Well, almost each and everyone has some other the time in their adolescentsuffered from acne vulgaris, commonly called pimples. What is acne exactly? Ourskin especially, over the face has a structure called as the pilo-sebaceousunit [skin structures consisting of a hair follicle and its associatedsebaceous gland]. It contains the hair follicle and the sebum gland along withits duct. Now, the function of sebum gland is to secrete sebum which then getsexpressed on the skin surface. It has got some antibacterial property. Sebum isoily in consistency and if there is increased expression of sebum then it mightblock the opening of the pilo-sebaceous duct. Due to this there is no drainagefrom the duct and this leads to the development of comedones. They areinitially white, also called as white comedones and later they form blackcomedones. These comedones eventually lead to the formation of pimples. Themost common site is the face though you do get them on the neck, back andchest. Usually associated with dandruff/seborrhic dermatitis but then dandruffis not a causative factor, at least that's what the doctors have to say till date.People with oily skin are more prone to get acne. Other causes are: - familyhistory - Hormonal activity like menstruation or puberty which is associatedwith increased levels of hormones. - Stress - Improper diet - Hyperactivity ofsebum gland - Bacteria [Propionibacterium acnes (P. acnes) is the anaerobicbacterium that causes acne] - Use of anabolic steroids

Why is acne so dreaded? Well the worst part about the acne is that theyoften leave behind a scar which is very much detested. These scars are morecommonly known as blemishes. Adolescent age group is socially very vulnerableand so this [Acne] can be a cause of depression amongst them with a fewdocumented proofs of suicide.

However acne is usually self limiting disease and shouldn't be troublesomeafter one crosses 25 years of age.

It has been documented that newly diagnosed acne patients have low levels ofvitamin A in their blood. There is an also decreased level of vitamin E So howdo we tackle acne? This can be done in the following ways: ? normalizingshedding into the pore to prevent blockage ? killing P. acnes ?anti-inflammatory effects ? hormonal manipulation Though the exact mode ofaction of is not known, recent studies suggest that topicalRetin-A decreases cohesiveness of follicular epithelial cells with decreasedmicrocomedo formation. Also, tretinoin stimulates mitotic activity andincreased turnover of follicular epithelial cells causing extrusion of thecomedones. Retin-A brings acne plugs (blockages) to the surface causingblackheads to be dislocated. The blackheads are then discarded from the skinduring cleansing. Retin-A can help control acne breakouts as well.

Indication: - acne vulgaris - wrinkle removal/anti-ageing - Hyperpigmentation. - Poor Skin Texture: from Retin-A removes dead cells increasingthe exfoliation process and thereby stimulating new skin cells to improve thetexture of the skin. - Preparation of skin for procedures like laser skinresurfacing and facial surgeries

Dosage:

Acne vulgaris: 0.1% cream Wrinkle removal: 0.05% cream

Application: Acne vulgaris: is to be applied once dailyover the affected areas in the evening, after washing with a mild alcohol-freefacial cleanser. Pat the face drybefore smoothing the Retin-A [Tretinoin] cream or gel on the skin. Liquid: Theliquid is to be applied using a fingertip, cotton swab or a gauze pad. In casea gauze or cotton is being used then care should be taken not to over saturateit, so as to avoid the liquid to run into areas where treatment is notintended. There may be a transient feeling of irritation or warmth on the areaof application. If the irritation becomes unbearable then discontinue theproduct and seek your physician. However there might be an unexpected apparentexacerbation of irritation during the early weeks of therapy and might be mostprobably due to the potency of the drug or some undetected acne lesion. Askyour physician/doctor to demonstrate on how to apply Retin-A. The doctor willalso recommend a daily skincare regimen to reduce the risk of complications andenhance results to guard against increased photosensitivity; you are advised touse sunscreen every morning and throughout the day. Use it for at least 6-7weeks. Once the lesions start responding to Retin-A, the progress can bemaintained by lesser applications. Wrinkle removal: Apply sparingly to theskin's surface until it has been completely absorbed, avoiding the eyes,initially use it 5 times a week, and after that use it for about 3 times aweek. Contra-indications: - acute eczema rosacea - cuts - abrasions - acutedermatitis - Eyes, nose, mouth, mucus membrane. In short, the product should bediscontinued in case the patient has hypersensitivity to any of itsingredients. Warning: Gels are flammable and one should avoid fire, flame orsmoking during its use. Keep out of reach of children. Keep tube tightlyclosed. Do not expose to heat or store at temperatures above 49'C. Specialprecautions: - Pregnancy: Pregnancy Category C. Teratogenic effects. -Lactation: It is not known whether this drug is excreted in human milk. Hencebetter use precaution while using this drug. - Pediatric age group: Noconclusive evidence of any safety effectiveness or side effect of Retin-A onchildren. Hence it is better avoided. - Geriatric age group: Safety andeffectiveness in a geriatric population have not been established. - Avoidconcomitant therapy with conventional acne, medical or cosmetic products. -Avoid excess exposure to wind or cold since this may irritate the skin whileusing this medication. - While on Retin-A, use soft soaps and avoid frequentwashing and hard scrubbing of the skin since dirt plays a very insignificantrole in acne formation.