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Acne Cosmetica, also known as "Acne due to Cosmetics" and "Cosmetic-Induced Acne," is a condition that occurs due to the use of certain makeup and beauty products. It is a term that was first coined in 1972 by dermatologist Albert M. Kligman to represent the post-adolescent acne they believed was caused by cosmetic use. As the name suggests, acne cosmetica is a form of acne triggered by the use of cosmetic products. This is certainly not limited to makeup, as any products applied to the face and the surrounding areas can instigate this type of breakouts. Products in the surrounding areas of the face include but are not limited to hair gels, conditioners, etc. This condition can occur in males or females, and even those not previously predisposed to acne breakouts. Acne cosmetica affects areas like the cheeks and forehead where cosmetics, hair care products, and lotions are most frequently applied. The condition develops over a period of weeks or months and appears as small, itchy, or rash-like pink bumps. If changes in product use, hygiene practices, or application techniques are not altered, the condition may persist indefinitely.

Signs and symptoms
Acne Cosmetica may have a slow onset. In some cases, the appearance of the signs and symptoms is not immediate after usage of the makeup or topical beauty product. With that being said, it may take days, weeks, and months for the lesions to develop. The signs and symptoms of acne cosmetic include: The pimples develop on the areas of application, which may include the face and neck (mostly), chest, back, and legs.


 * (In many cases) the condition is mild and small bumps may seen
 * Prolonged use of the offending cosmetic may cause severe skin lesion
 * Individuals with existing acne may have more severe condition
 * Individuals with existing acne may have more severe condition

Causes
This type of acne is caused by the use of comedogenic hair or skin care products. Comedogenic hair and skin care products and makeup are the cause of acne cosmetica. Comedogenic simply means a product that aggravates or causes acne in the skin. These types of cosmetics build-up in the follicle and block the pore. When the pore is blocked, skin oil builds up and a comedone appears on the skin. Excess skin oil builds up, clogging the pore and creating a blemish. Pomades or hair oils, heavy moisturizers, eye creams, and makeup are all common causes of acne cosmetica.

Mechanism / Pathophysiology
The mechanism of Acne Cosmetica was presumably a chemically induced plugging of the pilosebaceous orifice. This became a significant problem for dermatologists in the 1970s and 1980s, but with the improved formulations produced by cosmetic chemists over the past thirty years, a diagnosis of acne cosmetica has become relatively rare daily dermatological practice. It is considered a trigger to "basic" acne caused by several (topical) beauty products. Acne Cosmetica is typically not a serious medical condition. However, it can lead to unsightly and sometimes painful lesions and ultimately scars. When pimples are open, the skin barrier has been disrupted. Any makeup applied to the area can then get into deeper levels of exposed tissue than the product is designed to reach. The result can be added irritation with increased redness and swelling of the pimple.

Diagnosis
Acne Cosmetica is diagnosed through a simple physical examination by the physician or a dermatologist. The healthcare provider may ask several questions related to the individual’s age, family medical history, current medications, cosmetics, body lotions used, other medical conditions, infections, etc. If secondary infections develop, then a culture test may be done. Invasive methods, such as skin biopsy, are typically not required; a diagnosis of acne can be made through a physical examination itself.

Treatment
It is important to immediately discontinue the use of the comedogenic product and replace with a non-comedogenic makeup in order to improve the skin’s condition. The use of antiseptic, antibiotic topical applications, anti-inflammatory gels, lotions and creams such as benzoyl peroxide and salicylic acid will be beneficial. If infections occur, medications such as antibiotics may be used. In case of severe acne, isotretinoin is prescribed (though, NOT for pregnant women). However, there may be some adverse side effects for this drug, and therefore close monitoring is requested.

Another treatment method for Acne Cosmetica is called dermabrasion and is performed under local anesthesia. In this procedure, the raised lumpy acne scars and skin dark spots are abraded. There are other cosmetic procedures such as, chemical peeling, minor skin surgery (punch excision), and microdermabrasion, which may be used.

Further treatment options include phototherapy, which is a controlled exposure to light for a certain time duration; however, this method is not very effective for long-lasting acne. Surgical procedures using laser are also used as forms of treatment for Acne Cosmetica.

Ultimately, Taking care of oneself, being clean and hygienic (especially face and hands), avoiding the urge to touch/break the blisters, avoiding oily make-ups and creams, drinking lots of water, etc. are all simple practices that can ensure a faster recovery from Acne Cosmetica.

Most treatments methods for Acne Cosmetica are parallel to the medications used in the treatment of Acne Vulgaris.

Benzoyl peroxide
Benzoyl peroxide (BPO) is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects (mainly skin irritation). In the skin follicle, benzoyl peroxide kills C. acnes by oxidizing its proteins through the formation of oxygen free radicals and benzoic acid. These free radicals are thought to interfere with the bacterium's metabolism and ability to make proteins. Additionally, benzoyl peroxide is mildly effective at breaking down comedones and inhibiting inflammation. Benzoyl peroxide may be paired with a topical antibiotic or retinoid such as benzoyl peroxide/clindamycin and benzoyl peroxide/adapalene, respectively.

Side effects include increased skin photosensitivity, dryness, redness and occasional peeling. Sunscreen use is often advised during treatment, to prevent sunburn. Lower concentrations of benzoyl peroxide are just as effective as higher concentrations in treating acne but are associated with fewer side effects. Unlike antibiotics, benzoyl peroxide does not appear to generate bacterial antibiotic resistance.

Salicylic acid

Salicylic acid is a topically applied beta-hydroxy acid that stops bacteria from reproducing and has keratolytic properties. It opens obstructed skin pores and promotes shedding of epithelial skin cells. Salicylic acid is known to be less effective than retinoid therapy. Dry skin is the most commonly seen side effect with topical application, though darkening of the skin has been observed in individuals with darker skin types.

Antibiotics
Antibiotics are frequently applied to the skin or taken orally to treat acne and are thought to work due to their antimicrobial activity against C. acnes and their ability to reduce inflammation. With the widespread use of antibiotics for acne and an increased frequency of antibiotic-resistant C. acnes worldwide, antibiotics are becoming less effective, especially macrolide antibiotics such as topical erythromycin. Therefore, they are not recommended for use alone but are preferred as part of combination therapy. Commonly used antibiotics, either applied to the skin or taken orally, include clindamycin, erythromycin, metronidazole, sulfacetamide, and tetracyclines such as doxycycline and minocycline. Doxycycline 40 milligrams daily (low-dose) appears to have similar efficacy to doxycycline 100 milligrams daily and has fewer gastrointestinal side effects. When antibiotics are applied to the skin, they are typically used for mild to moderately severe acne. Antibiotics taken orally are generally considered to be more effective than topical antibiotics, and produce faster resolution of inflammatory acne lesions than topical applications. Topical and oral antibiotics are not recommended for use together.

Oral antibiotics are recommended for no longer than three months as antibiotic courses exceeding this duration are associated with the development of antibiotic resistance and show no clear benefit over shorter courses. Furthermore, if long-term oral antibiotics beyond three months are thought to be necessary, it is recommended that benzoyl peroxide and/or a retinoid be used at the same time to limit the risk of C. acnes developing antibiotic resistance.

Dapsone has shown efficacy against inflammatory acne but is generally not a first-line topical antibiotic due to higher cost and lack of clear superiority over other antibiotics. It is sometimes a preferred therapy in women or for people with sensitive or darker toned skin. Topical dapsone is not recommended for use with benzoyl peroxide due to yellow-orange skin discoloration with this combination. While minocycline is shown to be an effective acne treatment, it is no longer recommended as a first-line antibiotic due to a lack of evidence that it is better than other treatments, and concerns of safety compared to other tetracyclines.

Combination therapy
Combination therapy—using medications of different classes together, each with a different mechanism of action—has been demonstrated to be a more efficacious approach to acne treatment than monotherapy. The use of topical benzoyl peroxide and antibiotics together has been shown to be more effective than antibiotics alone. Similarly, using a topical retinoid with an antibiotic clears acne lesions faster than the use of antibiotics alone. Frequently used combinations include the following: antibiotic and benzoyl peroxide, antibiotic and topical retinoid, or topical retinoid and benzoyl peroxide. The pairing of benzoyl peroxide with a retinoid is preferred over the combination of a topical antibiotic with a retinoid since both regimens are effective but benzoyl peroxide does not lead to antibiotic resistance.

Professional Treatments
If limiting the use of cosmetics does not work, and ones acne breakouts/blemishes becomes uncontrollable, Comedo extraction is supported by limited evidence but is recommended for comedones that do not improve with standard treatment. Another procedure for immediate relief is injection of a corticosteroid into an inflamed acne comedo. Electrocautery and electrofulguration have also been reported as effective treatments for comedones.

Light therapy is a treatment method that involves delivering certain specific wavelengths of light to an area of skin affected by acne. Both regular and laser light have been used. The evidence for light therapy as a treatment for acne is weak and inconclusive. Various light therapies appear to provide a short-term benefit, but data for long-term outcomes, and for outcomes in those with severe acne, are sparse; it may have a role for individuals whose acne has been resistant to topical medications. A 2016 meta-analysis was unable to conclude whether light therapies were more beneficial than placebo or no treatment, nor how long potential benefits lasted. PDT has the most supporting evidence of all light therapies.

When regular light is used immediately following the application of a sensitizing substance to the skin such as aminolevulinic acid or methyl aminolevulinate, the treatment is referred to as photodynamic therapy (PDT). Many different types of nonablative lasers (i.e., lasers that do not vaporize the top layer of the skin but rather induce a physiologic response in the skin from the light) have been used to treat acne, including those that use infrared wavelengths of light. Ablative lasers (such as CO2 and fractional types) have also been used to treat active acne and its scars. When ablative lasers are used, the treatment is often referred to as laser resurfacing because, as mentioned previously, the entire upper layers of the skin are vaporized. Ablative lasers are associated with higher rates of adverse effects compared with nonablative lasers, with examples being postinflammatory hyperpigmentation, persistent facial redness, and persistent pain. Physiologically, certain wavelengths of light, used with or without accompanying topical chemicals, are thought to kill bacteria and decrease the size and activity of the glands that produce sebum. Disadvantages of light therapy can include its cost, the need for multiple visits, time required to complete the procedure(s), and pain associated with some of the treatment modalities. Typical side effects include skin peeling, temporary reddening of the skin, swelling, and postinflammatory hyperpigmentation.

Dermabrasion is an effective therapeutic procedure for reducing the appearance of superficial atrophic scars of the boxcar and rolling varieties. Ice-pick scars do not respond well to treatment with dermabrasion due to their depth. The procedure is painful and has many potential side effects such as skin sensitivity to sunlight, redness, and decreased pigmentation of the skin. Dermabrasion has fallen out of favor with the introduction of laser resurfacing. Unlike dermabrasion, there is no evidence that microdermabrasion is an effective treatment for acne.

Dermal or subcutaneous fillers are substances injected into the skin to improve the appearance of acne scars. Fillers are used to increase natural collagen production in the skin and to increase skin volume and decrease the depth of acne scars. Examples of fillers used for this purpose include hyaluronic acid; poly(methyl methacrylate) microspheres with collagen; human and bovine collagen derivatives, and fat harvested from the person's own body (autologous fat transfer).

Microneedling is a procedure in which an instrument with multiple rows of tiny needles is rolled over the skin to elicit a wound healing response and stimulate collagen production to reduce the appearance of atrophic acne scars in people with darker skin color. Notable adverse effects of microneedling include postinflammatory hyperpigmentation and tram track scarring (described as discrete slightly raised scars in a linear distribution similar to a tram track). The latter is thought to be primarily attributable to improper technique by the practitioner, including the use of excessive pressure or inappropriately large needles.

Subcision is useful for treatment of superficial atrophic acne scars and involves the use of a small needle to loosen the fibrotic adhesions that result in the depressed appearance of the scar.

Chemical peels can be used to reduce the appearance of acne scars. Mild peels include those using glycolic acid, lactic acid, salicylic acid, Jessner's solution, or a lower concentrations (20%) of trichloroacetic acid. These peels only affect the epidermal layer of the skin and can be useful in the treatment of superficial acne scars as well as skin pigmentation changes from inflammatory acne. Higher concentrations of trichloroacetic acid (30–40%) are considered to be medium-strength peels and affect skin as deep as the papillary dermis. Formulations of trichloroacetic acid concentrated to 50% or more are considered to be deep chemical peels. Medium-strength and deep-strength chemical peels are more effective for deeper atrophic scars, but are more likely to cause side effects such as skin pigmentation changes, infection, and small white superficial cysts known as milia.

Prognosis
The prognosis of Acne Cosmetica depends upon the severity of the signs and symptoms. In general, the prognosis is excellent with appropriate treatment. In many cases, the signs and symptoms improve following stoppage of the cosmetic product causing acne and with adequate treatment

Epidemiology
Similar to Acne Vulgaris, Acne Cosmetica globally affects approximately 650 million people, or about 9.4% of the population, as of 2010. It affects nearly 90% of people in Western societies during their teenage years, and may persist into adulthood if not treated. It is slightly more common in females than males (9.8% versus 9.0%) being that women apply makeup significantly more than men. Research has found that it affects people of all ethnic groups.

Research
As research involving the study of Acne Cosmetica are slim, a case study was conducted in the Department of Dermatology and Venereology and Medicine and the Institute of Medical Sciences to examine the association of post-adolescent acne with the use of cosmetics and cosmetic procedures. Comparison of different cumulative exposure categories with the lowest exposure category (multivariate analysis, logistic regression) showed that the odds ratios, which were always <1, progressively declined as cosmetic exposure increased [odds ratios (95% confidence intervals): 0.679 (0.501-0.922), 0.355 (0.258-0.487), 0.307 (0.217-0.433)]. However, some individual cosmetics had odds ratios >1. As a result, the research concludes that overall cosmetic use was negatively associated with post-adolescent acne. According the the authors, the term ‘acne cosmetica' is appropriate in the sense that some cosmetics may cause acne.