Acne

Acne:

Acne vulgaris (commonly known as acne) is a common skin problem. Acne appears in form of seborrhea, which is scaly red skin patches, acne also may appear as black and white heads on skin, pustules and sometimes as cysts (cystic acne).


Acne appears in more density in areas where sebaceous follicles are dense, face, upper chest and upper back are common areas for acne.


Severe cases of acne can lead to severe inflammation that need both topical and systemic treatment.


Acne usually appears during puberty and usually heals after some time (if mild), but it may also appear later, even in thirties, as acne rosacea.


What causes acne?


Acne can be triggered by many factors:

1-Acne is mainly triggered when sebaceous follicles are blocked due to over-activity and too much secretion, especially during puberty.



2-Testosterone can also trigger acne (for both male and female), so for post menopausal females, inflammations and acne rosacea is more likely to appear due to lack of anti-acne secretions (estradiols).


3-Psychological condition is also a major factor for acne, there are studies on this issue, but a link was identified.


4-Some bacteria may also cause acne and increase severity of already existing acne, most commonly, Propionobactarium acne.


5-Diet is mildly linked to acne, mainly chocolate and fatty diet.


How can acne be treated?

Acne treatment should be accompanied with diet control, various medications can be used for acne treatment:


1-Benzoyl peroxide and hydroxyquinolines are common topical treatments for mild to moderate acne that acts through peeling infected areas, treatment may take quiet long time, main side effect is photosensitivity (inability to tolerate sun and light), so sun screen should be used during this kind of acne treatment.



2-Antibiotics for acne: antibiotics can be used for acne, especially when acne is caused byPropionobacterium acne, common antibiotics used for acne are erythromycin, clindamycin, tetracycline and minocycline.


Avoid tetracycline for pregnant women as it causes teratogenic effects.

3-Topical medications for cystic acne: topical retinoids can be used for severe cystic acne, retinoids are derivatives of vitamin A, Adapalene is common as a topical treatment for cystic acne


4-Systemic retinoids: can be used with topical retinoids for severe acne management.


Natural medications for acne:

Although not clinically proven completely, there are natural treatments for acne that managed to treat some cases of acne:


1-Tea tree oil (topically).


2-Aloe vera (topically).


3-Topical caffeine.

Gout

Gout :

                 a metabolic disorder associated with the metabolism of purines (products of metabolism of meat).Usually enhanced by genetic factors.

Symptoms of Gout:

                                                 red, swollen joints in feet with acute attacks of pain.

Diagnosis: 

                             fluid sample is taken from joints and if crystals appear in it, it's positive.X-ray can be made to help in diagnosis(swollen joints).

Treatment:

                             NSAIDs and for acute attacks, colchicine.

                             For prevention of attacks, allopurinol can be used for a long time.

Calcium Channel Blockers (CCBs) for hypertension

 Calcium and heart beat:

Calcium is an essential element for the heart muscle to beat, with the entry of calcium into the muscle, the heart muscle starts to contract and when the calcium is out it starts to relax.

In hypertensive patients, there is a necessity to lower the amount of blood in vessels or to dilate the vessel.

So, if the amount of blood pumped by the heart reduced, a drop in blood pressure can be achieved and this is the aim of Calcium Channel Blockers.

Calcium Channel Blockers act by blocking receptors of calcium on the cardiac muscle, so there would be less stroke volume which can reduce blood pressure.

**Blood Pressure = stroke volume*heart rate(no. of beats per minute).

There are different types available of CCBs:

Ex. amlodipine, felodipine, diltiazim, verapamil.

These types differ in duration of action.

Side effects:

Most commonly, headache, nausea and arrythmia.

Interactions:

Mainly increases serum levels of carbamazepine, atorvastatin and simvastatin.

Erectile dysfunction(ED)

Erection: the ability of male sex organ to get the right shape for sexual intercourse (to erect), for appropriate time.

How it happens: when a male is sexually aroused blood flows into veins to the penis and nitric oxide is secreted , so smooth muscles in the walls of penis are stretched due to vasodilation.

Erectile dysfunction: is the partial or full loss of this ability.

Causes: either physical(especially veins) or psychological(usually depression)

Treatment: most commonly:

1-pills (Sildenafil, Taladafil,...)
                     
 2-surgical treatment.

Sildenafil: (Viagra™) is the most common treatment, it acts by inhibiting an enzyme called 

PD-5, so allowing much of nitric oxide leading to erection.

Cautions when using  Sildenafil:  1-if you are using nitrates (vasodilators).

                                                          2-  if having blood pressure disturbance.

It may also cause vision disturbance and skin rash.



                                                        
                   

Aspirin

 Aspirin ( acetyl salicylic acid), first isolated by a german chemist, is one of the widely-used NSAIDs allover the world.

Aspirin has been used for a variety of purposes, for ex.:

1-common cold as analgesic.

2-anti-rheumatic and for fever as anti-inflammatory and anti-pyretic.

3-prevention of complicated cardiovascular events, due to it's anti-platelet activity.SO, aspirin should be used with caution when used with anti-platelet drugs like clopidogril and warfarin as it would lead to bleeding

4-reducing catract in diabetic patients, but it's not so effective for that purpose.

Mechanism of action:

inhibition of COX-1 and COX-2 enzymes to reduce production of prostaglandins and stop inflammation.

USE WITH CAUTION IF1- sensitive to ibuprofen or have peptic ulcer.

                                           2-using other NSAIDs.

                                           3- using anti-platelet drugs.

New forms of aspirin have been produced for more safety on stomach like effervescent granules.

Interactions; replaces tolbutamide(anti-diabetic), valporic acid, phenytoin(anti-convulsant), and probencid.


                           

Paracetamol(Acetaminophen)

 One of NSAIDs, acts on COX enzymes, mainly COX-2.


Uses: 
 used as an analgesic and anti-pyretic.
 mainly for moderate pain as in headaches.



Dose: 
3 gm/day for a healthy person divided into three doses.

.

Special combination for hepatic patients: combine with methonine to reduce toxicity as methionine is converted into glutathione which metabolizes paracetamol.

NSAID's

Non-steroidal anti-inflammatory drugs:

Are a class of drugs used as anti-inflammatory, analgesic and usually anti-pyretic drugs that act by inhibition of a class of enzymes called prostaglandins.

Examples of NSAID's: Aspirin, celecoxib.


Prostaglandins are mainly produced by precursors mainly:

COX-1, COX-2 (cyclo-oxygenases)

Most NSAID's act on both COX-1 and COX-2.


Some NSAID's act only on COX-2, EX: Meloxicam, thus having less side effects especially on stomach.

Side effects: common side effects are stomach pain and ulceration.

see also   Aspirin, Paracetamol

If having any questions, don't hesitate!