Acne – the Cause and Symptom

Acne is a skin condition that caused pimples on our face and is also common on the shoulders, back, and upper chest. In fact, acne is characterized by pimples, cysts, and sometimes abscesses. Both cysts and abscesses are pus-filled pockets, but abscesses are somewhat larger and deeper.

Acne happens through an interaction between hormones, skin oils, and bacteria, resulting in inflammation to the hair follicles. The sebaceous glands that are attached to the hair follicles will secrete an oily substance, i.e. sebum, when sebum passes up from the sebaceous gland and hair follicle, along with dead skin cells to the surface of the skin through the pores, this process will somehow clog the hair follicles and blocking the sebum from leaving through the pores. The consequence of this is that the blocked sebum-filled hair follicle will promote overgrowth of Propionibacterium acnes in the hair follicle that are responsible to cause skin eruptions commonly known as acne pimples. Deeper inflammation produces cysts and sometimes an abscess.

In short, acne is caused by a buildup of dead skin cells, bacteria, and dried sebum that block the hair follicles in the skin.

If the blockage is incomplete, a blackhead (i.e. open comedone. Blackhead is flesh-colored bumps with tiny, dark dots at center) develops; and if the blockage is complete, a whitehead (i.e. closed comedone. Whitehead has similar appearance as blackhead but lack the dark dots) develops.

Why acne occurs during puberty? This is because during this time, the sebaceous glands are stimulated by an increased hormone levels, especially the androgens (i.e. testosterone), that caused excessive sebum production. However, hormone production will stabilize and acne usually disappears when a person reach mid-20s.

Nevertheless, any conditions that involve hormonal changes might cause the occurrence of acne. For example, acne may occur with each menstrual period in young women and may clear up or substantially worsen during pregnancy. Also, the use of certain drugs, particularly corticosteroids and anabolic steroids, can cause acne by stimulating the sebaceous glands. It is also true that certain cosmetics may worsen acne by clogging the pores.

In fact, it is quite difficult to pinpoint the exact cause of acne outbreak since it varies in severity (i.e. mild, moderate, and severe) for most people, nor there is a direct relationship between acne, foods and with a person daily activity. What is known is that acne is often worse in the winter and better in the summer, this can be attributed to the anti-inflammatory effect of sunlight.

For those with mild acne, they usually will develop a few non-inflamed blackheads or whiteheads, or a moderate number of small, mildly irritated pimples. The pimples are mildly uncomfortable and have a white center surrounded by a small area of reddened skin.

On the other hand, people with moderate acne have more comedones and pimples and sometimes larger, more inflamed pimples (i.e. pustules).

People with severe (i.e. deep or cystic) acne will have numerous large, red, and painful pus-filled lumps (nodules) that sometimes join together under the skin into giant, oozing abscesses. The nodules and abscesses of severe acne often rupture and might leave scars after healing.

Common acne treatments shall include topical antibiotics for mild acne, oral antibiotics for moderate acne, and oral isotretinoin for severe acne. It is good to know that there are various ways to tackle acne, and I will deal with it in my later post.

A word of warning is that you should never try to squeeze or open your pimples as this will likely increase inflammation and the depth of injury to your skin, making acne scarring more likely. For your information, acne scars can last a lifetime.

Cold sore

Cold sores, also called fever blisters, begin with tingling near the mouth, followed by a cluster of small, painful blisters on the lip and around the mouth. For some people cold sores can be very painful that caused them to have difficulty in eating, drinking, and sleeping.

Although cold sore is harmless but many regard it as something “annoyance” (just like dandruff or hemorrhoids) as no one wants to go through the day with a large, unsightly sore on the lip, more so if it appears on the days you're set for an interview or an important photograph.

The skin around the blisters is often red, swollen, and sore. The blisters may break open, leak a clear fluid, and then scab over after a few days but normally heal on their own within 14 days.

Cold sores are caused by the herpes simplex virus, which lies dormant in our body after a first infection. The herpes simplex virus usually enters our body through a break in the skin around or inside the mouth and is usually spread when a person touches a cold sore or touches infected fluid-such as from sharing eating utensils or razors, kissing an infected person, or touching that person's saliva. It is common for a parent who has a cold sore to spread the infection to his or her child in this way.

What is important here is that to prevent the transmission of cold sores in the first place, we have to avoid close contact with anyone who has active cold sores, and that kissing is a major transmitter of cold sores.

In general, after an initial outbreak, the next outbreak can occur when our immune system is weakened by a cold or fever (What is immune system? This is our body's natural defense system that helps us fight infections. It is good to know that an impaired immune system does not work properly and cannot effectively protect us against infection). New outbreaks can recur as frequently as every few weeks or as rarely as every few years. The triggers for cold sores can be attributed to colds and flu, tiredness, stress, menstruation, cold, wind, or strong sunshine that usually reactivate the virus, thus causing another cold sore.

What are the symptoms?

The first symptoms of cold sores may include pain around our mouth and on our lips, a fever, a sore throat, or swollen glands in our neck or other parts of the body. As for small children, they sometimes drool before cold sores appear. For some people, cold sores can be very painful.

What are the treatments available?

Sadly to say that there is no cure for cold sores, nor is there a cure for the herpes simplex virus (HSV) that causes them. But good news is that most cold sores will go away on their own, i.e. within 14 days and that the following measures may help to reduce the duration of cold sores and sometimes prevent a future outbreak/flare-ups.

Medicine and Drug Remedies

Treatment with medicines and drug depends on whether we are having a first outbreak or a recurrent outbreak or are trying to prevent future outbreaks.

For treating a first outbreak of cold sores, oral antiviral medications such as acyclovir, famciclovir and valacyclovir may reduce pain and improve the healing time.

As for treatment of recurrent cold sores, the following medicines may reduce the severity and duration of the outbreak:

Topical creams or ointments - available with or without a prescription, can work to reduce pain, itching, and healing time. Prescription creams and ointments included penciclovir cream (such as Denavir) and acyclovir ointment or cream; nonprescription creams and ointments included tetracaine cream (Viractin) and Lidocaine (Zilactin-L), Docosanol 10% (Abreva), Benzyl alcohol (Zilactin) and Dimethicone with sunscreen (Herpecin-L).

Oral antiviral medications (i.e. acyclovir, famciclovir, valacyclovir) - are available by prescription should be used when the first symptoms (such as burning or itching) develop. It is useful for people who have frequent and painful outbreaks and have little effect once the cold sore develops.

Home Treatment

• Placing a cool, wet towel on the sores or apply a small ice pack (a packet of frozen peas or crushed ice in a plastic bag, wrapped in a face cloth) to the area a few times a day for 10 to 15 minutes each time to help reduce redness, swelling, pain and dry out the sore.
   
• Take ibuprofen (such as Advil or Motrin) or acetaminophen (such as Tylenol) if you find your cold sore is very uncomfortable and want to reduce the pain. However, never give aspirin to anyone younger than 20 as it may link to Reye's syndrome, i.e. a very rare but serious disease that targets the brain and liver and can cause drowsiness, confusion, seizures, coma, and in severe cases, death.
   
• Using nonprescription ointments that can relieve pain, prevent cracking and bleeding or help heal the cold sore. Some products, such as Abreva, Zilactin, and Ziladent, can speed the healing of cold sores or prevent them if applied early enough. Other products such as Orajel and Anbesol can numb sore areas in the mouth or on the lips.
   
• Avoid sharing towels, razors, silverware, toothbrushes, or other objects that a person with a cold sore used.
   
• To avoid spreading the virus, don't touch active blisters or if after touching a sore, wash your hands to avoid spreading the virus. Don't pick or squeeze sores.
   
• If sunlight triggers cold sores, use sunscreen or a lip balm with sunscreen when you spend time in the sun. In this case, you may also want to wear a hat to help shade your mouth.
   
• If stress or fatigue is triggers, get plenty of sleep, and try deep breathing and muscle relaxation exercises.
   
• Cold sores are contagious, therefore it is advisable to avoid close contact (such as kissing) with people who have cold sores or genital herpes (also called HSV infection, is a viral infection caused by the herpes simplex virus (HSV) and a sexually transmitted disease (STD) that may cause skin blisters and sores in the genital area).
  
  
• Children who have a fever and many mouth sores are encouraged to drink water and other fluids to prevent dehydration (i.e. loses too much fluid from the body and is very dangerous for babies, small children, and older adults. It happens when there is an illness that causes a high fever, vomiting, or diarrhea). 

Alternative complementary medicine

The amino acid lysine - is considered a leading anti-cold sore supplement due to its ability to inhibit the growth of the cold sore virus. It’s most effective when used at the first sign of a cold sore. It is available in oral or cream formulation.

Melissa (Melissa officinalis) - is a powerful antiviral herb. Melissa cream, or lemon balm can help cold sores heal more quickly and prevent it recurrences. What a lovely name!

Vitamin C with flavonoids - this antioxidant combination can help to promote healing and boosts our body viral-fighting immune system cells.

Echinacea - is good for those whose cold sores caused by a weakened immune system that often make them have frequent outbreaks of cold sores.

See your doctor if:

The cold sore is getting worse, or is not getting better after about 10 days despite treatment;
You have frequent cold sores; and
You have developed a cold sore in or near your eye.

The Right Contraception for Pregnancy

According to statistics, each year, approximately 210 million pregnancies occur around the world. Of this figure, 38% are unplanned pregnancies and 22% of this ends in abortion. It is important to know that modern contraceptive methods allow women and men to enjoy a sexually fulfilled life and a loving and affectionate partnership, independent of their decision to become a mother or a father. 

But in the first place, why do people use contraception?

People choose to use contraception for various reasons, but the majority of them are due to:

• Wish not to have children or to delay parenthood;
• Require contraception to help space the timing of the births of their children; or
• They may feel their family is complete and to guard against the possibility of becoming pregnant again.

Therefore choosing the right contraception is important here, as some contraceptive methods are simply more reliable than others, and that the choice of contraceptive method impacts the ability to avoid an unintended pregnancy as well. Different methods suit different people, thus it is advisable to examine the advantages and the disadvantages of each method before making a decision. Nevertheless, we should also take into consideration the factors such as our age, our health and our medical condition and relationship status.

The choice of methods of contraception can be broadly divided into:

Hormonal

- The combined pill (micropill)
- The progestin-only pill (mini-pill)
- Intrauterine system (IUS)
- Implant
- Injection
- Contraceptive patch
- Vaginal ring
- Emergency pill

Barrier

- Intrauterine device (IUD, coil)
- Male condom
- Female condom
- Diaphragm plus spermicide
- Cervical cap plus spermicide

Alternative

- Male sterilisation
- Female sterilisation
- Withdrawal (Coitus Interruptus)
- Natural family planning (Fertility awareness)

Hormonal contraception

Most hormonal methods of contraception contain a combination of estrogen and progestin, which act by preventing an egg from a woman being released each month and thickening the mucus at the entrance of the womb, thus making it difficult for man’s sperm to get through. Other methods contain progestin only, which also work by thickening the mucus but also by changing the lining of the womb. In some women, it may also prevent ovulation. The methods are:

The combined pill - Contains estrogen and progestin. The woman is given one pack for each 28-day cycle. There are a number of different types of combined pills available. But please note that fertility will quickly return to normal when the pill is no longer taken.

The progestin-only pill - Only contains progestin. The woman takes one pill every day. Suitable for women who cannot tolerate estrogens. Further, it can be used while breastfeeding.

Intrauterine System (IUS) - A small plastic-shaped device with a cylinder containing progestin is inserted into the cavity of the womb. The tiny dose of progestin is released slowly. Suitable for women who prefer not to think about birth control on a daily basis. Can also be used by young women.

Implant - A small plastic rod containing a progestin reservoir is inserted in the upper arm. The progestin is released in tiny doses. Implant is particularly suitable for women who want long-term contraception, women who are breastfeeding and those who do not tolerate estrogen.

Injection - The injections contain progestin only or a combination of estrogen and progestin. It is given either once every month or once every three months. Suitable for women who are breastfeeding and those do not tolerate estrogen.

Contraceptive patch - Contains estrogen and progestin and is affixed to the abdomen, thigh, buttocks or upper arm. The hormones are released continuously and the patch has to be changed weekly.

Vaginal ring - Contains estrogen and progestin combination and is inserted into the vagina. It is replaced once a month.

Emergency pill - Works by delaying or inhibiting ovulation. Can contain either a combination of estrogen and progestin, or progestin only. Do note that emergency pill should not be used regularly.

Advantages of hormonal contraception

1. Hormonal methods are the most reliable form of protection against unintended pregnancy. 
2. Hormonal methods are easy to use. 
3. Hormonal methods are a reversible form of contraception; a woman can get pregnant again once she stops using it.
4. There are a number of options available to suit different needs, for example, different mixes and doses of hormones, and different application forms.
5. Added health benefits e.g. women may see noticeable improvements in their skin and hair condition, lighter and shorter periods too. 

Disadvantages of hormonal contraception

1. Hormonal methods do not protect against sexually transmitted diseases (STDs). 
2. Some women may experience side-effects.

Barrier Methods

Barrier methods are designed to stop sperm from entering the womb. The methods include:

Male condom - Latex or polyurethane sheath that fits over the penis when it is erect. It is closed at one end with a 'teat' at the top to hold the sperm when the man ejaculates. Provides protection against STDs if used properly.

Female condom - A polyurethane sheath which fits inside the vagina. The closed end covers the cervix and the open end is positioned at the entrance of the vagina. Provides protection against STDs if used properly.

Intrauterine device (IUD) - A small plastic and copper (usually T-shaped) device is inserted in the cavity of the womb. Prevents pregnancy by preventing sperm and eggs from meeting. Not recommended for women who have not given birth or for women with anaemia. Regular use is also not recommended.

Diaphragm plus spermicide - A dome-shaped circle made of rubber or silicone that is inserted into the vagina to form a barrier between the sperm and the entrance of the womb. It is important to have the diaphragm checked every 6 months.

Cervical cap plus spermicide - Cap made of rubber or silicone, similar to the diaphragm. Not recommended for women who have already given birth.

Advantages of barrier contraception

1. The condom is the only form of contraception that offers protection against STDs if used properly.
2. Barrier methods is most suitable for women who cannot or do not want to use hormonal contraception.
3. The IUD is a long-acting method which means it does not interfere with spontaneity.
4. Barrier methods offer protection against unintended pregnancy without acting on the natural hormone and fertility cycle, thus avoid the risk of pharmacological side effect.

Disadvantages of barrier contraception

1. Some methods need practice to be used correctly and effectively. 
2. Some methods such as the male and female condom can interfere with spontaneity, sensation and pleasure. 
3. Barrier methods are less reliable at preventing unintended pregnancy compared to hormonal methods.

Alternative methods

Alternative methods are less reliable than hormonal and barrier methods, particularly for inexperienced individuals. This is by:

Withdrawal method - When having sex, the man has to remove his penis from the vagina before ejaculation. The reason behind is to stop sperm from entering the vagina.

Advantages of alternative contraception

A natural alternative to barrier methods and hormonal methods.

Disadvantages of alternative contraception

1. Requires a high level of control from the man 
2. Frequently fails because small drops of sperm can escape from the penis into the vagina before the man ejaculates 
3. Causes impairment of sexual climax 

Natural methods

These methods involve some means of finding out when a woman is at her most fertile, so that she can be extra careful or to avoid sex altogether at these times. The women should practice to keep a daily record of their body temperature by using a special fertility thermometer.

Advantages of natural contraception

It is a natural alternative to barrier methods and hormonal methods based on the natural hormone and fertility cycle.

Disadvantages of natural contraception

1. This technique requires a significant level of motivation and a clear understanding of how to monitor fertility. 
2. Natural methods of contraception do not take into account fluctuations in the cycle. 
3. Many circumstances in everyday life can influence the rhythm of a woman menstrual cycle, making reliable calculation of the fertile and infertile days difficult and sometimes impossible.

Sterilisation

This method is only for people who have decided they definitely do not want children, either presently or in the future. It is very important to be aware that this is a permanent, non-reversible method of contraception. This can be performed by a surgical procedure to cut or block the fallopian tubes (female sterilisation) or the tubes that carry sperm (male sterilisation).