Health Watch

Acne - In and out

This detailed article on Acne by Senior Registrar Dermatology Unit NHC Dr. Sharnika Abeykirthi answers many questions on Acne sent to us by our readers in the course of last month and earlier.

Acne (or pimples) is an inflammatory disease of the pilosebacious unit. This unit consist of the sebum or oil secreting gland and a hair follicle. Acne is an extremely common condition affecting almost 80% of adolescents and young adults. It usually starts in adolescence and frequently resolves by mid twenties. Acne develops earlier in girls than boys.

A peak in severity occurs between 14-17 yrs in girls and 16-19 yrs in boys. Thereafter the acne resolves slowly. Although most people are free of acne in their late twenties there are few unfortunate ones. At the age of 40 yrs significant lesions are still present in 1% of males and 5% of females.

What causes acne?

There are 4 main factors contributing to the formation of acne.

1) Increased sebum production

In patients with acne, the sebum producing glands are larger and more responsive to different stimuli than the normal people. Hence these people produce more sebum than others.

2) Abnormal proliferation and shedding of cells at the opening of the pilosebaceous gland. (The unit which comprises the hair follicle and the sebaceous gland)

Because of this, the follicular opening is blocked and various substances accumulate within the gland and form a microcomedone.

Later these microcomedones turn into closed and open comedones which are also known as white heads and black heads respectively.

These comedones are the ones that later become acne.

3)Bacterial proliferation

A bacteria called Propionibacterium acne plays a role in formation of acne. But it is important to remember that acne is not infectious.

4)Inflammatory mediators

Acne act on the various substances within the blocked follicle and produce inflammatory mediators. The follicles rupture and these mediators are released causing acne.What other factors influence the formation of acne?

Genetic factors

This means that the tendency for you to get acne is influenced by, whether one or both of your parents have acne or not, not only that, the severity of acne, their distribution, scarring, response to treatment and the age at which their acne resolved could all be genetically determined. So if you have a parent who had severe scarring acne which persisted even at forty you should be extra cautious about your own acne.

Hormones

Androgen is the main hormone that causes acne. Increased androgens causes increased sebum secretion which lead to the formation of comedones and thereby cause acne. In addition, growth hormones and progesterone can also exacerbate acne.

Premenstrual flare

About 70% of women complain of a flare of their acne 2-7 days before their periods. This is partly due to the effect of hormones. On the other hand, due to the fluid retention during this time, the follicles get blocked and cause exacerbation of acne.

Sweating

Acne can get worse during periods of excessive sweating. This is especially seen in people who live or work in hot humid environments.

Occupation

Certain occupations are linked with formation of acne. Eg. Cooks can get acne due to working in hot environment. People dealing with oil can develop a special form of acne.

Smoking

There are certain studies that have shown relationship between acne and the number of cigarettes you smoke daily.

Drugs

Certain drugs can aggravate acne. These include steroids, androgens, certain contraceptive pills, antiepileptic drugs, iodides, lithium etc.

What about diet?

It is very common to hear that certain foods like chocolates, fatty foods are blamed for exacerbating acne. But scientific proof for this is lacking. There are some trials that have shown that Western civilization food habits give a high blood glucose index which triggers your insulin secretion and thereby influence androgen secretion.

This in turn can cause acne. The best advice you can give an acne patient is, that can eat anything they want in moderate amounts. "Eat sensibly", contain all the advice that should be given.

How does acne present?

Acne can present itself in a in number of different ways. The initial presentation is with multiple comedones (what we commonly call white heads and black heads) These lesions become inflamed and cause papules, pustules and in some people nodules. Nodules are common in males. Acne not only affects your face, but chest, back and upper arms as well.

(More on Acne next week)

131 AIDS deaths in Sri Lanka

According to the National STD / AIDS control programme of the Health Department a total of 131 people had died of AIDS in Sri Lanka up to 2004.

This is revealed in a report published by the Research and Publication Unit of the National Dangerous Drugs Control Board on drug abuse information.

According to this report in the section on HIV / AIDS related information, the reported AIDS cases in Sri Lanka by gender in the years 2003 and 2004 were 2003 - males 114 females 47 and 2004 - males 130 and females 49. The HIV cases reported in this period were 2003 - males 309 and females 214 and in 2004 - males 363 and females 251.

How much activity does a child need?

A healthy level of physical activity requires regular participation in activities that increase energy expenditure above resting levels. An active child should participate in physical education classes, play sports, perform regular household activities, spend recreational time outdoors and regularly travel by foot or bicycle.

Physical activity need not be strenuous to be beneficial. Healthy children, when in an environment conducive to physical activity, will be active.

Emphasis should be placed on play (rather than exercise) and on activities that the child enjoys, that are consistent with the child's skill level. Participation in games should be promoted for enjoyment and for health reasons, not for gaining honours.

What are the general guidelines for healthy physical activity?

. Regular walking, cycling and outdoor play; use of playgrounds; and interaction with other people.

. Weekly participation in age-appropriate organised sports lessons at schools.

. Daily school physical education that includes at least 20 minutes of co-ordinated large-muscle exercise.

. Opportunities for physical activity that are fun, increase confidence in participating in physical activity and involve co-operation with friends and peers.

. Positive role modelling for a physically active lifestyle by parents, other caretakers and school personnel. Physical activity is important for all people. Physical activity may be particularly helpful for children and adults with a weight problem in relation to both their physical and psychological well-being.

(Reference: Food Based Dietary Guidelines for Sri Lankans, prepared by Dr. Renuka Jayatissa and Prof. Sunethra Athukorale)

Contact lenses at cost price for eye affected average diabetic patients

Dr. Mahen Wijesuriya, President Diabetic Association of Sri Lanka speaking at the Health Quest No. 3 programme on Diabetic Eye, said that he would explore the possibility of getting good quality contact lenses for the eye-affected average diabetic patients at cost price.

He came out with this idea when Dr. Dhushayantha Wariyapola, Consultant Ophthalmologist, Sri Jayawardenapura General Hospital, main speaker at the programme speaking on Diabetic retinopathy said most of these patients whose retina is seriously affected needed intra-ocular or contact lenses to restore vision. Although there are cheap lenses in the market he always recommended patients to go in for fair quality lenses at least, for better eye health and vision.

Then the question came up if a patient could not afford to pay for those lenses what would happen?

Dr. Viraj Peramuna, a member of the HealthWatch Medical Authority Panel who was present related a personal experience he had encountered recently when he distributed some contact lenses the Lions Club of Pamunugama had received as a donation from abroad for some patients.

Several of them came back to him and complained that an eye surgeon in a Government Hospital where they went to get the lenses put in refused to carry out the operation on the ground that the lenses were of poor quality.

It was at this stage that Dr. Wijesuriya intervened to find out whether it would be possible for NGOs like the Diabetic Association to get down good quality lenses and give them at cost to patients.

He said the Diabetic Association was doing this now with regard to insulin. Patients are being given this at cost making no profit at all. Thus helping the average patient to cut down on medical expenses.

Some of those present in the audience, while commending Dr. Wijesuriya for coming out with this idea, said that they doubted very much whether it was workable because all these lenses had their Agents in the country and the manufacturers would not like to bypass them and offer lenses to any NGOs to be sold at no-profit basis. Dr. Wijesuriya however said he would still look into the possibility.

Dr. Wariyapola explaining in detail how diabetes affects the retina said that it is always best for diabetic patients to get annual check-ups done which will enable to make early diagnosis of eye retinopathy, thus making possible early treatment avoiding serious complications later on leading even to blindness.

A detailed article on Retinopathy will be carried shortly. The programme was sponsored by Philo Biotics, Vidya Mawatha, Colombo.

Vitamin C and diabetes mellitus

Free radicals are implicated in pathogenic tissue damage in diabetes, which is responsible for many adverse reactions such as non-enzymic glycosylation of proteins.

Vitamin C being the principal modulator of free radicals is postulated to alleviate these effects.

Studies among animal models in which diabetes has been induced have shown that Vitamin C supplementation decreases cataract formation, prevent hyperlipidaemia (high lipid content of blood), and an improvement in myocardial (heart muscle) performance. The mechanisms are not fully understood.

Health Question Box

Boiled paddy and unboiled paddy red rice - Is there a difference?

C. S. Perera from Biyagama, Kelaniya writes:

Sometime back Health Authorities advised us to consume rice obtained from boiled paddy as boiling fixes the bran on to the rice grain. In the diabetic clinics, patients are advised to take i.e. raw rice obtained from unboiled paddy. Is there a difference between these two kinds of rice for diabetic patients? Please direct this to a doctor cum dietician.

Dr. Renuka Jayatissa Consultant Nutritionist MRI, Colombo replies:

No difference.

There is hardly any difference at all except that in the boiled paddy, the bran gets stuck to the seed and the nutritional value retains a little more than in the unboiled paddy red rice, because in the process of pounding or milling in the unboiled paddy, the bran gets removed to some extent.

Those who eat highly polished rice should eat more vegetables to compensate for the loss of bran and the vitamins, for better health.

She also advices those who lead sedentary life styles to eat less rice for better health.

New hope for end-staged liver diseased patients

From Singapore comes the news that the difficulties encountered in getting cadaveric donors for liver transplanting in end-stage liver patients has never been overcome with two new programmes of living donor liver transplantations that have successfully been carried out Gleneagles Hospital, Singapore.

Liver Transplant Surgeon of Gleneagles Hospital Dr. Tan Kai-Chan writing to the HealthWatch states:

For patients with end-stage liver disease, liver transplantation can be a lifesaving treatment and offers them a new lease of life.

Many patients die before cadaveric donor is found due to shortage of donors. In Asia, due to the increasing incidence of liver disease, Gleneagles Hospital launched the Living Donor Liver Transplant Programme (LDLT) in April 2002 in Singapore.

Gleneagles is a leading private Hospital and is the only Hospital to be allowed to perform this highly complex LDLT procedure. During LDLT, the operation on the donor and recipient are started simultaneously. After operation, the recipient will be closely monitored for infection, rejection and regeneration of the transplanted liver.

Some common diseases where transplantation may be considered include:

- Chronic Hepatitis B/C Cirrhosis

- Primary Biliary Cirrhosis

- Primary Sclerosing Cholangitis

- Carloli's Syndrome

- Hepatocellular Carcinoma

- Wilson's Disease

- Fulminant Liver Failure

Donor criteria:

- Age between 18 and 60

- Parents/siblings/spouse or any other first or second-degree relatives or close friends.

- No evidence of significant cardiopulmonary, renal or neurological disease.

- No evidence of liver disease.

- Compatible blood types.

- Normal Haematological and serum chemistry. Normal liver and kidney function, Normal ECG and CXR.

- No history of Diabetes Mellitus.

- No history of severe or uncontrolled hypertension.

- No history of Deep Vein Thromboses or Pulmonary Embolism.

- No history of bleeding tendencies.

- Serologically negative for Hepatitis B, C and HIV.

- Demonstration of adequate liver volume on CT volumetric scans.

- Arteriographic documentation of satisfactory arterial supply for the anticipated graft.

- Successful completion of a psychiatric assessment.

The team of experts shall review these criteria.

The purpose of the donors evaluation process is to minimize the risk.

The donor may be commenced on iron medication and injected with Epogen, a red blood cell stimulant. The donor is nursed in ICU for 24 hours after operation. He will be hospitalised for 6 to 8 days. After one month, he may resume light work. He will be prescribed vitamins for the next few months.

The recipient will be hospitalized for 3 to 4 weeks, first in ICU and then in surgical ward. He will be closely monitored for infection, rejection and regeneration of the transplanted liver.

Medications: Immunosuppressive medications are given to the patient to prevent rejection and antibiotics to prevent infection. Most patients will be maintained on a primary immunosuppressive agent, either Tacrolimus (Prograf) or Cyclosporin (Neural). One of these agents is generally taken for life following a transplant.

Patients usually require a higher dose of these agents immediately following their transplant because rejection more commonly occurs in the first three months. In time, the dose is lowered but life long therapy is necessary.

Health Letter Box

Diyawanna Walkers' Club

We had this letter from the Diyawanna Walkers' Club.

Request for information on the benefits and advantages of regular walking

We are an organisation recently inaugurated and one of our main objectives is to educate our members on the benefits of walking by providing information through articles and lectures.

Therefore we shall be most grateful if you could kindly assist us by providing information/articles on the 'Benefits and advantages of regular walking' which could be shared with our membership.

It would be further appreciated if you could kindly let us know the names and telephone numbers of a few 'Doctors of Sports Medicine' as well, whom we could contact, so that we could request such doctor to deliver a lecture to our members of the 'Benefits and advantages of regular walking'.

- Diyawanna Walkers' Club

Any doctors in this speciality interested in helping them, please get in touch with Nalake Weeraman, President of the Club on 2889412.

Compiled and coordinated by Edward Arambewala