has an indirect effect on acne, individuals will get variable results when changing what they eat. This is because we all metabolize foods differently. Some people may be more sensitive to certain foods, and so those foods will have a greater impact on their acne than others that don't have those metabolic issues.

For example, skin with a tendency for acne has been shown to be insulin resistant. Insulin is a hormone that regulates carbohydrate metabolism, as well as playing a role in protein metabolism and fat metabolism. Insulin regulates the way our cells use the available energy in the bloodstream - so insulin makes the liver and fat cells (adipose tissue) take in some of the glucose in the bloodstream and stores it as fat.

People with insulin resistance don't respond to the normal amounts of insulin released in the body. Because the regulation of blood glucose levels (which insulin ultimately is responsible for) is so important, the pancreas starts producing more insulin when the liver and fat cells don't respond. Blood glucose levels can build up if the body still doesn't respond.

High levels of insulin can cause high blood pressure, fluid retention, and can lead to type 2 diabetes.

Thus, for those with insulin resistance, poor quality carbohydrates such as white bread, sugar, and sugary foods, may be a problem. These types of carbohydrates are digested quickly and enter the blood stream rapidly. Normally, insulin would trigger the body removing those excess blood sugars into cells. But with insulin resistance, they hang around longer in the blood, as well as causing the body to have high levels of insulin in the blood.

This is important for acne sufferers, particularly women, in that excess insulin can cause higher levels of male hormones. These androgen hormones have long been implicated in acne. They increase the oil production of the sebaceous glands, which leads to clogged pores and provides a breeding ground for the acne bacteria.

In another study, researchers implicate the high levels of refined carbohydrates (such as bread and cereals) in teenage acne. Following a similar rationale, they suggest that high levels of blood sugars increase the levels of insulin and insulin-like growth factor (IGF-1), which leads to excess production of male hormones. These male hormones then trigger acne outbreaks.

And as well as that, insulin-like growth factor (IGF-1) encourages certain skin cells (keratinocytes) to increase. Keratinocytes are also implicated in acne.

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