Acne-Risk factors

Hormonal changes in your body can provoke or aggravate acne. Such changes are common in:

• Teenagers, both boys and girls
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• Women and girls, two to seven days before their periods
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• Pregnant women
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• People using certain medications, including cortisone

Other risk factors include:

• Exposing your skin directly to greasy or oily substances, or to certain cosmetics.
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• Having a family history of acne. If your parents had acne, you may be likely to develop it too.
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• Friction or pressure on your skin caused by items such as telephones or cell phones, helmets, tight collars and backpacks.

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ACNE-Myth Breaker

• Myth:Washing your face more often will help clear up acne
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• Reality:Facial blemishes are not caused by dirt. Contrary to what you may have seen in commercials, pores do not get blocked from the top down due to "impurities". Rather, the walls of a pore stick together within the skin, starting acne formation. Far from preventing acne, frequent washing may actually irritate pores and cause them to become clogged. A washcloth can add even more irritation. The best bet is to wash very gently with bare hands, and only wash twice a day.
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• Myth:Stress causes acne
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• Reality:Stress may have an effect on hormones and theoretically can promote acne. However, an effective acne treatment regimen is more powerful than a bout of stress any day. Some psychiatric medications may have acne as a side effect, but stress itself is no big deal. Your time is better spent determining the right course of acne treatment rather than feeling guilt about stress.
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• Myth:Masturbation or sex causes acne
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• Reality:This antiquated notion, originating as early as the 17th century to dissuade young people from having premarital sex, is just plain wrong. Don't believe the hype.
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• Myth:The sun will help get rid of acne
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• Reality:The sun may work in the short-term to hasten the clearing of existing acne while reddening your skin, thus blending your skin tone with red acne marks. However, a sun burn is actually skin damage. Sun exposure causes irritation which can make acne worse. People will often notice their skin breaking out as it heals from sun damage. The sun is a short-term band-aid which will often bite back with more acne in the weeks following exposure. Having said that, I don't want to give the impression that the sun is evil. It is not. We get our vitamin D from the sun for instance. Limiting sun exposure on acne prone areas of your body is most likely prudent, but some exposure from time to time is not only unavoidable, but is perfectly okay.
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• Myth:Diet and acne are related
  
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• Reality:The bottom line is we need more research. We do know that people in some indigenous societies do not experience acne whatsoever across the entire population. This is in stark contrast to the widespread presence of acne throughout all modern society. It leaves us to ponder the question of whether the indigenous people's diet contributes to their acne-free skin. Discovering a dietary way of preventing acne may be a future reality, however, we may live so differently from our hunter/gatherer ancestors that it has become close to impossible to replicate our ancestral diet. But, let's see if we can work together to come to some concensus from our own experiences.

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Non-inflammatory acne

Microcomedones become non-inflamed skin blemishes called comedones--either a whitehead or a blackhead:

WhiteheadWhen the trapped sebum and bacteria stay below the skin surface, a whitehead is formed. Whiteheads may show up as tiny white spots, or they may be so small that they are invisible to the naked eye.

BlackheadA blackhead occurs when the trapped sebum and bacteria partially open to the surface and turn black due to melanin, the skin's pigment. It is not dirt and can not be washed away. Blackheads can last for a long time because the contents very slowly drain to the surface
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A blackhead or whitehead can release its contents to the surface and heal. Or, the follicle wall can rupture and inflammatory acne can ensue (see below). This rupture can be caused by random occurence or by picking or touching the skin. This is why it is important to leave acne prone skin relatively untouched.

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Acne-a normal follicle

A normal follicle looks like this:

For reasons no one completely understands, follicles, often called pores, sometimes get blocked. Sebum (oil) which normally drains to the surface gets blocked and bacteria begins to grow. Both whiteheads and blackheads start out as a microcomedone. The picture below is a microcomedone:

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Primary Pulmonary Hypertension-Treatment

What therapy is available for patients with primary pulmonary hypertension?
Doctors can choose from a variety of drugs that help lower blood pressure in the lungs and improve heart performance in many patients.

Physicians now know that patients with PPH respond differently to the different medications that dilate or relax blood vessels and that no one drug is consistently effective in all patients.

Because individual reactions vary, different drugs have to be tried before chronic or long-term treatment begins.

During the course of the disease, the amount and type of medicine also may have to be changed.

To find out which medicine works best for a particular patient, doctors evaluate the drugs during cardiac catheterization.

• At present, about one-quarter of patients can be treated with calcium channel-blocking drugs given orally.
• Intravenous prostacyclin is a vasodilator. It helps patients who don't respond to treatment with calcium channel blockers given by mouth. It's continuously delivered by a portable, battery-operated infusion pump. Despite this complexity, prostacyclin improves pulmonary hypertension and permits increased physical activity. This improves the quality of life for patients of all ages. Prostacyclin is sometimes used as a bridge to help patients waiting for a transplant. In other cases it's used for long-term treatment.

Besides oral calcium channel blockers and chronic intravenous prostacyclin, clinical trials are under way to evaluate new drugs to improve the treatment of PPH.
Some patients also do well by taking medicines that make the right ventricle's work easier.

• Anticoagulants, for example, can decrease the tendency of the blood to clot, thus permitting the blood to flow more freely.
• Diuretics reduce the amount of fluid in the body, further reducing the amount of work the heart has to do.
• Some patients also require supplemental oxygen delivered through nasal prongs or a mask if breathing becomes difficult. Some need oxygen around the clock.

Transplantation (heart-lung or lung) is reserved for patients who don't respond to medical therapy. The decision whether a patient requires heart-lung transplantation or lung transplantation is made after a thorough evaluation at a lung transplantation center.


What are the long-term prospects for patients with primary pulmonary hypertension?
Despite the complexity of some of the various medical therapies, accurate, early diagnosis and initiation of treatment have saved the lives of many patients with PPH.

With optimal medical and/or surgical therapy, patients can often return to a virtually normal lifestyle, including running a household, returning to school and participating in many physical activities.
Most doctors and patients agree that it's very important for both patients and families to be as informed as possible.

This lets everyone understand the illness and apply the information to what is happening. In addition to family and close friends, support groups can help PPH patients.

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Primary Pulmonary Hypertension-causes & symptoms

What causes primary pulmonary hypertension?
We don't know the cause; there may be one or more causes.

The low incidence makes learning more about the disease extremely difficult.

Studies of PPH also have been difficult because a good animal model of the disease hasn't been available.

We think that in most people who develop primary pulmonary hypertension, the blood vessels are very sensitive to certain factors that trigger this disease to develop.

• For example, people with Raynaud's syndrome seem more likely than others to develop PPH.
• In addition, appetite suppressants, cocaine and HIV are some factors believed to trigger the constriction, or narrowing, of the pulmonary artery.

What are the symptoms of primary pulmonary hypertension?

• The first symptom is often fatigue or tiredness. Many patients think that they're simply "out of shape."
• Difficulty in breathing, dizziness and even fainting spells can occur.
• Swelling in the ankles or legs, bluish discoloration of the lips and skin, and chest pain more often occur later in the disease.

One of the great difficulties in treating PPH is that the diagnosis is often delayed due to the slowly progressive and insidious onset of the symptoms.


How is a patient with primary pulmonary hypertension evaluated?
Significant advances in PPH therapy over the past decade have markedly affected the survival and quality of life for people with this disease.
The optimal medical and/or surgical treatment for patients with PPH depends upon a thorough evaluation at a medical center with expertise in pulmonary hypertension.
The evaluation includes a right heart cardiac catheterization.

In this procedure the doctor places a thin, flexible tube (a catheter) through an artery or vein in the patient's arm, leg or neck, then threads it into the right ventricle and pulmonary artery.

This is the only way to measure the pressure in the pulmonary artery and find out what medical therapy is appropriate for a given patient.

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Primary or Unexplained Pulmonary Hypertension

AHA Recommendation
There is extremely wide variability in the severity of pulmonary hypertension among various patients.

Evaluating, accurately diagnosing and treating the condition is also very complex.

For these reasons, patients with symptoms that suggest pulmonary hypertension require thorough evaluation at a medical center with expertise and experience in pulmonary hypertension.


What is primary pulmonary hypertension (or unexplained pulmonary hypertension)?
Primary or unexplained pulmonary hypertension (PPH) is a rare lung disorder in which the blood pressure in the pulmonary artery rises far above normal levels for no apparent reason.

The pulmonary artery is a blood vessel carrying oxygen-poor blood from the right ventricle (one of the heart's pumping chambers) to the lungs.

In the lungs, the blood picks up oxygen, then flows to the heart's left side, where the left ventricle pumps it to the rest of the body through the aorta.
Hypertension is a medical term for abnormally high blood pressure. Normal average (also called "mean") pulmonary artery pressure is about 14 mm Hg at rest.
In patients with PPH, the average blood pressure in the pulmonary artery is greater than 25 mm Hg at rest and greater than 30 mm Hg during exercise.

This abnormally high pressure (pulmonary hypertension) is linked with changes in the small blood vessels in the lungs.

These changes increase resistance to blood flowing through the vessels.

This increased resistance puts a strain on the right ventricle, which now must work harder than usual to move enough blood through the lungs.

• In the United States, an estimated 500 to 1,000 new cases of primary pulmonary hypertension are diagnosed each year.
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• The greatest number is reported in women between ages 20 and 40. However, men and women in all age ranges — as well as very young children — can develop PPH.

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