Tài liệu Diseases and Disorders Acne docx

LINK DOWNLOAD MIỄN PHÍ TÀI LIỆU "Tài liệu Diseases and Disorders Acne docx": http://123doc.vn/document/1036277-tai-lieu-diseases-and-disorders-acne-docx.htm

4
“The Most
Difficult Puzzles
Ever Devised”
C
HARLES BEST, ONE of the pioneers in the search for a cure for
diabetes, once explained what it is about medical research
that intrigued him so. “It’s not just the gratification of knowing
one is helping people,” he confided, “although that probably is a
more heroic and selfless motivation. Those feelings may enter in,
but truly, what I find best is the feeling of going toe to toe with
nature, of trying to solve the most difficult puzzles ever devised.
The answers are there somewhere, those keys that will solve the
puzzle and make the patient well. But how will those keys be
found?”
Since the dawn of civilization, nothing has so puzzled people—
and often frightened them, as well—as the onset of illness in a
body or mind that had seemed healthy before. A seizure, the in-
ability of a heart to pump, the sudden deterioration of muscle
tone in a small child—being unable to reverse such conditions or
even to understand why they occur was unspeakably frustrating
to healers. Even before there were names for such conditions, even
before they were understood at all, each was a reminder of
how complex the human body was, and how vulnerable.
While our grappling with understanding diseases has been
frustrating at times, it has also provided some of humankind’s
most heroic accomplishments. Alexander Fleming’s accidental
discovery in 1928 of a mold that could be turned into penicillin
Foreword
Foreword
5
has resulted in the saving of untold millions of lives. The isola-
tion of the enzyme insulin has reversed what was once a death
sentence for anyone with diabetes. There have been great strides
in combating conditions for which there is not yet a cure, too.
Medicines can help AIDS patients live longer, diagnostic tools
such as mammography and ultrasounds can help doctors find
tumors while they are treatable, and laser surgery techniques
have made the most intricate, minute operations routine.
This “toe-to-toe” competition with diseases and disorders is
even more remarkable when seen in a historical continuum. An as-
tonishing amount of progress has been made in a very short time.
Just two hundred years ago, the existence of germs as a cause of
some diseases was unknown. In fact, it was less than 150 years ago
that a British surgeon named Joseph Lister had difficulty persuad-
ing his fellow doctors that washing their hands before delivering a
baby might increase the chances of a healthy delivery (especially if
they had just attended to a diseased patient)!
Each book in Lucent’s Diseases and Disorders series explores
a disease or disorder and the knowledge that has been accumu-
lated (or discarded) by doctors through the years. Each book also
examines the tools used for pinpointing a diagnosis, as well as
the various means that are used to treat or cure a disease. Finally,
new ideas are presented—techniques or medicines that may be
on the horizon.
Frustration and disappointment are still part of medicine, for
not every disease or condition can be cured or prevented. But the
limitations of knowledge are being pushed outward constantly;
the “most difficult puzzles ever devised” are finding challengers
every day.
6
Introduction
A Disease That Is
Often Ignored
F
RED WAS TWELVE years old when he developed acne. At first he
noticed white bumps under his skin. Then, small pimples with
black tops appeared. Larger red pimples, many of which were filled
with pus, followed. He explains:
From the time I was twelve to eighteen was pretty miserable
skin-wise. I had pimples on my face, neck, back, and upper arms.
It was continuous; when one went away another one took its
place. I’d go to school in the morning; in the afternoon I’d look
in the mirror and I’d have a bunch of great big welts on my face
that sprouted up while I was at school.
It was humiliating. I used all my money on creams and med-
icated pads. But they didn’t help. My acne was too bad. I asked
my parents to take me to a doctor for medicine. But my parents
thought that seeing a doctor wouldn’t help. They thought that
acne was a part of growing up. They told me that it wasn’t any-
thing to take seriously. Everyone got acne and eventually it
would go away with no harm done. In the meantime, I just had
to live with it.
1
Like many people, Fred’s parents were misinformed about acne.
Acne is not harmless. It is a disease that causes the development
of pimples and cysts on the skin of millions of people, the major-
ity of whom are teenagers. If acne is left untreated, it can lead to
the development of permanent scars. Unfortunately, since acne is
such a common condition, is not life threatening, and often dis-
appears as a person ages, many people do not take acne seriously.
New York City dermatologist Dr. Bruce Katz explains: “Parents
just don’t get it. . . . Acne is not a trivial cosmetic problem to be
waited out until pimples disappear on their own, but a medical
condition that, left untreated, can leave youngsters with unsightly
scars. . . . Acne should be taken very seriously.”
2
A Disease That Is Often Ignored
7
Although commonly perceived as a cosmetic problem, acne is actually a disease
that causes emotional trauma and lasting physical damage like these scars.
Making matters worse, because the seriousness of acne is often
trivialized, many people with acne find themselves ridiculed or
shunned by their peers. Instead of being treated with under-
standing, they are frequently teased or laughed at. Fred explains:
“I took a lot of teasing. Any kid with acne was a target. Pizza Face,
Hamburger Man, and Frankenstein were just a few of the names
I was called.”
3
Even when people have no intention of being rude or hurtful,
it is not uncommon for people with acne to be confronted by un-
pleasant reactions from strangers because acne visibly affects a per-
son’s appearance. A young man describes his experience:
Me and some friends, there were about five of us, we were going
to a birthday party at the house of one of my closest friend’s
cousins. I had never met the cousin before. . . . When we arrived,
a pretty young woman opened the door and my friend started to
introduce all of us. She greeted everyone with a warm smile and
a kiss on the cheek, but when it was my turn to be introduced she
just smiled politely and shook my hand. I felt that I repulsed her.
4
Common Misconceptions
Ignorance about acne has led many people to believe common mis-
conceptions—for example, that a lack of cleanliness or eating sweets
can cause acne. These misconceptions make many people with acne
wrongly feel that they are somehow responsible for their condi-
tion. Misperceptions may also cause other people to treat people
with acne unsympathetically. An acne patient explains how her fa-
ther’s belief in one such misconception affected her:
It was almost as if I had an enemy in the home as well as the
enemy of acne, because it was his ignorance of acne and his ig-
norance of my feelings, which was belittling. If he saw me eat-
ing chocolate I’d be given “that look.” You know . . . “you
shouldn’t be eating and enjoying that” . . . which, I think is fair
to say, is a common reaction from family and friends.
5
In order to counteract these and other misconceptions as well
as improve the way individuals with acne are treated by others,
Acne
8
it is important that everyone learn more about acne. By under-
standing what causes acne, how it is treated, and how different be-
haviors affect the disease, people with acne will be better able to
cope. At the same time, learning about acne will help friends and
family members to provide more support for their loved ones.
Learning about acne will also help others become more sensitive
about the way they interact with people with acne.
Indeed, once Fred and his family learned more about acne, his
parents took him to the doctor, where he was given medicine that
helped get his acne under control. Today, Fred is a grown man with
his own family. In the years that have passed he has learned quite
a bit about acne, and so have his parents. “When the grandkids
started breaking out, my parents insisted they be taken to the doc-
tor right away,” Fred explains. “It took some time, but we’ve all
learned just how serious acne is.”
6
A Disease That Is Often Ignored
9
What Is Acne?
A
CNE IS A COMMON skin disease that affects tiny ducts in the skin
where hair grows. These ducts are known as follicles. Acne
occurs when the follicles become clogged and infected. This causes
sores known as acne lesions, or pimples, to develop on and under
the skin.
Excess Hormones Cause Excess Oil Production
There are a number of factors that cause the follicles to become
clogged and infected. One important factor is the overproduc-
tion of androgen. Androgen is a chemical, or male sex hormone,
that both males and females normally produce. However, hor-
monal changes in the body during puberty, pregnancy, or the fe-
male menstrual cycle cause some people to produce higher than
usual levels of androgen. Although scientists are unsure why, ex-
cess androgen stimulates the sebaceous oil glands inside the fol-
licles to enlarge and manufacture excess amounts of oil called
sebum. Whereas the normal production of sebum is necessary
for healthy skin, excess sebum leads to the development of acne.
Normally, the sebaceous oil glands produce small amounts of
sebum, whose job it is to moisten and protect the skin. In order to
do this, sebum works its way up through the hair follicles, where
it washes away dead cells that accumulate in the follicles. Then se-
bum empties onto the skin through tiny openings in the follicles
called pores. Here sebum protects the skin from bacteria that live
on the skin by washing the bacteria away.
However, when excess sebum is produced, it accumulates in
the follicles rather than spilling out onto the surface of the skin.
This occurs because the follicles are extremely small and narrow.
Therefore, large volumes of sebum cannot pass through the folli-
10
Chapter 1
cles to the surface of the skin at the rate the sebum is produced. In-
stead, sebum becomes trapped in the follicles, where it mixes with
dead skin cells, forms sticky plugs that block the pores, and pre-
vents sebum from reaching the surface of the skin. As a result,
the skin around the clogged follicles dries out. At the same time,
since not every follicle becomes clogged, excess oil that spills onto
the skin through unclogged follicles causes the skin to feel oily.
What Is Acne?
11
Clogged and infected hair follicles like this can cause sores, or acne lesions, to
form under the skin.
Therefore, a person with acne may have dry skin around clogged
follicles and oily skin everywhere else.
Worse yet, without sebum to wash away bacteria on the skin,
bacteria grow and multiply around the clogged follicles. Eventu-
ally, bacteria get inside the clogged follicles, where they mix with
sebum and dead cells and cause an infection. This most commonly
occurs on the parts of the body that have the largest sebaceous
glands, such as the face, chest, neck, shoulders, upper back, and
buttocks. The result is the development of one type of acne lesion
known as a comedone.
Inflammation Makes Acne Worse
Unfortunately, the damage does not end there. Once bacteria enter
the follicles, the immune system, which protects the body from in-
fection and disease, reacts. Blood, rich with infection-fighting white
blood cells, rushes to the area. As the infection worsens, pus and
Acne
12
Infection occurs when bacteria enter a clogged hair follicle, causing the area
around the follicle to become swollen and painful.
other powerful chemicals are also produced to combat the infection.
This causes the infected area to become hot, red, swollen, and painful.
Heat, redness, swelling, pain, and the presence of pus are all
characteristics of inflammation, which in the case of acne appears
on the skin in the form of papules, pustules, and cysts, other types
of acne lesions.
Different Types of Lesions
Whether a person develops comedones, papules, pustules, cysts,
or a combination of these lesions depends on how severely the hair
follicles are clogged and inflamed. The worse the inflammation,
the more severe the acne lesion. For example, comedones, which
are basically enlarged, clogged hair follicles, form before the hair
follicles become inflamed or in the earliest stages of inflammation.
Comedones contain sebum, dead skin cells, and bacteria that are
trapped in the follicles, but comedones do not contain pus, nor are
they red or swollen. That is why comedones are the least severe
type of acne lesion.
Since comedones do not contain pus, they are quite small. All
comedones have either a white or black tip. Hence, comedones are
commonly known as whiteheads or blackheads.
Whiteheads and Blackheads
Whiteheads look like small white bumps and are usually about the
size of a pinhead. They form under the skin as the follicles become
more and more clogged and enlarged. Whiteheads never reach the
skin’s surface or open up. Therefore, they are called closed come-
dones.
Blackheads, on the other hand, are closed comedones that con-
tinue to grow upward until they break through the skin’s sur-
face. At this point, the enlarged hair follicle is visible and open to
the skin’s surface. For this reason, blackheads are known as open
comedones.
To the naked eye the contents of an open comedone look black.
The black color is the result of oxidation, a process of discoloration
that occurs when dead cells, sebum, and bacteria mix with oxygen
in the air. However, some people mistakenly think that dirt trapped
What Is Acne?
13