3.Philadelphia: NH,Manaf ZA,Azizan NZ. High glycemic load high glycemic

3.Philadelphia: Elsevier mosby;2005:1116-18.)
 In Malaysia, the prevalence of facial acne
vulgaris amoung teenagers was reported as 67.5%.(Ismail NH,Manaf ZA,Azizan NZ. High glycemic
load high glycemic load  diet, milk and
ice cream consumption are related to acne vulgaris in Malaysian young adults: a
case control study.BMC Dermatology 2012;12(13):2-7.) The prevalence
and severity of acne scarring in the population has not been well studied,
although it may be related to severity and duration of initial acne.(Maibach HI,
Bashir SJ, McKibbon A. Evidence based dermatology. London: BC Decker Inc;
2002:186-187.)

“A study in united kingdom of 2,133 healthy
volunteers aged 18-70 years taken from the general population showed o.7% of
people to have acne scars, only 0.1% was considered to have disfiguring
scars.80-90% of these acne scared subjects had ice-pic scars.” .(Maibach HI, Bashir
SJ, McKibbon A. Evidence based dermatology. London: BC Decker Inc;
2002:186-187.)

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“The prevalence of acne in the general population
has not been frequently assessed, and studies differ in terms of design,
subjects examined and criteria for acne. Cross sectional prevalence studies in
which adolescent in the 16-18 years old age group were examined by
dermatologist indicate that the prevalence of at least minimal acne in this age
group is 88-90%. It is therefore; likely that almost everyone will have at
least minimal.(Maibach
HI, Bashir SJ, McKibbon A. Evidence based dermatology. London: BC Decker Inc;
2002:186-187.)

acne at some stage in their life.About 90% have only
mild or minimal acne and 1% has moderate acne, few have severe. In general acne
was more severe in boys than girls.””The prevalence of acne in school children
ranges from 30% to100% depending on age, with 93.3% of 16-18 years old were
experiencing acne.acne account for 3% of dermatologic primary care visit and
0.6% of all visits to family physicians.”

In western countries, acne is ubiquitous that
affects between 40-50 million of individuals in the united states.(cordain L
implication for the role of diet in acne.Semin cutan Med surg
2005;24(84-91):84-89.) “some degree of facial acne has been found in
54% of women and 40% of men  older than
25 years of age. In this same group clinical facial acne afflicted 12% of the
women and 3% of men and persisted in to middle age. In 10-12 years old
childrens,28-61% of the population has clinically diagnosed acne, whereas
79-95% of 16-18 years adolescent are afflicted.” cordain L implication for the role of diet in
acne.Semin cutan Med surg 2005;24(84-91):84-89.)

 

skin

Skin is one of the heaviest body organs.70kg person
will have about 2kg(6 pounds) of skin. Its thicknes ranges from 1.5-4.0mm.33(Susan standring,
Harold Ellis, Jeremih C Healy, Debit Johnson Endrew Williams petricia Collins,
et al. gry`s Anatomy. 39th ed. Elsevier Churchill Livingstone: 2005:
Pp 15,7.)

The skin comes in to contact with a large no of
organisms most of the organisms find skin a hostile environment and do not
survive. One has a ranges of bacteria living on their skin as
commensals,example:Propionibacterium acnes, Pityrosporum ovale and
Staphylococcus epidermidis.35(Gorbach. Sherwood L, Bartlett, John G, Blacklow, Neil R.
Infectious Diseases. 3rd ed. Lippincott Williams and Williams: 2004:
Pp1151-2.)

LAYERS OF THE SKIN

The skin consists of two mutually dependent layers,
the epidermis and dermis, which rest on a fatty subcutaneous layer, the
paniculus adiposus.

EPIDERMIS

The epidermis is an avascular layer and is entirely
dependent on the underlying dermis for nutrient delivery and waste disposal via
diffusion through the dermoepidermal junction.It is a proliferating layer that
generates on its surface a constantly renewing tough barrier of protein and
lipid, the stratum corneum.35(Gorbach. Sherwood L, Bartlett, John G, Blacklow, Neil R. Infectious
Diseases. 3rd ed. Lippincott Williams and Williams: 2004: Pp1151-2.)

 

The principal cells of epidermis are keretinocytes.
Non keretinocytes with in the mature epidermis include melanocytes, langerhans
cells,lymphocytes and merkel cells.33(Susan standring, Harold Ellis, Jeremih C
Healy, Debit Johnson Endrew Williams petricia Collins, et al. Gray`s Anatomy.
39th ed. Elsevier Churchill Livingstone: 2005: Pp 15,7.)

Keretinocytes

 

These cells form the most suoerficial layer of the
skin and are responsible for synthesis of the tough structural protein keratin.36(George F Murphy.
Dermatopathology. A practical guide to common disorders.WB Saunders
company(USA);1995:P4.)

 

The population of keretinocytes
undergoes continous renewal throughout life. A mitoticlayer of cells at the
base replaces those shed at the surface,keretinocytes transform from polygonal
living cells to non viable flattend squames full of intermediate filament
proteins(keratin) embedded in a dense matrix of cytoplasmic proteins to form mature
keratin. The process is known as keratinisation or cornification.33(Susan standring,
Harold Ellis, Jeremih C Healy, Debit Johnson Endrew Williams petricia Collins,
et al. gry`s Anatomy. 39th ed. Elsevier Churchill Livingstone: 2005:
Pp 15,7.)

The epidermis can be divided in to
number of layers from deep to superficial as follows

1.Stratum basale –Basal layer

2 Stratum spinosum- Spinous or prickle
cell layer

3 Stratum granulosum-Granular layer

4 Stratum lucidum- Clear layer

5 Stratum corneum- Cornified layer33(Susan standring,
Harold Ellis, Jeremih C Healy, Debit Johnson Endrew Williams petricia Collins,
et al. gry`s Anatomy. 39th ed. Elsevier Churchill Livingstone: 2005:
Pp 15,7.)

DERMIS

The primary function of the dermis is to
sustain and support the epidermis. It has a matrix composed of an interwoven
collagenous and elastic network in an amorphous ground substances of
glycosaminoglycans,glycoprotein and bound water.33(Susan standring,
Harold Ellis, Jeremih C Healy, Debit Johnson Endrew Williams petricia Collins,
et al. gry`s Anatomy. 39th ed. Elsevier Churchill Livingstone: 2005:
Pp 15,7.)

ADNEXAL STRUCTURES

Adnexal 
structures include pilosebaceous unit, sweat glands, apocrine gland and
mammary glands. They often are found deep within the dermis,and in the   face may even lie in the Subcutaneous fat
beneath the dermis.

Pilocebaceous unit

The pilosebaceous unit (pilary complex)
consist of the hair and its follicle with an associated arrector pili muscle,
sebaceous gland and sometimes an apocrine gland.33,37(Susan standring,
Harold Ellis, Jeremih C Healy, Debit Johnson Endrew Williams petricia Collins,
et al. gry`s Anatomy. 39th ed. Elsevier Churchill Livingstone: 2005:
Pp 15,7.)

SEBACEOUS GLAND

The
normal function of sebaceous gland is to produce and secrete sebum. Typically
they consist of a cluster of secretory acini which opens by a short common duct
in to the dermal pilary canal of the hair follicle.33(Susan standring,
Harold Ellis, Jeremih C Healy, Debit Johnson