Acne: Causes and practical management -- Copyright -- Contents -- Preface -- Practical acne therapy -- Genetics -- Diet -- Hormones -- Stress -- Comedones (plugs in pores) -- Blemishes-a brief catalogue -- Nodules -- Scars and sinuses -- Support -- Introduction -- Nomenclature -- The three acnes and grading -- Acne vulgaris -- Acne rosacea -- Acne inversa (hidradenitis suppurativa) -- Grading the three acnes -- Acne vulgaris -- Acne rosacea -- Acne inversa (hidradenitis suppurativa) -- References -- Chapter 1 The three acnes and their impact -- 1.1 Acne vulgaris -- 1.1.1 Terminology -- 1.1.2 The starting point -- 1.2 Acne rosacea -- 1.2.1 The "pimply" part -- 1.2.2 The "redness" part -- 1.2.3 The third part, the firm fibrosis -- 1.2.4 Part four-ocular rosacea -- 1.2.5 Putting it all together -- 1.2.6 The inflammatory epiphenomena in acne rosacea -- 1.2.7 The "acne rosacea" versus "rosacea" controversy -- 1.2.8 Summary -- 1.3 Acne inversa (formerly hidradenitis suppurativa) -- 1.3.1 Before the rupture, where and why? -- 1.3.2 After the rupture, what next? -- 1.3.3 So what invaders are important in acne inversa? -- 1.3.4 What makes this disease behave so much worse than acne vulgaris? -- 1.3.5 So what can one possibly do to settle down all this inflammation? -- 1.3.6 So how do you get rid of all this material? -- 1.3.7 What does the future offer? -- 1.4 The psychology of acne -- 1.4.1 Acne as a stress -- 1.4.2 Acne and self-image -- 1.4.3 Isotretinoin therapy and the psyche -- 1.4.4 The isotretinoin-depression question -- 1.4.5 Isotretinoin in perspective -- References -- Chapter 2 The folliculopilosebaceous unit-the normal FPSU -- 2.1 Anatomy -- 2.2 Genetics -- 2.2.1 Acne vulgaris -- 2.2.2 Acne rosacea -- 2.2.3 Acne inversa/hidradenitis suppurativa (AI/HS) -- 2.2.4 The scottish twins -- 2.3 Epigenetics -- 2.3.1 The farmer's boys -- 2.4 Embryology.

2.5 Histology -- 2.5.1 Onwards and downwards -- 2.5.2 What is going on inside the FPSU? -- 2.6 Physiology -- 2.6.1 Hair first -- 2.6.2 Oil second -- 2.6.3 Last but definitely not least: the follicle -- 2.6.4 Looking deeper -- 2.7 Biochemistry -- 2.8 Hormones, enzymes, receptors, and the intracrine system -- Patient Tip Box -- 2.8.1 The intracrine system -- 2.9 FoxO1 and mTORC1 -- 2.9.1 The next step -- 2.9.2 The broad view -- References -- Chapter 3 Pathogenetic mechanisms summarized -- 3.1 Acne vulgaris -- 3.2 Acne rosacea -- 3.3 Acne inversa/hidradenitis suppurativa (AI/HS) -- 3.4 Other variants -- 3.4.1 Malassezia folliculitis -- 3.4.2 Eosinophilic pustular folliculitis (ofuji's disease) -- 3.4.3 Dissecting terminal folliculitis -- 3.4.4 Acne keloidalis -- 3.4.5 Epidermal growth factor receptor (EGFR) inhibitor eruption -- 3.4.6 Acné excoriée des jeunes filles -- References -- Chapter 4 The acne hormones -- 4.1 The endogenous hormones -- 4.1.1 Androgens and their sources -- 4.1.2 Estrogens and their sources -- 4.1.3 Progesterone and the progesteroids -- 4.1.4 Insulin -- 4.1.5 Growth hormone and insulin-like growth factor-1 -- 4.2 The exogenous hormones -- 4.2.1 Anabolic steroids -- 4.2.1.1 Mothers' milk -- 4.2.1.2 Muscle makers -- 4.2.2 Oral contraceptive hormones -- 4.2.2.1 Oral estrogens -- 4.2.2.2 Oral progestins -- 4.2.2.3 Extended cycles -- 4.2.3 Other exogenous birth control hormones -- 4.2.3.1 Implants -- 4.2.3.2 Intrauterine devices -- 4.2.3.3 Intravaginal devices -- 4.2.3.4 Topicals: the patches -- 4.2.3.5 Intramuscular (depot) injections -- 4.2.4 Dietary sources of hormones -- 4.2.4.1 The impact of diet on acne -- 4.2.4.1.1 The ice cream salesman's son -- 4.2.4.1.2 Reproductive hormones -- 4.2.4.1.3 Insulin -- 4.2.4.1.4 Insulin-like growth factor 1 (IGF-1) -- 4.2.4.1.5 Growth factors and androgens combined -- 4.2.4.1.6 Dairy intolerance.

4.2.4.2 Carbohydrate load versus dairy load -- References -- Chapter 5 Exogenous acnegens and acneform eruptions -- 5.1 Chemicals and medications -- 5.2 Endocrine imitators and disruptors -- 5.2.1 Environmental contamination -- 5.3 Foods -- 5.3.1 Iodine and bromine -- 5.3.2 Chocolate -- 5.3.3 Casein and whey -- 5.4 Photodamage, glycation, and the acne and aging processes -- 5.5 Smoking and nicotine -- References -- Chapter 6 Follicular flora, fauna, and fuzz -- 6.1 Propionibacterium acnes (P. acnes) -- 6.1.1 Normal role of P. acnes -- 6.1.2 Pathogenic role of P. acnes -- 6.2 Malassezia species -- 6.2.1 Normal role -- 6.2.2 Immunogenicity -- 6.2.3 Pruritogenicity -- 6.2.4 Malassezia in the acnes -- 6.3 Staph, strep, and gram-negative organisms -- 6.4 Demodex -- 6.5 Vellus hairs -- References -- Chapter 7 The inflammatory response -- 7.1 Innate immunity -- 7.2 Adaptive (acquired) immunity -- 7.3 Inflammation as the primary acnegen -- 7.4 Mediators, cellular and humoral, and neuroimmunology -- 7.5 Allergy (shared antigens) -- 7.6 Inflammation, pigment, and PIH -- 7.7 Inflammation and scarring -- References -- Chapter 8 Management -- 8.1 Prevention -- 8.2 General principles of management -- 8.3 Diet -- 8.3.1 Dairy -- 8.3.1.1 The deli-planning heiress -- 8.3.1.2 The pharmaceutical executive -- 8.3.2 Carbohydrates, glycemic load, and hyperinsulinemia -- 8.3.3 The paleolithic diet -- 8.3.4 High-fructose corn syrup (HFCS) -- 8.3.5 Metformin -- 8.3.6 Synthesis and summary -- 8.4 Comedolytics and other topicals -- 8.4.1 Standard topical comedolytics -- 8.4.1.1 Retinoids -- 8.4.1.2 Benzoyl peroxide -- 8.4.1.3 Salicylic acid -- 8.4.1.4 Alpha and beta-hydroxy acids -- 8.4.2 Unclassified topicals -- 8.4.2.1 Azelaic acid -- 8.4.2.2 Sulfur -- 8.4.2.3 Zinc compounds -- 8.4.2.4 Resorcinol -- 8.4.3 Systemic comedolytics -- 8.4.3.1 Vitamin A -- 8.4.3.2 Isotretinoin.

8.4.3.2.1 Teratogenicity -- 8.4.3.2.2 Contraception -- 8.4.3.2.3 Inflammatory bowel disease -- 8.4.3.2.4 Depression -- 8.4.3.2.5 Other side effects -- 8.4.3.2.6 The convict who looked like Chief -- 8.4.3.3 Acitretin -- 8.4.3.4 Summary -- 8.5 Anti-inflammatories and antimicrobials -- 8.5.1 Antibiotics as anti-inflammatories -- 8.5.1.1 In acne vulgaris -- 8.5.1.2 In acne rosacea -- 8.5.1.3 In acne inversa -- 8.5.1.4 In dissecting terminal folliculitis (DTF) and acne keloidalis -- 8.5.2 Antibiotics as antibiotics -- 8.5.3 Ketoconazole, ivermectin, and crotamiton -- 8.5.3.1 In acne vulgaris -- 8.5.3.2 In acne rosacea -- 8.5.3.3 In acne inversa/hidradenitis suppurativa and dissecting folliculitis and cellulitis -- 8.5.4 Steroids -- 8.5.4.1 The Marine -- 8.5.5 Nonsteroidal anti-inflammatory drugs (NSAIDs) and biologics -- 8.5.6 Phototherapy -- 8.5.7 Post-inflammatory hyperpigmentation -- 8.5.7.1 Prognosis -- 8.6 Hormone manipulations and therapy -- 8.6.1 Birth control pill selection -- 8.6.1.1 Estrogens -- 8.6.1.2 Progestins -- 8.6.2 Androgen receptor blockade -- 8.6.2.1 Spironolactone -- 8.6.2.2 Cyproterone acetate -- 8.6.2.3 Flutamide -- 8.6.2.4 Drospirenone -- 8.6.2.5 Topical androgen blockers -- 8.6.3 Dihydrotestosterone minimization -- 8.6.3.1 Finasteride -- 8.6.3.2 Dutasteride -- 8.6.3.3 Diet -- 8.6.4 Phototherapy-hormone interactions -- 8.7 Surgery -- 8.7.1 Acne vulgaris -- 8.7.1.1 Acne surgery for patients -- 8.7.1.2 Acne surgery for physicians -- 8.7.2 Acne rosacea -- 8.7.3 Acne inversa/hidradenitis suppurativa -- 8.7.3.1 Mini-unroofing by punch biopsy -- 8.7.3.2 Unroofing -- 8.7.3.3 Wide surgical excision -- 8.7.3.4 Healing options -- 8.7.3.4.1 Primary closure -- 8.7.3.4.2 Secondary intention -- 8.7.3.4.3 Split-thickness mesh grafting -- 8.8 Lights and lasers -- 8.8.1 Light and other radiation in acne -- 8.8.1.1 Radiation's targets.

8.8.1.2 Light as a practical acne therapy -- 8.8.2 Lasers -- References -- Chapter 9 Acne in pregnancy -- 9.1 Epidemiology -- 9.2 Pathogenesis -- 9.3 Team up with Mother Nature -- 9.4 Targeting therapy -- 9.4.1 Clinical manifestations -- 9.4.2 Pathology -- 9.4.3 Diagnostic evaluation -- 9.4.4 Overview and general approach to treatment -- 9.4.5 Milk and pregnancy -- 9.4.6 Active therapy -- 9.4.6.1 Avoidance of harm -- 9.4.6.2 Lesion-directed therapy -- 9.4.6.3 Nonprescription topicals -- 9.4.6.4 Antimicrobials -- 9.4.6.5 Combination topicals -- 9.4.6.6 Anti-inflammatories -- 9.4.6.7 Hormone blockers -- 9.4.6.8 Procedural therapies -- 9.5 Discussion -- 9.6 Summary and conclusion -- References -- Chapter 10 Putting it all together -- 10.1 Lifestyle choices and the acnes -- 10.1.1 The "processed cheese queen" -- 10.2 Therapeutic choices and the acnes -- 10.2.1 Acne vulgaris -- 10.2.2 Acne rosacea -- 10.2.3 Acne inversa/hidradenitis suppurativa -- 10.3 Conclusion -- References -- Chapter 11 Appendices -- 11.1 Appendix A: the rosacea "classification and staging" controversy -- 11.2 Appendix B: the dairy versus carbohydrate controversy -- References -- Chapter 12 The handouts -- 12.1 Acne -- 12.2 The "zero-dairy" diet -- Why avoid milk products? -- What about hormone-free milk? -- Is lactose-free milk or "organic" milk ok? -- What are the options? -- How do the cow hormones make Acne? -- How long do I need to do this? -- What else can I do for my hormones? -- What about my calcium intake? -- What else does dairy hormone do? -- 12.3 The risks and benefits of isotretinoin -- Introduction and History -- Side effect concerns -- Isotretinoin medication guide: "Be Smart" booklets and the iPLEDGE rules -- Our concerns -- Our perspective -- So what are the real risks of isotretinoin? -- Pregnancy and teratogenesis -- Mental status changes and depression.

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