When should you start to treat acne?

Since everyone gets acne at some time, the right time to treat it is when it bothers you. This can be when severe acne flares suddenly, mild acne that just won't go away, or even when a single pimple decides to show up the week before your prom or wedding. The decision is yours.

What other skin conditions can mimic acne?

• Rosacea: This condition is characterized by pimples in the middle third of the face, along with redness, flushing, and superficial blood vessels. It generally affects people in their 30s and 40s and older. There is sometimes no "bright line" separating acne from rosacea; however, there are no blackheads or whiteheads in rosacea.



• Pseudofolliculitis: This is sometimes called "razor bumps" or "razor rash." When cut close to the skin, curly neck hairs bend under the skin and produce pimples. This is a mechanical problem, not a bacterial one, and treatment involves shaving less (growing a beard, laser hair removal.) Pseudofolliculitis can, of course, occur in patients who have acne too.



• Folliculitis: Pimples can occur on other parts of the body, such as the abdomen, buttocks, or legs. These represent not acne but inflamed follicles. If these don't go away on their own, doctors can prescribe oral or external antibiotics, generally not the same ones used for acne.



• Gram-negative folliculitis: Some patients who have been treated with oral antibiotics for long periods develop pustules filled with bacteria resistant to the antibiotics which have previously been used. Bacterial culture tests can identify these germs, leading the doctor to prescribe different antibiotics or other forms of treatment.

What causes acne?

No one factor causes acne. Acne happens when oil (sebaceous) glands come to life around puberty, stimulated by male hormones from the adrenal glands of both boys and girls. Sebum (oil) is a natural substance which lubricates and protects the skin, and under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria (which live on everyone's skin and generally cause no problems) to multiply and cause surrounding tissues to become inflamed.

Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt, and do not reflect poor hygiene.

Here are some factors that don't usually cause acne, at least by themselves:

• Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.



• Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and dairy products in aggravating acne, these findings are far from established.



• Dirt: As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.



• Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.



• Hormones: Some women break out cyclically, but most women (and men) don't. Some oral contraceptive pills may help relieve acne, but unless a woman has abnormal menstrual periods and excessive hair growth, it's unlikely that hormones play much of a role in causing acne. Pregnancy has a variable effect on acne; some women report that they clear up completely, and others get worse, while many others see no overall change.



• Cosmetics: Most cosmetic and skin-care products are not pore-clogging ("comedogenic"). Of the many available brands, those which are listed as "water-based" or "oil-free" are generally a better choice.

In occasional patients, the following may be contributing factors:

• Pressure: In some patients, pressure from helmets, chinstraps, collars, suspenders, and the like can aggravate acne.



• Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium, which is used to treat bipolar disorder. Most cases of acne, however, are not drug-related.

What is acne? What are the different types of acne?

Acne (acne vulgaris, common acne) is not just a problem for teenagers; it can affect people from ages 10 through 40. It is not unusual for women, in particular, to develop acne in their mid- to late-20s, even if they have not had breakouts in years (or ever). On the positive side, those few individuals who have acne into their 40s may well grow out of it. Acne can appear on the skin as any of the following:

1. congested pores ("comedones"),
2. whiteheads,
3. blackheads,
4. pimples ("zits"),
5. pustules, or
6. cysts (deep pimples, boils). The pus in pustules and cysts is sterile and does not actually contain infectious bacteria.

These blemishes occur wherever there are many oil (sebaceous) glands, mainly on the face, chest, and back.

You can do a lot to treat your acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, you should consult a physician for treatment options.

Clopidogrel

Clopidogrel is an oral antiplatelet agent (thienopyridine class) to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. It is marketed by Bristol-Myers Squibb and Sanofi-Aventis under the trade name Plavix, by Sun Pharmaceuticals under the trade name Clopilet, by Ranbaxy Laboratories under the trade name Ceruvin. It works by irreversibly inhibiting a receptor called P2Y12. Adverse effects include hemorrhage.

Clinical use

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Indications

Clopidogrel is indicated for:[2]
Prevention of vascular ischaemic events in patients with symptomatic atherosclerosis
Acute coronary syndrome without ST-segment elevation (NSTEMI),
ST elevation MI (STEMI)

It is also used, along with aspirin, for the prevention of thrombosis after placement of intracoronary stent. [2]

International guidelines granted the highest grade of recommendation for NSTE-ACS, PCI and stent,[clarification needed] for Clopidogrel in addition to Aspirin. Consensus-based therapeutic guidelines recommend also the use of clopidogrel, instead of aspirin, in patients requiring antiplatelet therapy but with a history of gastric ulceration, as inhibition of the synthesis of prostaglandins by aspirin (acetylsalicylic acid) can exacerbate this condition. A study has shown that in patients with healed aspirin-induced ulcers, however, patients receiving aspirin plus the proton pump inhibitor esomeprazole had a lower incidence of recurrent ulcer bleeding than patients receiving clopidogrel. [3] However, a more recent study suggested that prophylaxis with proton pump inhibitors along with clopidogrel following acute coronary syndrome may increase adverse outcomes, possibly due to inhibition of CYP2C19 which is required for activation of clopidogrel, itself a pro-drug.[4]

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Dosage forms

Clopidogrel is marketed as clopidogrel bisulfate (clopidogrel hydrogen sulfate), most commonly under the trade names Plavix, as 75 mg oral tablets.

Atorvastatin

Atorvastatin (INN) (pronounced /əˌtɔrvəˈstætən/) (Lipitor, Pfizer), is a member of the drug class known as statins, used for lowering blood cholesterol. It also stabilizes plaque and prevents strokes through anti-inflammatory and other mechanisms.

Atorvastatin inhibits HMG-CoA reductase, the rate-determining enzyme located in hepatic tissue that produces mevalonate, a small molecule used in the synthesis of cholesterol and other mevalonate derivatives. This lowers the amount of cholesterol produced which in turn lowers the total amount of LDL cholesterol. Atorvastatin was first synthesized in 1985 by Bruce Roth while working at Parke-Davis Warner-Lambert Company (now Pfizer). With 2008 sales of US$12.4 billion, Lipitor is likely the top-selling drug in the world.[1] US patent protection is scheduled to expire in June 2011.[2] However, Pfizer made an agreement with Ranbaxy Laboratories to delay the generic launch in the US until November 2011.[1]

Lipitor is not the only statin; there are several other statins on the market.[3][4]

Contraindications
Active liver disease: cholestasis, hepatic encephalopathy, hepatitis, and jaundice.
Unexplained elevations in AST or ALT levels
Pregnancy.
Breast-feeding.

Fluvastatin

Fluvastatin (Lescol, Canef, Vastin) is a member of the drug class of statins, used to treat hypercholesterolemia and to prevent cardiovascular disease. It has also been shown to exhibit antiviral activity against Hepatitis C.[1]