ACNE VULGARIS

Acne vulgaris is an extraordinarily common disease; the process is centered around the pilosebaceous units of the face, upper back, and chest.

ETIOLOGIC FACTORS IN ACNE:
The primary lesion is termed a comedo and results from the impaction and distention of the follicle with improperly desquamated follicular epithelium.

Another factor in the development of acne is the onset of sebum secretion that follows the puberal surge of androgen levels, which not only further distends the follicle but also provides nutrition for Propionibacterium acnes, an anaerobic diphtheroid that lives within the follicles. Although of very little infectious potential, P.acnes is very inflammatory and in certain individuals provokes a vigorous inflammatory and immune response.
Some patients are predisposed to severe acne because of underlying hormonal abnormality, namely some adult women with therapeutically resistant acne.

COMEDONAL ACNE
The comedo is the primary acne lesion. It may be present as a visible blackhead or whitehead, or exist as microcomedo at the center of an inflammatory lesion.

INFLAMMATORY ACNE
Most patients have a significant number of inflammatory papules in addition to comedones. Some patients have predominantly deep nodules that result in scars.

 

Papulopustular Acne

Nodulocystic acne

CONVENTIONAL TREATMENT:
Comedonal Acne is treated with topical tretinoin (vitamin A) usually in a cream form. The adverse effect expected is mild irritation of the skin to which it is applied. The skin will be somewhat reddish and perhaps have the appearance of being windburned, and patients often complain of an associated dryness.
Inflammatory acne are treated either with topical or systemic antibiotic treatment in addition to the topical tretinoin. Benzoyl peroxide in 2.5% to 10% concentrations is of great value; however, a percentage of the population is severely irritated by this medication.

Patients whose disease is predominantly composed of deep nodules that result in scars or patients who have significant acne that is refractory to oral antibiotic therapy are considered for isotretinoin treatment. Isotretinoin (13-cis-retinoic acid) is a metabolite of vitamin A that has profound effects on the skin. Unfortunately, the great benefits of isotretinoin are balanced by a significant side effect profile. The side effects of all oral retinoids are identical to the effects of vitamin A intoxication. Dryness of the skin and mucous membranes is expected, with the lips, nasal mucosa and conjunctiva most severely affected. Some patients develop thinning of scalp hair. Few patient complain of muscle and joint pain, and a syndrome of diffuse idiopathic skeletal hyperostosis has been reported in a few patients on long term retinoid treatment. The most serious concern regarding oral retinoid treatment is the potential for birth defect. Women of childbearing age must take extreme care to avoid conception while taking the drug.

PhytoCort Acne Gel
The Goal Of The PhytoCort Acne Gel Treatment:
 

PATIENTS INSTRUCTIONS:
Because of the many misconceptions about acne, no discussion of its treatment would be complete without a section on patients' instructions.

• No popping, picking, or emptying of lesions. Manipulation of acne lesions can force inflammatory comedonal contents into the tissue and prolong inflammation and produce scar.
   

• Clean gently (dirt has no role in the acne process). Excessive or vigorous face washing can have the same effect as squeezing pimples and generally results in more severe skin disease.
   

• Minimize but do not eliminate cosmetics.
   

• Finally, diet has no known influence on the acne process.

ACTIVE INGREDIENTS OF PHYTOCORT ACNE GEL
TEA TREE OIL:
Tea tree oil is useful in removing transient skin flora while suppressing but maintaining normal resident flora. (Carson C F. Riley T V. American Journal of Infection Control 24(3). 1996. 186-189).

Terpinen-4-ol, alpha-Terpineol and Alpha-pinene are the active constituents in tea tree oil. They were found to be active against Propionibacterium acnes Staphylococcus aureus, and Staph. Epidermidis. (Raman A. Weir U. Bloomfield S F. Letters in Applied Microbiology 21(4). 1995. 242-245). Studies showed that 32 strains of Propionibacterium acnes are susceptible to the essential oil of Melaleuca alternifolia, tea tree oil. The minimum bactericidal concentration of tea tree oil for five strains was 0.25% or less while, for the remainder, it was 0.50%.(Carson C F. Riley T V. Letters in Applied Microbiology 19 (1). 1994. 24-25). Isolates of Staphylococcus aureus tested were susceptible to the essential oil of Melaleuca alternifolia, Of the isolates tested, 64 were methicillin-resistant S. aureus and 33 were mupirocin-resistant. (Carson C F. Cookson B D. Farrelly H D. Riley T V. Journal of Antimicrobial Chemotherapy 35(3). 1995. 421-424)

The in vitro antifungal activity of tea oil, the essential oil of Melaleuca alternifolia, has been evaluated against 26 strains of various dermatophyte species, 54 yeast, among them 32 strains of Candida albicans and other Candida sp. as well as 22 different Malassezia furfur strains. Tea tree oil was found to be able to inhibit growth of all clinical fungal isolates. (Nenoff P. Haustein U F. Brandt W. Skin Pharmacology 9(6). 1996. 388-394).

Randomised clinical trial has been performed on 124 patients to evaluate the efficacy and skin tolerance of 5% tea-tree oil in the treatment of mild to moderate acne, and compared with 5% benzoyl peroxide lotion. The results of this study showed that both 5% tea-tree oil 5% benzoyl peroxide had a significant effect in ameliorating the patients' acne by reducing the number of inflamed and non-inflamed lesions (open and closed comedones) although the onset of action in the case of tea-tree oil was slower. Encouragingly, fewer side effects were experienced by patients treated with tea-tree oil.(Bassett I B. Pannowitz D L. Barnetson R S C. Medical Journal of Australia 153 (8). 1990. 455-456, 458).

ALOE VERA:
Extracts of Aloe vera gel have anti-inflammatory activity suggested its inhibitory action on the arachidonic acid pathway via cyclooxygenase. (Vazquez B. Avila G. Segura D. Escalante B. Anti-inflammatory activity of extracts from Aloe Vera gel. Journal of Ethnopharmacology 55(1). 1996. 69-75).

It has also been found that Aloe vera contains active polysaccharide fraction that is present in various chain lengths. The polysaccharides consist of several monosaccharides of which mannose is dominant. These polysaccharides were found to have immunomodulatory activity. (T Hart L A. Van Den Berg A J J. Kuis L. Van Dijk H. Labadie R P. Planta Medica 55 (6). 1989. 509-512). A. vera was found to have the same effecte , both orally and topically.( Davis R H. Leitner M G. Russo J M. Byrne M E. Journal of the American Podiatric Medical Association 79 (11). 1989. 559-562).

Aloe vera has the ability to increase the phagocytic activity of blood maccrophage, thus has the potential use as an immunostimulant. (Stuart R W. Lefkowitz D L. Lincoln J A. Howard K. Gelderman M P. Lefkowitz S S. International Journal of Immunopharmacology 19(2). 1997. 75-82).

Aloe vera has the power of restoration of tissue integrity. This is achieved mainly by the synthesis of the connective tissue matrix and increasing its collagen.(Chithra P. Sajithlal G B. Chandrakasan G. Molecular & Cellular Biochemistry 181(1-2). 1998. 71-76).

Aloe vera has been found to have free radical scavenger ability that help in keeping healthy young skin free of disease (Desai K N. Wei H. Lamartiniere C A. Cancer Letters 101(1). 1996. 93-96).

FUMARIA:
Fumaric acid esters reduce the rate of proliferation and thereby decrease the numberof cells per rete peg as well as the size of the individual keratinocytes. The decrease of the number of cells in the rete pegs might be caused by an increased differentiation time. This ability of fumaric acid esters makes it useful for treating nodular acne. (Bacharach Buhles M. Rochling A. Gammal S E. Altmeyer P. Acta Dermato-Venereologica 76(3). 1996. 190-193).
The alkaloid component of fumaria: narlumidine, protopine and protopine-nitrate hav been found to have antifungal activity( Singh U P. Singh K P. Tripathi V K. Pandey V B. International Journal of Tropical Plant Diseases 12(2). 1994. 209-212).

ARNICA:
Four sesquiterpenoids 1-4 were isolated as antimicrobial agents from the dried flowers of Heterotheca inuloides, a Mexican medicinal plant locally known as "arnica". 7-Hydroxy-3,4-dihydrocadalin (3) and 7-hydroxycadalin (4) exhibited potent antibacterial activity against Gram-positive bacteria with minimum inhibitory concentrations (MICs) ranging from 6.25 to 12.5 mu-g/ml. Notably, 7-hydroxy-3,4-dihydrocadalin showed bactericidal activity against methicillin-resistant Staphylococcus aureus (MRSA) with a minimum bactericidal concentration (MBC) of 12.5 mu-g/ml. (Kubo I. Muroi H. Kubo A. Chaudhiri S K. Sanchez Y. Ogura T. Planta Medica 60 (3). 1994. 218-221)
Due to its importance from the pharmaceutical point of view , it has been agreed about the significance of saving the natural stocks of Arnica montana L. and to take action to extend the cultivation.( Ziegler B. Michler B. Arnold C G. Pz (Pharmazeutische Zeitung) Wissenschaft 137 (5). 1992. 198-201).

ROSE HIP:
It contains high level of vitamin C ( 8.40 mg/100ml). (Veturia Ileana N. Bogdan I Buletinul Institutului Agronomic Cluj-Napoca Seria Zootehnie Si Medicina Veterinara 46 1992. 169-175). Vitamin C helps skin healing by giving strength to blood vessels and enhancing the skin circulation, It is required for the synthesis of collagen, the intercellular "cement" which holds tissues together. It is also one of the major antioxidant nutrients.

VITAMIN A (Beta Carotene):
It is necessary for growth & repair of body tissues; helps maintain smooth, soft disease-free skin.

VITAMIN E:
It is a major anti-oxidant nutrient. It retards cellular aging due to oxidation. 
It is D-Alpha Tocopherol (100% Natural) and is 4 times more potent in biological activity than d1-Alpha Tocopherol (Synthetic) Vitamin E. Natural Vitamin E is derived from soybeans and synthetic Vitamin E is a petroleum by-product.

TOXICITY PRECAUTIONS
PhytoCort Acne Gel being 100% natural is completely safe. To exclude very rare cases of hypersensetivity, very small amount of the gel should be applied to the frontal surface of the forearm before starting the treatment with the gel, and observe the appearance of any skin reaction in the form of local redness or itching.

APPLICATION
It should be applied 3-5 times daily to the affected area of the skin.
The best result is obtained when it is combined with the nutritional capsule for troubled skin.