The costs and social impact of acne are substantial. In the United States, acne vulgaris is responsible for more than 5 million doctor visits and costs over US$2.5 billion each year in direct costs.[13] Similarly, acne vulgaris is responsible for 3.5 million doctor visits each year in the United Kingdom.[19] Sales for the top ten leading acne treatment brands in the US in 2015, have been reported as amounting to $352 million.[175]
The third phase of the life cycle of acne is inflammation. At this point, your body’s immune system may deal with the problem, but if it doesn’t, different bacteria can move into the pore. Detecting an enemy bacterial invader, your body responds by emitting white blood cells to the infected area. In some cases, the white blood cells have a difficult time fighting the bacteria, and some die, contributing to the oily buildup and creating pus.
When whiteheads and blackheads become infected with bacteria, called Propionibacterium acnes, it leads to inflammatory acne. Regular bacteria is found in most whiteheads and blackheads, but P. acnes is attracted to the closed, oily environment. This bacteria makes acne more difficult to treat. The four different pimple types that characterize inflammatory acne are papules, pustules, nodules and cysts.
Hydroquinone lightens the skin when applied topically by inhibiting tyrosinase, the enzyme responsible for converting the amino acid tyrosine to the skin pigment melanin, and is used to treat acne-associated postinflammatory hyperpigmentation.[34] By interfering with new production of melanin in the epidermis, hydroquinone leads to less hyperpigmentation as darkened skin cells are naturally shed over time.[34] Improvement in skin hyperpigmentation is typically seen within six months when used twice daily. Hydroquinone is ineffective for hyperpigmentation affecting deeper layers of skin such as the dermis.[34] The use of a sunscreen with SPF 15 or higher in the morning with reapplication every two hours is recommended when using hydroquinone.[34] Its application only to affected areas lowers the risk of lightening the color of normal skin but can lead to a temporary ring of lightened skin around the hyperpigmented area.[34] Hydroquinone is generally well-tolerated; side effects are typically mild (e.g., skin irritation) and occur with use of a higher than the recommended 4% concentration.[34] Most preparations contain the preservative sodium metabisulfite, which has been linked to rare cases of allergic reactions including anaphylaxis and severe asthma exacerbations in susceptible people.[34] In extremely rare cases, repeated improper topical application of high-dose hydroquinone has been associated with an accumulation of homogentisic acid in connective tissues, a condition known as exogenous ochronosis.[34]
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Aside from adding bacteria to your skin, these forms of contact can irritate the skin, adding to the appearance of redness and causing increased inflammation. In the event that your pimples get ruptured during this process, the oil and bacteria that was trapped inside could spread to the surrounding skin on your face, which causes acne to spread. So, not only will rubbing, squeezing and scratching leave your acne-ridden skin further irritated, it will increase the amount of acne you will have to deal with.
Acne treatment that you apply to the skin: Most acne treatments are applied to the skin. Your dermatologist may call this topical treatment. There are many topical acne treatments. Some topicals help kill the bacteria. Others work on reducing the oil. The topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Your dermatologist will determine what you need.
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