Acne Causes and Treatment

Definition

Acne is a skin condition that causes whiteheads, blackheads, and inflamed red lesions (papules, pustules, and cysts) to form. These growths are commonly called pimples or "zits."

Alternative Names

Acne vulgaris; Cystic acne; Pimples; Zits

Causes, incidence, and risk factors

Acne occurs when tiny holes on the surface of the skin, called pores, become clogged. Each pore is an opening to a canal called a follicle, which contains a hair and an oil gland. Normally, the oil glands help keep the skin lubricated and help remove old skin cells. When glands produce too much oil, the pores can become blocked, accumulating dirt, debris, and bacteria. The blockage is called a plug or comedone.

The top of the plug may be white (whitehead) or dark (blackhead). If it ruptures, the material inside, including oil and bacteria, can spread to the surrounding area and cause an inflammatory reaction. If the inflammation is deep in your skin, the pimples may enlarge to form firm, painful cysts.

Acne commonly appears on the face and shoulders, but may also occur on the trunk, arms, legs, and buttocks.

Acne is most common in teenagers, but it can happen at any age, even as an infant. Three out of four teenagers have acne to some extent, probably caused by hormonal changes that stimulate oil production. However, people in their 30s and 40s may also have acne.

Acne tends to run in families and can be triggered by:

•     Hormonal changes related to menstrual periods, pregnancy, birth control pills, or stress

•     Greasy or oily cosmetic and hair products

•     Certain drugs (such as steroids, testosterone, estrogen, and phenytoin)

•     High levels of humidity and sweating

Despite the popular belief that chocolate, nuts, and other foods cause acne, research does not confirm this idea.

Symptoms

•     Blackheads

•     Crusting of skin eruptions

•     Cysts

•     Pustules

•     Redness around the skin eruptions

•     Scarring of the skin

•     Whiteheads

Signs and tests

Your doctor can diagnose acne based on the appearance of the skin. Testing is usually not required.

Treatment
Take the following self-care steps to lessen the effects of acne:

• Clean your skin gently with a mild, non-drying soap (such as Dove, Neutrogena, or Basics). Remove all dirt or make-up. Wash once or twice a day, including after exercising. However, avoid excessive or repeated skin washing.

• Shampoo your hair daily, especially if it's oily. Comb or pull your hair back to keep the hair out of your face. Avoid tight headbands.

• Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to skin infections and scarring.

• Avoid touching your face with your hands or fingers.

• Avoid greasy cosmetics or creams. Look for water-based or "non-comedogenic" formulas. Take make-up off at night. Non-comedogenic products have been tested and proven not to clog pores and cause acne.

If these steps do not clear up the blemishes to an acceptable level, try over-the-counter acne medications. These products are applied directly to the skin. They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid. They work by killing bacteria, drying up the oil, and causing the top layer of your skin to peel. They may cause redness or peeling of the skin.

If pimples are still a problem, a dermatologist can prescribe stronger medications and discuss other options with you.

Prescription medicines include:

• Oral antibiotics (taken by mouth) such as minocycline, doxycycline, tetracycline, erythromycin, and amoxicillin

• Topical antibiotics (applied to the skin) such as clindamycin, erythromycinm or dapsone

• Retinoic acid cream or gel (Retin-A) and isotretinoin pills (Accutane) -- pregnant women and sexually active adolescent females should NOT take Accutane, as it causes severe birth defects. Women taking Accutane must use two forms of birth control before starting the drug and enroll in the iPledge program.

• Prescription formulas of benzoyl peroxide, sulfur, resorcinol, salicylic acid

• A pill called spironolactone may help women with hormonally controlled acne.

• A laser procedure called photodynamic therapy may also be helpful.

Birth control pills can sometimes help clear up acne. (In some cases, though, they may make it worse.)

Your doctor may also suggest chemical skin peeling, removal of scars by dermabrasion, or removal, drainage, or injection of cysts.

A small amount of sun exposure may improve acne. However, excessive exposure to sunlight or ultraviolet rays is not recommended because it increases the risk of skin cancer.

Expectations (prognosis)

Acne usually subsides after adolescence, but may last into middle age. The condition generally responds well to treatment after 6 - 8 weeks, but may flare up from time to time. Scarring may occur if severe acne is not treated. Some people, especially teenagers, can become significantly depressed if acne is not treated.

Complications

Possible complications include:

• Changes in skin color

• Cysts

• Damage to self-esteem, confidence, personality, and social life

• Permanent facial scars

• Side effects of Accutane (including very dry skin and mucus membranes, high triglyceride levels, liver damage, and birth defects in an unborn baby; call your doctor right away if you become pregnant while taking this drug)

• Side effects of other medications

Calling your health care provider

Call your doctor or a dermatologist if:

• Self-care measures and over-the-counter medicine have not helped after several months

• Your acne is severe (for example, you have lots of redness around the pimples or you have cysts) or getting worse

• You develop scars as your acne clears up

Call your pediatrician if your baby has acne that does not clear up on its own within 3 months.


References:
Acne, rosacea, and related disorders. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 7.

Tips to Get the Insurance Claims

A formal request to an insurance company asking for a payment based on the terms of the insurance policy. Insurance claims are reviewed by the company for their validity and then paid out to the insured or requesting party (on behalf of the insured) once approved.

Homeowners are tallying up the damage inflicted by a brutal winter, and insurance claims are sure to mount with each discovery of a damaged roof or burst pipe.

The challenge for many is knowing whether they are getting the full compensation their policies should provide.

"We expect insurance companies to stand behind us when disaster strikes, but far too often we see insurance carriers deny, delay and underpay legitimate claims," says Phillip Sanov, a Houston-based attorney and head of the Lanier Law Firm Bad Faith Insurance Practice Group.

Insurance companies, increasingly focused on their bottom line and appeasing shareholders, will try to cut corners when it comes to claims, Sanov says.

"Its not necessarily the individual [claims adjuster] who comes out and has his feet on the ground," he says. "He has to answer to two or three levels above him and do what he's instructed to by the corporate office somewhere. It's a trickle-down effect."

Underpaying claims happens as often as it does because many policyholders have little understanding of the nuances of their coverage. There are also emotional considerations. After snow crashes through a roof or gale-force winds shatter windows, many homeowners just want to deal with the emergency at hand, avoid a prolonged battle and cut their losses.

"Insurance companies know that nine out of 10 policyholders are just going to give up and say, 'It's not worth it, I don't want to fight anymore,'" Sanov says. "It's only 10% to 20% that will really pursue a claim and get an advocate to fight for what they deserve."

The Florida State Legislature's Office of Program Policy Analysis and Government Accountability issued a report last year that looked at the relationship between public adjusters, policyholders and the state-run Citizens Property Insurance program -- an insurer established for those otherwise unable to afford or get coverage -- in the wake of the 2005 hurricane season.

That audit found that policyholders who retained public adjusters for their claims got 747% higher compensation than those working solely with their insurance company. For non-hurricane claims, policyholders got 574% higher compensation.

"The average insured does not know what he is entitled to," says Joseph Zevuloni, president and CEO of Zevuloni & Associates, a Florida-based public adjusting firm. "They will look at something that is broken and try to figure out what it will cost to fix. However, there are other damages they are not trained to look for or know any better. By the time they find out, the insurance company may say that they waited too long, never reported it, that they don't deserve it or it is not included in their policy."

Six steps homeowners should be prepared to take before and after filing a claim:

Carefully Review Coverage

Don't wait for an emergency or need to file a claim before you fully review and understand your existing policy. Before filing a claim, review your policy in light of the damage or have a professional do so to fully understand what your policy covers and what it doesn't. Coverage should be periodically reviewed to make sure it is adequate and fits your needs.

"Examine your policy ahead of time and know what they are paying for," Zevuloni says. "The average consumer who goes out and buys a policy has no clue what it actually says. Many terms and much of the language are intentionally very ambiguous. The average consumer cannot interpret it accurately without some professional assistance."

A policyholder may be underinsured or face exclusions for things they need.

"Let's say your house was built 30 years ago and it doesn't conform to the same building standards as today," Zevuloni says. "If you apply for some kind of a building permit they will require you to do certain things to bring it up to code. The policy should provide for that. If it doesn't have that language, you are out of luck."

Take Photos and Video

The availability and ease of digital cameras allows homeowners to provide the insurer with "before and after" documentation.

"A week before a storm hits, go take pictures of your walls and your roof," Sanov says. "The most reasonable thing for a person to do is to take pictures inside their home, of the walls and the ceiling. The carrier will not be able to claim damage was pre-existing or normal wear and tear."

Document the Damage

Beyond photographing or making a video to show damages, homeowners can hire their own adjuster, who will act independently of one provided by the insurance company.

Keep track, and have duplicate copies of all estimates and receipts. Also, repare a detailed inventory of all damaged possessions, with their approximate age, initial price and estimated cost to replace.

Make Temporary Repairs

Don't wait for an insurance adjuster to start making temporary repairs. Broken windows and leaking roofs should be fixed right away so the insurance company cannot dismiss some claims as the result of waiting too long to do so. Save all receipts and documentation, as the insurer will likely reimburse most of these expenses.

Don't Assume Something Isn't Covered

Just because a claim is initially rejected doesn't mean the policy doesn't say otherwise.

"This happens to us all the time -- an insured will call in and say their claim was denied because mold is not covered and even their agent agrees," Zevuloni says. "But if the mold was caused by a water leak or water damage, it may be covered. If there is causation, the coverage may be limited to $10,000 to $15,000 on most policies, but it is covered."

Gird for Battle

"It does become more of a fight," Sanov says. "You hate to talk in those term, but policyholders are fighting with their insurance company. As claims mount and each adjuster is given a bottom line to preserve, the problems multiply and become greater and greater all the time. It is hard, in the position I'm in, to say anything in defense of them, given the way I've seen policyholders treated."

For those concerned that countering a claim will be costly, Sanov says most attorneys and public adjusters work on a contingency basis. Many states also allow the cost of such expertise to be reimbursed by an insurance company if an initial claim is found to have be inadequate.

Policyholders need not fear their insurer dropping them or raising rates if they challenge a payout. "They will not drop you because of a claim," Zevuloni says. "They will only drop you if you are a risk to them -- if they find out, for example, that you store propane tanks in the house or you have exposed wiring."

Tips Insurance Planning

Insurance is an important part of financial planning — but understanding insurance and buying the right product can be tricky. From whole to term life, riders to convertibility clauses, how do you make sense of all the choices? Most people rely on the expertise of their insurance advisor, broker, or sales representative to help them make the right decision. Yet, for some people, insurance representatives have developed a bad reputation, and many people do not trust the “recommendations” they receive.

From my own experience in the insurance industry, and knowing how representatives are trained, I wouldn’t trust many insurance sales reps either. Here are some steps you can take to ensure you get the right product for the right price:

•     Understand your needs. No one understands your financial situation better than you. That means you should avoid letting someone else tell you how much protection you need. You can get a rough estimate of your insurance needs by adding together your debt, estimated funeral costs, and six months to a year of income replacement. [J.D.'s note: One common rule of thumb is to multiply your yearly income by between 5 and 10, using the lower level if you don't have many dependents and few debts, and the higher level if you have larger debts and multiple dependents. But Ray is right: understand your own needs.] Taking stock of your financial policy can allow you to select the right policy for your needs. As sales representative, we were trained to sell large policies. Remember, you may not need an exorbitant policy — you need the policy that’s right for you and your family’s financial situation.

•     Understand term insurance versus permanent insurance. Understanding the difference between term and permanent life insurance (such as whole life) can help you make an informed decision about your insurance needs. Today, a term insurance policy should be able to cover most of your debt and financial needs. In turn, you may not need to purchase a whole life policy. Try not to be sold by the “what if” scenario you might hear from an insurance sales rep. Insurance companies traditionally make more profit from whole life policies than term policies, so be prepared to hear a sales representative promote whole life as the best possible choice (even though it might not be the best fit for your needs). Remember, buy what you need and make adjustments as changes become necessary. Term insurance is typically renewable and should have a convertibility clause which allows you to make changes in the future. There are certain situations where a whole life policy maybe more advantageous than term; however, do not purchase it simply because your sales representative told you should.

•     Speak with an independent broker. These brokers will have access to many more products than just one firm can provide. When I worked as an independent broker, I was able to offer much more to my clients than just a company product.

•     Avoid one-meeting recommendations. If your broker makes a recommendation in the first meeting, you know that they have not really analyzed your situation and looked for best options. So just say, “No, thank you” and keep researching.

•     Understand how the advisor gets paid. Find out if they are compensated through commission, fee-plus-commission, or fee only. If there is any commission involved with the sale, make sure to look at all alternative products available. With commissions, the advisor may have a conflict of interest. Just because your advisor is commission-based doesn’t mean they are bad — just ask more questions with them. I always worked on 100% commission, but I would give my clients several options and disclose if I got paid differently.

•     Recognize that insurance is for protection — not investing. Term insurance provides protection only, without a savings component. Whole life and universal life policies have a savings component and are much more expensive. You are almost always better off just paying for term insurance, and using the cost savings to invest elsewhere.

•     Ask the tough questions. Don’t be afraid to ask the advisor questions. You should know the product inside out before buying it. Is the policy renewable and non-cancelable? How long are premiums guaranteed for? Is there an accidental death rider? What are the exclusions?

•     Watch out for “know-it-all” advisor. If the advisor answers all your questions without referring to anything, or pretends she “knows it all”, chances are that she does not. Insurance policies are complicated, and even the best advisors do not know every product 100 percent and may have to look things up. There is nothing wrong with that.

•     Compare similar products. When you price shop, make sure you compare similar products.

•     Don’t replace old whole-life policies. If you have had a whole-life policy for several years, try not to replace it. You may lose all the premiums you have paid. You may also have to pay new administration fees (if applicable), and reset some clauses (such as the suicide clause). If your situation has changed and you need more insurance, just buy more. (This warning does not apply to term life.)

•     Do not buy expensive riders. The advisor might ask you to add on all types of riders. Stay away from them unless you fully understand them and need them. Again, in training there was always an emphasis on selling riders. Often I didn’t see any benefits to the client.

•     Do your homework. Make sure you do your homework before purchasing an insurance product. Make sure it fits your needs and budget, and make sure you understand the contract. The advisor is obligated to explain it to you. Don’t sign until you understand the contract.

•     Take a 30-day free look. You have 30 days to look at the policy and understand it. If you are not satisfied with it during that time, cancel the policy and you will get your premium back.

•     Keep it simple. Do not make your insurance planning complicated. Because it is based on protecting your family, it should be based on your needs. Don’t fall for all the bells and whistles the company may try to sell to you.

I hope these steps will help in your insurance planning. The basic idea is to educate yourself by doing your homework so that you can understand what you are buying.

Foods to eat that boost memory.

Food for Memory Enhancement

There are times when it's difficult to concentrate on studies or even at work. Though it is a cliché to hear people saying eat the right food to increase brainpower, chances are they're true. It's just a matter of finding the right food supplement and eating a balanced diet together with a healthy lifestyle. And that means no smoking, sleeping early, with regular body exercise. These factors contribute a lot to boosting the brain's power to perform effectively.

When looking for the right food that could increase memory, try the following organic and natural foods and even food supplements that are helpful. Studies show that by using the Functional Magnetic Resonance Imaging tool, researchers were able to test the brain's capability to retain memory with the help of different food groups as subjects.

Oily fish - Moms are actually right about the idea of telling their kids that eating fresh cooked fish make kids really smart. Examples of fish usually being forced to eat by kids are sardines, salmon, herring, or mackerel etc., are rich in omega 3 fatty acids. Tuna for instance is composed of good fatty acids that are needed by the cells of the brain to be more powerful and improve memory. Aside from omega 3, some sardines have nutrient called choline, which is a chemical of the brain that is very important for memory.

Soy - Protein in food boosts the brain cells in transmitting information to the brain for added memory power. Soy has this benefit of pure form of nutrient that is extracted from soybeans. Because the protein coming from it is isolate it can be found in supplements may it be in powder or liquid form. Soy can also be found in supplements rich in isoflavone, especially soymilk. This is effective for verbal and visual memory that also

contributes to mind flexibility.

Eggs - Some still take this idea for granted, but the brain must be provided with essential fats. Good fatty acids must be derived from healthy foods like eggs since the body does not produce this naturally.

Gingkgo biloba - This is widely used in the Eastern part of the world for thousands of years now and most well known as the most effective cure for memory deficiency. It helps increase blood circulation in the brain and helps increase the supply of oxygen to it. It is a wonderful compound but do not assume instant effects for it could take three to four weeks before the results can be felt. And because it eliminates free radicals in the brain, it also helps in preventing any damages in the brain cells.

Rosemary - This special herb minimizes brain fatigue and recent clinical studies show that it can boost the memory up to 18%. Another organic plan that helps in transmitting messages to brain cells is Sage. This herb maximizes the level of chemicals in the brain that act as stimulants to brain retrieval.

Many people may take this for granted but "Water" is one of the most important elements in keeping a healthy brain, thus, contributing to a good memory. The human brain is composed of 70% water. The more it is hydrated, the more it functions to the highest level. When it becomes dehydrated, it could produce cortisol, a hormone that alleviates the capacity of the brain to store information.

Iron rich foods help people to concentrate and increase brainpower. Clinical studies also show that iron could develop an individual's span of attention. This can either be taken in supplements or in beans, lean meats, seafood and iron fortified snacks. Taking vitamin C supplements or citrus fruits aids the body in absorbing all the iron taken in each meal.

In the market today, many American tested brain boosting food supplements are endorsed to the public. In general Vitamin B complex supplements resulted as one of the most promising in alleviating mental and physical stress. It helps ensure acetylcholine activity, which is an important chemical for the brain's memory function. Vitamin B at the same time carries oxygen to the brain, which helps prevent free radicals from damaging the system. If supplements are not available, eggs, liver,

soybeans, tofu food, green beans, and lentils can be found everywhere.

These entire brainpower building foods can be found daily, just make sure to have them included in the daily diet. Doctors' advice: have an egg for breakfast, green or black tea during lunch, with sage in pasta sauce at dinner, and 6 to 8 glasses of water the whole day, can make each person feel like Einstein.