Premenstrual Dysmorphic Syndrome

Acne is a disease rarely associated with systemic medical problems, but the extent and morbidity of acne should not be underestimated because of his disfigurement may have important negative psychosocial consequences for affected individuals, including decreased self-esteem, social embarrassment, social withdrawal, depression and even unemployment [1, 3].

Risk factors / triggers
1. Food / Nutrition
Foods such as nuts, cola, milk, cheese, fried foods and iodized salt have been implicated as triggers of acne, but the links between nutrition and acne has not really been proven as they are rarely supported by good analysis, epidemiological and therapeutic studies [4, 5]. On the other hand, recurrent acne as noted by Niemeier et al (2006) may be a sign of a skin disorder of the underlying power.

2. Genetic
A genetic background is supported by a case-control study by Goulden et al, as noted Rzany et al (2006). This stated that the risk of adult acne in relatives of patients with acne compared with those of patients without acne is significantly higher [4].

3. Hormones
According Rzany et al (2006), hormonal influences on acne are not disputed, as illustrated by the high incidence of acne among teenage boys. Premenstrual flare was also recorded as the cause [acne 5].

4. Nicotine
Smoking has also been designated as a risk factor for acne, but conflicting data exist regarding the link between smoking and acne. Some population studies have found links between smoking and acne, while some others have not [4].

Sticky
Contrary to popular belief by young patients and sometimes their parents, acne does not come from bad behavior and it is not a disease of poor hygiene. It also has nothing to do with lack of cleanliness [2].

Types of acne
There are two main types of acne, inflammatory and noninflammatory, they can manifest themselves in different ways,
1. Acne comedones, acne is a non-inflammatory
2. Papules and pustules of inflammatory acne
3. acne nodular acne (inflammatory acne)
4. inflammatory acne with hyperpigmentation (this occurs more frequently in patients with skin tone darker) [1]
The clinical
In general, acne is limited to body parts, which have the largest of the sebaceous glands and the most abundant, like the face, neck, chest, back and arms. Among dermatologists, it is almost universally accepted that the clinical manifestation of acne is the result of four key processes as described below [1, 6],

1. Increased production of sebum in the pilosebaceous follicle. Sebum is the secretion of lipid-rich sebaceous glands, which has a central role in the development of acne and also provides a growth medium for Propionibacterium acnes (P acnes), an anaerobic bacterium, which is a normal constituent skin flora. Compared with persons affected, acne sufferers have higher rates of production of sebum. Otherwise, the severity of acne is often proportional to the amount of sebum produced [1, 6].

2. Abnormal follicular differentiation, which is the first structural changes in the pilosebaceous unit in acne vulgaris [1].

3. The colonization of the plugged follicle serum rich with Propionibacterium acnes (P acnes). P acnes is an anaerobic bacterium, which is a normal skin flora and fills the androgen stimulated sebaceous glands to androgens [follicle is a steroid hormone such as testosterone or androsterone, that controls the development and maintenance of ] male characteristics. People with acne have more account of P acnes compared to those without acne [1, 6].

4. Inflammation. This is a direct or indirect result of the rapid and excessive increase of P.