Acne

Acne is a common disease of the skin, caused by hair follicles becoming blocked. It is characterised by pimples (zits), blackheads or whiteheads, and sometimes scarring. Acne can be persistent, but effective treatments are available.

General information

Most people will get acne at some time during their lives. Anyone can get acne, even babies, but it is most common in teenagers. The most common form of acne (medical name: acne vulgaris) affects people during their teenage and early twenties. In some people, however, the condition may persist in adulthood.

You should consult your doctor if your baby develops acne that does not clear up on its own within three months. Other skin conditions that may resemble acne include rosacea and keratosis pilaris.

Causes

There are tiny holes on the surface of the skin, called pores. The pores open to a follicle, which contains a hair and an oil gland. The gland releases oil to lubricate and protect the skin. Acne occurs when the glands produce too much oil, which causes the pores to become blocked; and dirt, bacteria, and dead skin cells to build up.

The blockage is called a plug. If the top of the plug is white, it is called a whitehead; if the top of the plug is black, it is called a blackhead. The plugged follicle enlarges producing a bump, which, if it ruptures, releases irritating substances and bacteria that produce inflammation. Inflammation at the surface of the skin produces red bumps (papules) and inflammation deeper in the skin causes pustules (pimples). Even deeper inflammation causes hard painful cysts.

Hormonal changes related to puberty, menstrual periods, pregnancy, birth control pills, or stress can cause excessive oil secretion that results in acne. Oil-based cosmetics and hair products and certain drugs (e.g. steroids, testosterone, and oestrogen) can also cause acne.

People with acne may be advised to minimise intake of milk and sugary foods and drinks.

Signs and symptoms

Acne typically affects the areas of the skin with the highest number of hair follicles, i.e. the face, upper part of the chest, and the back. It may also occur on the arms, legs, and buttocks. The most obvious signs and symptoms of acne include:

Small red bumps (papules)
Small red pus-filled, blister-like lesions (pustules) cysts
Scarring
White raised bumps (whiteheads)
Small dark spots (blackheads)

Diagnosis

A simple examination of your skin allows your doctor to diagnose acne. Laboratory tests are not usually required.

Treatment

Acne usually responds well to six to eight weeks of treatment, but it may flare up (return) from time to time. The earlier treatment is started, the less likely there will be scarring. Self-care that can help your acne includes:

Cleaning your skin gently with a mild soap twice daily
Using over-the-counter topical (applied to the skin) medications containing benzoyl peroxide, sulphur, or salicylic acid (which are antibacterial and mild exfoliating or peeling agents)
Shampooing your hair daily and keeping your hair from touching your face
Avoiding scrubbing or repeated skin washing
Not popping or picking your pimples (as this can worsen the infection)
Using water-based (rather than oil-based) cosmetics or creams
Removing make-up at night

If self-care and use of non-prescription medication does not produce improvement in your acne you should see your doctor or a dermatologist (skin specialist). Prescription-only medications include:

More potent topical formulations of benzoyl peroxide, sulphur, or salicylic acid
Oral (taken by mouth) or topical antibiotics
Topical retinoids – drugs derived from vitamin A that help to keep skin pores clear, e.g. tretinoin or retinoic acid
Some oral contraceptives are helpful in treating acne
Spironolactone – a drug that affects hormone activity can help some women with persistent acne

People with severe acne may be prescribed a powerful oral retinoid, isotretinoin, which works by reducing the skin’s oil secretion. Because of side effects, including birth defects, isotretinoin is only used in close dialogue with your doctor or a dermatologist.

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Other medical treatments and minor procedures that might help your acne include:

Chemical skin peeling
Dermabrasion for removal of scars
Removal or drainage of large cysts or injection of cortisone.

References

Fulton Jr, J. (2013). Acne vulgaris (Web Page). Medscape Reference. New York: WebMD LLC. [Accessed 11/02/14] Oakley A. (2014). Acne Management (Web Page). Hamilton: DermNet New Zealand. [Accessed 11/02/14] O’Toole, M.T. (Ed.) (2013). Acne. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis: Elsevier Mosby. PubMed Health (2012). Acne (Web Page). Bethesda: U.S. National Library of Medicine. [Accessed 11/02/14]

Created: February 2014

Swallowing difficulties (dysphagia)

Causes of swallowing difficulties

Swallowing difficulties can happen at any age. There are a wide range of causes for them, including:

some medicines, such as antipsychotics
heartburn and acid reflux
cancer, such as mouth or throat cancers
nervous system or brain disorders
muscle disorders
blockages or structural issues with your mouth, throat or oesophagus.

Symptoms of swallowing difficulties

Symptoms of swallowing difficulties may include:

coughing or choking when eating or drinking
bringing food back up, may be through your nose
the feeling that food is stuck in your throat
having issues chewing your food
problems with dribbling.

Swallowing difficulties can cause weight loss, dehydration and chest infections.

Diagnosing swallowing difficulties

Let your healthcare provider know if you have swallowing difficulties. They will ask you about your symptoms and check if any other health conditions you have may be the cause.

Your healthcare provider may refer you to a specialist for tests. These may include a:

gastroscopy—a camera is passed down through your mouth to look at your throat and stomach
swallowing study—your throat and stomach are x-rayed as you swallow small amounts of food.

Treating swallowing difficulties

How your swallowing difficulties are treated depends on the cause and how severe it is. Treatments may include:

medicines to treat acid reflux
swallowing therapy with a speech and language therapist
making changes to what you eat and drink, such as softer foods and using thickener in drinks
using special spoons, plates and cups
surgery to widen your oesophagus.
using special medication lubricants eg Gloup to help make it easier to swallow tablets etc. For more information click here.

Self care for swallowing difficulties

As well as seeing your healthcare provider, the following tips may help you to get food or liquids into your stomach.

Sit upright in a chair—at a table is best.
Have regular small meals instead of the main large meals.
Eat or drink small mouthfuls at a time.
If your voice is gurgly when you eat or drink, give a small cough to make sure your airway is clear.
Wet food will be easier to swallow as dry food can catch in your throat.
If your food has 2 consistencies, such as fruit in juice and cereal in milk, try to mix it into 1 consistency, or eat the solid and liquid portions separately.
Concentrate on eating and avoid talking.
Hot, ice-cold or fizzy liquids are easier to swallow than room temperature liquids.
If you are told to have thickened liquids, avoid ice-cream and jelly as they thin before swallowing.
Drink from the top half of you cup to avoid tipping your head back.

Have a look at our range of Gloup medication lubricants here which can help with difficulties swallowing tablets...

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