Study Finds Smoking Linked to Breast Cancer Risk Nghiên cứu phát hiện thuốc lá có liên quan tới ung thư vú

Study Finds Smoking Linked to Breast Cancer Risk	Nghiên cứu phát hiện thuốc lá có liên quan tới ung thư vú
Association becoming more apparent as smoking women age, researchers say By Steven Reinberg HealthDay Reporter TUESDAY, March 1 (HealthDay News) -- Both smoking and exposure to secondhand smoke appear to increase the risk for breast cancer among postmenopausal women, new research shows. Although earlier studies had found little or no connection between breast cancer and smoking, as more women smokers reach menopause the connection may be surfacing for the first time, experts noted. "The findings are important because smoking was not previously thought to increase the risk of breast cancer, but this study adds to the increasing evidence that it does," said lead researcher Dr. Karen Margolis, a senior clinical investigator at HealthPartners Research Foundation in Minneapolis. However, Susan Gapstur, vice president of epidemiology for the American Cancer Society, said earlier research had shown some connection between smoking and breast cancer. "When you put together the body of work in the last few years, it calls for more studies," she said. "This study has answered that call." "This certainly adds to the evidence that long-term smoking increases the risk for breast cancer," Gapstur said. "On the on the flip side, it appears that 20 years after stopping the risk goes down to that of an average individual. I think that's good news." Many risk factors for breast cancer cannot be changed, such as age, genetics and family history of the disease, Margolis noted. "Now smoking can be added to the list of things that can lower breast cancer risk that already include having children, breast-feeding, keeping alcohol consumption low, avoiding weight gain, being physically active and avoiding hormone therapy with estrogen plus progestin," she said. The report is published in the March 1 online edition of the BMJ. For the study, Margolis's group collected data on 79,990 women aged 50 to 79 who took part in the Women's Health Initiative study. Over 10 years of follow-up, 3,250 women developed breast cancer. As part of the study, the women were asked if they smoked, had stopped smoking or had never smoked. The women were also asked about their exposure to secondhand smoke at home and at work. The researchers found that women who smoked had a 16 percent increased risk of developing breast cancer. Among women who quit, the increased risk was 9 percent, they added. The greatest risk was for women who had smoked for 50 years or longer, compared with women who never smoked, Margolis's team found. The risk was also high for women who started smoking when they were teenagers. Even after quitting, the risk continued for up to 20 years, the researchers noted. "We also observed some evidence that extensive exposure to passive smoking may raise the risk of breast cancer," Margolis said. Nonsmokers exposed to secondhand smoke for more than 10 years as children, more than 20 years as adults at home and more than 10 years at work had a 32 percent increased risk of developing breast cancer, the researchers found. However, the link between breast cancer and secondhand smoke was seen in those exposed to the greatest amount of passive smoking and "therefore more research is needed to confirm these findings," the researchers noted. Dr. Paolo Boffetta, deputy director of the Tisch Cancer Institute and Institute for Transitional Epidemiology at Mount Sinai School of Medicine in New York City and co-author of an accompanying journal editorial, said that "tobacco smoking, particularly when started early in life, may increase the risk of breast cancer." "This evidence is becoming stronger and stronger," he said. "In previous studies, the evidence was not so strong. It is only now that women who started smoking in large numbers are getting to the age where the risk of breast cancer is getting high." Right now, the association between smoking and breast cancer is still not a sure thing, Boffetta said, "but, it is getting more likely."

Houses Gone Wild - Abandoned Homes Nhà Hoang

Houses Gone Wild - Abandoned Homes Nhà Hoang

We think of feral dogs as dangerous, foreboding and to-be-avoid – but wild houses have a strange allure despite (or likely because) they are abandoned abodes, deserted homes gone from domestic spaces slowly back to nature. As photographer James D Griffioen muses, the Latin root refers both to while beasts but also to something that belongs to the dead, gone back to the Earth.

Some of his shots capture this process at an incredibly late stage, such as the house above which is entirely camouflaged by the greenery that has grown to cover it – only discernible because the branches and vines conform to the shape of the structure.

Others photos catch the domestic devolution at intermediate stages, snapshots of partial overgrowth where there is still some strange balance of building and nature – one could almost imagine someone still occupying this structure and simply never leaving it.

As these images illustrate, nature really is the ultimate equalizer – whether smaller or large, wood shack or brick mansion, all of these structures in this Feral Houses photography set are likewise subject to the elements.

From the photographer: “For a few beautiful months during the summer, some of these houses become “feral” in every sense: they disappear behind ivy or the untended shrubs and trees planted generations ago to decorate their yards. The wood that framed the rooms gets crushed by trees rooted still in the earth. The burnt lime, sand, gravel, and plaster slowly erode into dust, encouraged by ivy spreading tentacles in its endless search for more sunlight. Like some of the dogs I’ve seen using these houses as shelter … these houses are reverting to a wild state, as from domestication, a word derived itself from domesticus (the Latin for belonging to the domus, or house). Now these houses are feralis. They belong only to the dead.”

Urban Abandonments: 7 Deserted Wonders of the (Post)Modern World: & Kỳ quan bị bỏ hoang của thế giới (Hậu) hiện đại

Urban Abandonments: 7 Deserted Wonders of the (Post)Modern World: & Kỳ quan bị bỏ hoang của thế giới (Hậu) hiện đại

(Check out our complete collection of 100+ Abandoned Buildings, Places and Property.)

(7) Ghost Towns of the American West are what come to mind for many when they think of abandoned settlements. However, there are fascinating abandonments all over the world. Some of these have a clear historical reason for being deserted, while the abandonment of others remains a mystery. Here are six more amazing examples of urban deserts from around the globe. (6) San Zhi, Taiwan is an abandoned settlement on the outskirts of Taipei, Taiwan. A mysterious series of accidents led this would-be tourist town to go unused upon its completion. Further, regional beliefs also kept the abandoned settlement from demolished – for fear of angering spirits dwelling in the complex. (5) Near Genoa, Italy is a small abandoned village. What would cause people to leave such a beautiful place? To be fair, though, the ruins left behind are aesthetically compelling in their own right. The structures are remarkably intact and provocative. (4) Promyshlennyi, Russia was abandoned with the fall of the Soviet Union, cut off from communication with and support from the government. When utilities and electricity stopped working, people simply left to find a home an work elsewhere, leaving buildings behind and many belongings in the wreckage. (3) New York, USA has a surprising number of abandoned airfields – directly in and around the city. Given the relative density of the city and its surroundings it seems unusual that these have been left unused for so long. Each of these anomolous airfields has its own story. (2) Tere-Hole, Siberia is a lake with a recently dicovered treasure in the middle: a ruin dating back 1500 years. Located in a vast wilderness of lakes, this long-abandoned stronghold is 600 by 450 feet. Excavations this year may reveal ancient artifacts. (1) Pripyat, Ukraine was once a thriving city of 50,000, but was abandoned following the nuclear disaster at Chernobyl. For a long time the amazingly preserved city – rapidly abandoned by the populace – was a virtual museum, a snapshot of the times. Pripyat has since been looted and only images and architecture remain. The site will be unfit for human habitation for hundreds of years due to nuclear fallout.

Acne 4 – Mụn trứng cá 4

Acne Treatments

There are many products available for the treatment of acne, many of which are without any scientifically proven effects. Generally speaking, successful treatments show little improvement within the first two weeks, instead taking a period of approximately three months to improve and start flattening out. Many treatments that promise big improvements within two weeks are likely to be largely disappointing. However, short bursts of cortisone can give very quick results, and other treatments can rapidly improve some active spots, but usually not all active spots.

Modes of improvement are not necessarily fully understood but in general treatments are believed to work in at least 4 different ways (with many of the best treatments providing multiple simultaneous effects):

• normalising shedding into the pore to prevent blockage
• killing Propionibacterium acnes
• anti-inflammatory effects
• hormonal manipulation

A combination of treatments can greatly reduce the amount and severity of acne in many cases. Those treatments that are most effective tend to have greater potential for side effects and need a greater degree of monitoring, so a step-wise approach is often taken. Many people consult with doctors when deciding which treatments to use, especially when considering using any treatments in combination. There are a number of treatments that have been proven effective:

A tube of Basiron (also sold as Benzac) from Galderma Laboratories, used for the treatment of acne. Its active ingredient is benzoyl peroxide.

Topical bactericidals

Widely available OTC bactericidal products containing benzoyl peroxide may be used in mild to moderate acne. The gel or cream containing benzoyl peroxide is applied, twice daily, into the pores over the affected region. Bar soaps or washes may also be used and vary from 2% to 10% in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide also prevents new lesions by killing P. acnes. In one study, roughly 70% of participants using a 10% benzoyl peroxide solution experienced a reduction in acne lesions after six weeks. Unlike antibiotics, benzoyl peroxide has the advantage of being a strong oxidizer and thus does not appear to generate bacterial resistance. However, it routinely causes dryness, local irritation and redness. A sensible regimen may include the daily use of low-concentration (2.5%) benzoyl peroxide preparations, combined with suitable non-comedogenic moisturisers to help avoid overdrying the skin.

Care must be taken when using benzoyl peroxide, as it can very easily bleach any fabric or hair it comes in contact with.

Other antibacterials that have been used include triclosan, or chlorhexidine gluconate. Though these treatments are often less effective, they also have fewer side-effects.

Prescription-strength benzoyl peroxide preparations do not necessarily differ with regard to the maximum concentration of the active ingredient (10%), but the drug is made available dissolved in a vehicle that more deeply penetrates the pores of the skin.

Topical antibiotics

Externally applied antibiotics such as erythromycin, clindamycin or tetracycline kill the bacteria that are harbored in the blocked follicles. While topical use of antibiotics is equally as effective as oral use, this method avoids possible side effects including upset stomach and drug interactions (e.g. it will not affect use of the oral contraceptive pill), but may prove awkward to apply over larger areas than just the face alone.

Oral antibiotics

Oral antibiotics used to treat acne include erythromycin or one of the tetracycline antibiotics (tetracycline, the better absorbed oxytetracycline, or one of the once daily doxycycline, minocycline, or lymecycline). Trimethoprim is also sometimes used (off-label use in UK). However, reducing the P. acnes bacteria will not, in itself, do anything to reduce the oil secretion and abnormal cell behaviour that is the initial cause of the blocked follicles. Additionally the antibiotics are becoming less and less useful as resistant P. acnes are becoming more common. Acne may return soon after the end of treatment - days later in the case of topical applications, and weeks later in the case of oral antibiotics. Furthermore, side effects of tetracycline antibiotics can include yellowing of the teeth and an imbalance of gut flora, so are only recommended after topical products have been ruled out.

It has been found that sub-antimicrobial doses of antibiotics such as minocycline also improve acne. It is believed that minocycline's anti-inflammatory effect also prevents acne.

Hormonal treatments

In females, acne can be improved with hormonal treatments. The common combined oestrogen/progestogen methods of hormonal contraception have some effect, but the antiandrogen, Cyproterone, in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels. Diane-35 is not available in the USA, but a newer oral contraceptive containing the progestin drospirenone is now available with fewer side effects than Diane 35 / Dianette. Both can be used where blood tests show abnormally high levels of androgens, but are effective even when this is not the case. Along with this, treatment with low dose spironolactone can have anti-androgenetic properties, especially in patients with polycystic ovarian syndrome.

If a pimple is large and/or does not seem to be affected by other treatments, a dermatologist may administer an injection of cortisone directly into it, which will usually reduce redness and inflammation almost immediately. This has the effect of flattening the pimple, thereby making it easier to cover up with makeup, and can also aid in the healing process. Side effects are minimal, but may include a temporary whitening of the skin around the injection point; and occasionally a small depression forms, which may persist, although often fills eventually. This method also carries a much smaller risk of scarring than surgical removal.

Topical retinoids

A group of medications for normalizing the follicle cell lifecycle are topical retinoids such as tretinoin (brand name Retin-A), adapalene (brand name Differin), and tazarotene (brand name Tazorac). Like isotretinoin, they are related to vitamin A, but they are administered as topicals and generally have much milder side effects. They can, however, cause significant irritation of the skin. The retinoids appear to influence the cell creation and death lifecycle of cells in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar but milder effects and is used in many over-the-counter moisturizers and other topical products. Effective topical retinoids have been in use over 30 years but are available only on prescription so are not as widely used as the other topical treatments. Topical retinoids often cause an initial flare up of acne and facial flushing.

Oral retinoids

A daily oral intake of vitamin A derivative isotretinoin (marketed as Accutane, Amnesteem, Sotret, Claravis, Clarus) over a period of 4-6 months can cause long-term resolution or reduction of acne. It is believed that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin has been shown to be very effective in treating severe acne and can either improve or clear well over 80% of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects (many of which can be severe). About 25% of patients may relapse after one treatment. In those cases, a second treatment for another 4-6 months may be indicated to obtain desired results. It is often recommended that one lets a few months pass between the two treatments, because the condition can actually improve somewhat in the time after stopping the treatment and waiting a few months also gives the body a chance to recover. Occasionally a third or even a fourth course is used, but the benefits are often less substantial. The most common side effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa). Oral retinoids also often cause an initial flare up of acne within a month or so, which can be severe. There are reports that the drug has damaged the liver of patients. For this reason, it is recommended that patients have blood samples taken and examined before and during treatment. In some cases, treatment is terminated or reduced due to elevated liver enzymes in the blood, which might be related to liver damage. Others claim that the reports of permanent damage to the liver are unsubstantiated, and routine testing is considered unnecessary by some dermatologists. Blood triglycerides also need to be monitored. However, routine testing are part of the official guidelines for the use of the drug in many countries. Some press reports suggest that isotretinoin may cause depression but as of September 2005 there is no agreement in the medical literature as to the risk. The drug also causes birth defects if women become pregnant while taking it or take it while pregnant. For this reason, female patients are required to use two separate forms of birth control or vow abstinence while on the drug. Because of this, the drug is supposed to be given to females as a last resort after milder treatments have proven insufficient. Restrictive rules for use were put into force in the USA beginning in March 2006 to prevent misuse, causing occasioned widespread editorial comment.

Sulphur

Sulphur is probably the oldest acne remedy known to medicine and its origins as an anti-acne treatment date to ancient Greek, Roman, and Chinese texts citing its efficacy in balneotherapy. Sulphur formulations are effective both as a micro-exfoliant and as a mild antiseptic. Sulphur is hydrophilic and can easily penetrate sebaceous pores where its antiseptic properties can assist local immune response in rapidly eliminating infection resulting from acne proliferation. Because the growth of acne bacteria is limited naturally by the skin's slightly acidic pH, alkaline cleansers (including soaps and detergents) can have a detrimental effect on controlling acne proliferation. Sulphur-based cleansers with a balancing or neutral pH can help eliminate acne and prevent future breakouts by maintaining the hydrolipidic layer's acidity and thereby controlling acne populations on the surface of the skin. Sulphur is abundant in keratin and its use is also helpful in promoting collagen synthesis. An active ingredient in prescription and over-the-counter lotions, creams, gels, washes, and shampoos, sulphur is also very effective in controlling seborrheic dermatitis, rosacea, eczema, psoriasis, pityriasis versicolor, scabies, and lice.

Dermabrasion

Dermabrasion is a cosmetic medical procedure in which the surface of the skin is removed by abrasion (sanding). It is used to remove sun-damaged skin and to remove or lessen scars and dark spots on the skin. The procedure is very painful and usually requires a general anaesthetic or "twilight anaesthesia", in which the patient is still partly conscious Afterward, the skin is very red and raw-looking, and it takes several months for the skin to regrow and heal. Dermabrasion is useful for scar removal when the scar is raised above the surrounding skin, but is less effective with sunken scars.

In the past, dermabrasion was done using a small, sterilized, electric sander. In the past decade, it has become more common to use a CO₂ or Er:YAG laser. Laser dermabrasion is much easier to control, much easier to gauge, and is practically bloodless compared to classic dermabrasion.

Microdermabrasion comes from the above mentioned technique dermabrasion. Microdermabrasion is a more natural skin care that is a gentler, less invasive technology for doing an exfoliation on the skin. The goal of the microdermabrasion is to eliminate the superficial layer of the skin called the epidermis. If the surface of the abraded skin is touched, a roughness of the skin will be noticed. The roughness is keratinocytes, which are better hydrated than the surface corneocytes. Keratinocytes appear in the basal layer from the proliferation of keratinocyte stem cells. They are pushed up through the cells of the epidermis, experiencing gradual specialization until they reach the stratum corneum where they form a layer of dead, flattened, strongly keratinized cells called squamous cells. This layer creates an efficient barrier to the entry of foreign matter and infectious elements into the body and reduces moisture loss. Keratinocytes are shed and restored continuously from the stratum corneum.

The time of transit from basal layer to shedding is generally one month. Corneocytes are cells derived from keratinocytes in the late stages of terminal specialization of squamous epithelia. The microdermabrasion is done to eliminate some of the corneocytes. These cells are responsible for the impermeability of the skin. The minimizing or elimination of scars, skin lesions, blotchiness and stretch marks from the skin can be an easy process with the use of skin exfoliation. The result depends on how well the procedure known as "skin remodeling" works. Results are optimal and fewer treatments are needed with more recent and/or superficial scars. Still, microdermabrasion can be used on scars that showed up during puberty or many years later.

Phototherapy - 'Blue' and red light

Light exposure has long been used as a short term treatment for acne. Recently, visible light has been successfully employed to treat mild to moderate acne (phototherapy or deep penetrating light therapy) - in particular intense violet light (405-420 nm) generated by purpose-built fluorescent lighting, dichroic bulbs, LEDs or lasers. Used twice weekly, this has been shown to reduce the number of acne lesions by about 64% and is even more effective when applied daily. The mechanism appears to be that a porphyrin (Coproporphyrin III) produced within P. acnes generates free radicals when irradiated by 420 nm and shorter wavelengths of light. Particularly when applied over several days, these free radicals ultimately kill the bacteria. Since porphyrins are not otherwise present in skin, and no UV light is employed, it appears to be safe, and has been licensed by the U.S. FDA.

The treatment apparently works even better if used with a mixture of the violet light and red visible light (660 nanometer) resulting in a 76% reduction of lesions after three months of daily treatment for 80% of the patients; and overall clearance was similar or better than benzoyl peroxide. Unlike most of the other treatments few if any negative side effects are typically experienced, and the development of bacterial resistance to the treatment seems very unlikely. After treatment, clearance can be longer lived than is typical with topical or oral antibiotic treatments; several months is not uncommon. The equipment or treatment, however, is relatively new and reasonably expensive to buy initially, although the total cost of ownership can be similar to many other treatment methods (such as the total cost of benzoyl peroxide, moisturizer, washes) over a couple of years of use.

Subcision

Subcision is a process used to treat deep rolling scars left behind by acne or other skin diseases. Essentially the process involves separating the skin tissue in the affected area from the deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area. Once the skin has leveled, treatments such as laser resurfacing, microdermabrasion or chemical peels can be used to smooth out the scarred tissue.

Photodynamic therapy

In addition, basic science and clinical work by dermatologists Yoram Harth and Alan Shalita and others has produced evidence that intense blue/violet light (405-425 nanometer) can decrease the number of inflammatory acne lesion by 60-70% in four weeks of therapy, particularly when the P. acnes is pretreated with delta-aminolevulinic acid (ALA), which increases the production of porphyrins. However this photodynamic therapy is controversial and apparently not published in a peer reviewed journal. A phase II trial, while it showed improvement occurred, failed to show improved response compared to the blue/violet light alone.

Laser treatment

Laser surgery has been in use for some time to reduce the scars left behind by acne, but research has been done on lasers for prevention of acne formation itself. The laser is used to produce one of the following effects:

• to burn away the follicle sac from which the hair grows
• to burn away the sebaceous gland which produces the oil
• to induce formation of oxygen in the bacteria, killing them

Since lasers and intense pulsed light sources cause thermal damage to the skin, there are concerns that laser or intense pulsed light treatments for acne will induce hyperpigmented macules (spots) or cause long-term dryness of the skin.

In the United States, the FDA has approved several companies, such as Candela Corp., to use a cosmetic laser for the treatment of acne. However, efficacy studies have used very small sample sizes (fewer than 100 subjects) for periods of six months or less, and have shown contradictory results. Also, laser treatment being relatively new, protocols remain subject to experimentation and revision, and treatment can be quite expensive. Also, some Smoothbeam laser devices had to be recalled due to coolant failure, which resulted in painful burn injuries to patients.

Less widely used treatments

• Aloe vera: there are treatments for acne mentioned in Ayurveda using herbs such as Aloe vera, Neem, Haldi (Turmeric) and Papaya. There is limited evidence from medical studies on these products. Products from Rubia cordifolia, Curcuma longa (commonly known as Turmeric), Hemidesmus indicus (known as ananthamoola or anantmula), and Azadirachta indica (Neem) have been shown to have anti-inflammatory effects, but not aloe vera.
• Azelaic acid (brand names Azelex, Finevin and Skinoren) is suitable for mild, comedonal acne.
• Calendula used in suspension is used as an anti-inflammatory agent.
• Cortisone injection into spots, also cortisone pills are sometimes used.
• Heat: local heating may be used to kill the bacteria in a developing pimple and so speed healing.
• Naproxen or ibuprofen are used for some moderate acne for their anti-inflammatory effect.
• Nicotinamide, (Vitamin B3) used topically in the form of a gel, has been shown in a 1995 study to be of comparable efficacy to topical clindamycin topical antibiotic used for comparison. Topical nicotinamide is available both on prescription and over-the-counter. The property of topical nicotinamide's benefit in treating acne seems to be its anti-inflammatory nature. It is also purported to result in increased synthesis of collagen, keratin, involucrin and flaggrin and may also according to a cosmetic company be useful for reducing skin hyperpigmentation (acne scars), increased skin moisture and reducing fine wrinkles.
• Tea tree oil (melaleuca oil) dissolved in a carrier (5% strength) has been used with some success, where it is comparable to benzoyl peroxide but without excessive drying, kills P. acnes, and has been shown to be an effective anti-inflammatory in skin infections.
• Rofecoxib was shown to improve premenstrual acne vulgaris in a placebo controlled study.
• Zinc: Orally administered zinc gluconate has been shown to be effective in the treatment of inflammatory acne, although less so than tetracyclines.
• Comedo extraction
• Pantothenic acid, (high dosage Vitamin B5)
• Detoxification is a common method used by alternative medicine practitioners for the treatment of acne, although there have been no studies to prove its success. Detoxification is the process of cleansing the body of toxins purportedly caused by the environment, pharmaceutical drugs, food, and cosmetics.

History of some acne treatments

The history of acne reaches back to the dawn of recorded history. In Ancient Egypt, it is recorded that several pharaohs were acne sufferers. From Ancient Greece comes the English word 'acne' (meaning 'point' or 'peak'). Acne treatments are also of considerable antiquity:

• Ancient Rome: bathing in hot, and often sulfurous, mineral water was one of the few available acne treatments. One of the earliest texts to mention skin problems is De Medicina by the Roman writer Celsus.
• 1800s: Nineteenth century dermatologists used sulphur in the treatment of acne. It was believed to dry the skin.
• 1920s: Benzoyl Peroxide is used
• 1930s: Laxatives were used as a cure for what were known as 'chastity pimples'. Radiation also was used.
• 1950s: When antibiotics became available, it was discovered that they had beneficial effects on acne. They were taken orally to begin with. Much of the benefit was not from killing bacteria but from the anti-inflammatory effects of tetracycline and its relatives. Topical antibiotics became available later.
• 1970s: Tretinoin (original Trade Name Retin A) was found effective for acne. This preceded the development of oral isotretinoin (sold as Accutane and Roaccutane) in 1980.
• 1980s: Accutane is introduced in the United States, and later found to be a teratogen, highly likely to cause birth defects if taken during pregnancy. In the United States more than 2,000 women became pregnant while taking the drug between 1982 and 2003, with most pregnancies ending in abortion or miscarriage. About 160 babies with birth defects were born.
• 1990s: Laser treatment introduced
• 2000s: Blue/red light therapy

Future treatments

A vaccine against inflammatory acne has been tested successfully in mice, but it is not certain that it would work similarly in humans.

A 2007 microbiology article reporting the first genome sequencing of a Propionibacterium acnes bacteriophage (PA6) said this "should greatly enhance the development of a potential bacteriophage therapy to treat acne and therefore overcome the significant problems associated with long-term antibiotic therapy and bacterial resistance."

Talarozole, a retinoic acid metabolism blocking agent, is currently under investigation for acne therapy in combination with tretinoin.

Preferred treatments by types of acne vulgaris

• Comedonal (non-inflammatory) acne: local treatment with azelaic acid, salicylic acid, topical retinoids, benzoyl peroxide.
• Mild papulo-pustular (inflammatory) acne: benzoyl peroxide or topical retinoids, topical antibiotics (such as erythromycin).
• Moderate inflammatory acne: benzoyl peroxide or topical retinoids combined with oral antibiotics (tetracyclines). Isotretinoin is an option.
• Severe inflammatory acne, nodular acne, acne resistant to the above treatments: isotretinoin also known as Accutane, can be prescribed by a doctor, or contraceptive pills with cyproterone for females with virilization or drospirenone.

Acne 3 – Mụn trứng cá 3

Acne 3 – Mụn trứng cá 3

Acne Causes Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, that contains a fine hair (see "Normal Pilosebaceous Unit" diagram). These units are most numerous on the face, upper back, and chest. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line

Nguyên nhân Các bác sĩ mô tả mụn trứng cá là căn bệnh của các đơn vị pilocebaceous (PSUs). Được tìm thấy phần lớn trên cơ thể, PSUs bao gồm một tuyến bã nhờn kết nối với các kênh, gọi là nang lông, có chứa một sợi lông mảnh (xem sơ đồ: “đơn vị chất nhờn lông bình thường”). Các tuyến bã nhờn tạo ra một chất dầu gọi là bã nhờn thường đưa lên bề mặt da thông qua chỗ mở của nang lông, thường được gọi là một lỗ chân lông. Các tế bào được gọi là dòng tế bào sừng.

Normal Pilosebaceous Unit

The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria Propionibacterium acnes (P. acnes) that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin – sebum, shed skin cells, and bacteria – leading to lesions or pimples.

Lông, bã nhờn, và tế bào nang mà lấp đầy nang lông hẹp có thể tạo nên một cái nút, là một dấu hiệu sớm của mụn trứng cá. Cái nút sẽ ngăn bã nhờn đạt đến bề mặt da thông qua lỗ chân lông. Các hỗn hợp của dầu và các tế bào cho phép vi khuẩn mụn trứng cá Propionibacterium (P. acnes) mà thường sống trên da phát triển trong các nang bị bít kín. Những vi khuẩn này tạo ra các hóa chất và en-zim và thu hút các bạch cầu gây viêm. (Viêm là một phản ứng đặc trưng của các mô đối với bệnh hoặc chấn thương và được đánh dấu bằng bốn dấu hiệu sưng, nóng, đỏ và đau). Khi vách của nang bị bít kín vỡ ra, nó đổ tất cả mọi thứ ra vùng da xung quanh - bã nhờn, các tế bào da bong ra, và vi khuẩn - dẫn đến các tổn thương hoặc nổi mụn.

People with acne frequently have a variety of lesions, some of which are shown in the diagrams below. The basic acne lesion, called the comedo (KOM-e-do), is simply an enlarged and plugged hair follicle. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the skin's surface. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Những người có mụn trứng cá thường có nhiều thương tổn, một số trong đó được thể hiện trong các biểu đồ dưới đây: Tổn thương mụn trứng cá cơ bản, được gọi là ngòi trứng cá (KOM-e-do), chỉ đơn giản là một nang lông bị nở rộng và bít kín. Nếu nang bị bít, hoặc ngòi trứng cá, nằm bên dưới da, nó được gọi là một ngòi trứng cá đóng và tạo ra một vết sưng màu trắng gọi là mụn đầu trắng Một ngòi trứng cá đạt đến bề mặt da và mở ra được gọi là một ngòi trứng cá mở hoặc mụn đầu đen bởi vì nó trông đen trên bề mặt da. Biến đổi màu đen này là do các thay đổi bã nhờn khi nó được tiếp xúc với không khí. Nó không phải là do bụi bẩn. Cả hai mụn đầu trắng và mụn đầu đen đều có thể ở trong da trong một thời gian dài.

Microcomedo

Open Comedone (Black Head)

Closed Comedone (White Head)

Primary causes The root causes of why some people get acne and some do not are not fully known. It is known to be partly hereditary. Several factors are known to be linked to acne:	Nguyên nhân cơ bản Nguyên nhân chính tại sao một số người bị mụn trứng cá và một số khác lại không bị mụn thì không được biết đến một cách đầy đủ. Nó được biết đến một phần là do di truyền. Một vài yếu tố liên quan đến mụn trứng cá được biết đến như:
* Family/Genetic history. The tendency to develop acne runs in families. For example, school-age boys with acne often have other members in their family with acne as well. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.	*Tiền sử di truyền-gia đình: Các xu hướng hay bị nổi mụn trong gia đình. Những nam sinh có mụn thường có các thành viên khác trong gia đình cũng bị mụn. Một gia đình có tiền sử mụn trứng cá thì thường liên quan đến sự xuất hiện mụn sớm hơn và thương tổn do mụn gây ra nhiều hơn.
* Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the follicular glands to get larger and make more sebum.	* Các hoạt động nội tiết: Chẳng hạn như chu kỳ kinh nguyệt và tuổi dậy thì. Ở tuổi dậy thì sự gia tăng các nội tiết tố sinh dục nam gọi là Androgen làm cho các tuyến nang lớn hơn và tiết nhiều chất nhầy.
* Inflammation, skin irritation or scratching of any sort will activate inflammation. Anti-inflammatories are known to improve acne.	*Viêm nhiễm, kích ứng da hoặc làm trầy xước bất cứ phần nào cũng sẽ kích thích tình trạng viêm. Các thuốc kháng viêm được biết đến như là cách để cải thiện mụn trứng cá.
* Stress, through increased output of hormones from the adrenal (stress) glands. While the connection between acne and stress has been debated, scientific research indicates that "increased acne severity" is "significantly associated with increased stress levels." The National Institutes of Health (USA) list stress as a factor that "can cause an acne flare." A study of adolescents in Singapore "observed a statistically significant positive correlation […] between stress levels and severity of acne."	*Stress, thông qua sự tăng sinh hormone từ tuyến thượng thận.Trong khi đó mối liên hệ giữa Stress và sự hình thành mụn đã được tranh luận.Các nghiên cứu khoa học đã cho thấy rằng “sự gia tăng nghiêm trọng mụn trứng cá” là “có sự liên hệ đáng kể với mức gia tăng Stress”. Viện y tế quốc gia ( Mỹ) đã đưa ra các dẫn chứng cho thấy rằng Stress như là một yếu tố “ có thể gây nổi mụn trứng cá một cách bất ngờ” . Một nghiên cứu của thanh thiếu niên tại Singapo “ quan sát thống kê thấy có mối tương quan tích cực giữa mức độ Stress và mức độ nghiêm trọng của mụn trứng cá”.
* Hyperactive sebaceous glands, secondary to the three hormone sources above.	*Các tuyến nhờn tăng hoạt, là triệu chứng thứ phát của ba nguồn nội tiết tố trên.
* Accumulation of dead skin cells that block or cover pores.	* Sự tích luỹ của các tế bào da tạo thành khối che lấp lỗ chân lông.
* Bacteria in the pores. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. In-vitro resistance of P. acnes to commonly used antibiotics has been increasing.	* Vi khuẩn ở trong các lỗ chân lông. Vi khuẩn Propionibacterium (P. acnes) thuộc loại vi khuẩn kị khí là nguyên nhân gây mụn trứng cá. Vi khuẩn P. acnes trong môi trường phòng thí nghiệm ngày càng tăng khả năng kháng các loại thuốc kháng sinh được sử dụng nhiều.
* Use of anabolic steroids.	* Sử dụng chất kích thích (steroidtăng chuyển hóa)
* Any medication containing lithium, barbiturates or androgens.	* Bất kỳ các loại thuốc có chứa các thành phần như lithium, barbiturates hoặc androgen.
* Exposure to certain chemical compounds. Chloracne is particularly linked to toxic exposure to dioxins, namely Chlorinated dioxins.	* Tiếp xúc với các hợp chất hoá học nhất định. Chứng ban Clo thì đặc biệt liên quan đến việc phơi nhiễm Dioxin, cụ thể là dioxin đã bị clo hoá.
* Exposure to halogens. Halogen acne is linked to exposure to halogens (e.g. iodides, chlorides, bromides, fluorides).	* Tiếp xúc với các nguyên tố hoá học thuộc nhóm Halogen. Mụn trứng cá có liên quan đến việc phơi nhiễm các Halogen ( ví dụ iodides, clorua, bromua, florua)
* Chronic use of amphetamines or other similar drugs.	* Bị mãn tính do sử dụng các chất kích thích hoặc các loại thuốc tương tự.
Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I). In addition, acne-prone skin has been shown to be insulin resistant.	Một số hormone có liên quan đến mụn trứng cá như :Testosterone Androgen, dihydrotestosterone (DHT) và dehydroepiandrosterone sulfate (DHEAS), cũng như là yếu tố tăng trưởng giống insulin 1(IGF-1). Ngoài ra, da dễ bị mụn trứng cá được thấy là hay kháng insulin.
Development of acne vulgaris in later years is uncommon, although this is the age group for Rosacea which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).	Sự phát triển của mụn trứng cá (viêm nang bã) ở những năm lớn tuổi hơn thì không còn phổ biến, mặc dù đây là nhóm tuổi của chứng trứng cá đỏ cái mà cũng có hình thức tương tự. Chứng viêm nang bã do mụn trứng cá ở phụ nữ trưởng thành có thể là đặc điểm chính của một tình trạng như mang thai và các rối loạn như hội chứng buồng trứng đa nang hay hội chứng phát phì hay hội chứng Cushing hiếm gặp. Vào thời kỳ mãn kinh, mụn trứng cá xuất hiện có liên quan đến sự sụt giảm lượng hormone Estradiol-hormone ngừa mụn trứng cá. Việc thiếu estradiol cũng là nguyên nhân làm cho tóc thưa đi, các cơn nóng bừng, da bị mỏng, nhiều nếp nhăn, khô âm đạo và có báo hiệu giảm mật độ xương, và loãng xương cũng như gây ra mụn trứng cá (trong trường hợp này gọi là mụn tiền mãn kinh).
Diet Chocolate The popular belief that chocolate intake, in and of itself, is a cause of acne is not supported by scientific studies. As discussed below, various studies point not to chocolate, but to the high glycemic nature of certain foods containing simple carbohydrates as a cause of acne. Chocolate itself has a low glycemic index.	Chế độ ăn uống Socola Có nhiều quan niệm cho rằng ăn socola là nguyên nhân gây mụn trứng cá nhưng lại không có bằng chứng khoa học nào cho thấy điều này. Như thảo luận dưới đây, các nghiên cứu chỉ ra rằng không phải socola là nguyên nhân, mà nguyên nhân chính là do hàm lượng Glycemic cao trong các thực phẩm carbohydrates đơn là nguyên nhân gây ra mụn. Bản thân socola lại có hàm lượng Glycemic thấp.
Milk Recently, three epidemiological studies from the same group of scientists found an association between acne and consumption of partially skimmed milk, instant breakfast drink, sorbet, cottage cheese, and cream cheese. The researchers hypothesize that the association may be caused by hormones (such as several sex hormones and bovine insulin-like growth factor 1 (IGF-1)) or even iodine present in cow milk.	Sữa Gần đây, ba nghiên cứu dịch tể học từ cùng một nhóm các nhà khoa học đã tìm thấy mối liên quan giữa mụn và sữa đã tách kem một phần, thức uống nhanh bữa sáng, sorbet, phô mai và kem phomat. Hiệp hội các nhà nghiên cứu đã đưa ra giả thiết rằng có thể là do kích thích tố (hormone giới tính và một số yếu tố tăng trưởng giống Insulin 1 ở bò (IGF-1) hoặc thậm chí i-ốt có trong sữa bò.
Carbohydrates The long-held belief that there is no link between diets high in refined sugars and processed foods, and acne, has recently been challenged. The previous belief was based on earlier studies (some using chocolate and Coca-Cola) that were methodologically flawed. The recent low glycemic-load hypothesis postulates that rapidly digested carbohydrate foods (such as soft drinks, sweets, white bread) produce an overload in blood glucose (hyperglycemia) that stimulates the secretion of insulin, which in turn triggers the release of IGF-1. IGF-1 has direct effects on the pilosebaceous unit (and insulin at high concentrations can also bind to the IGF-1 receptor) and has been shown to stimulate hyperkeratosis and epidermal hyperplasia. These events facilitate acne formation. Sugar consumption might also influence the activity of androgens via a decrease in sex hormone-binding globulin concentration.	Carbohydrates Lâu nay có nhiều quan niệm cho rằng không có mối liên hệ giữa chế độ ăn giàu đường tinh chế, thực phẩm chế biến và mụn trứng cá, nhưng gần đây quan niệm này đã không còn được thừa nhận. Quan niệm cũ dựa trên các nghiên cứu trước đó (sử dụng một số socola và cocacola) đã sai về mặt phương pháp. Gần đây các giả thiết về tải Glycemic thấp cho rằng các thức ăn carbohydrate tiêu hóa nhanh chóng (như nước ngọt, kẹo, bánh mì trắng) tạo nên một tình trạng quá tải về lượng đường trong máu (tăng đường huyết), kích thích sự tiết insulin từ đó kích thích sản xuất IGF-1. IGF-1 có tác dụng trực tiếp trên các đơn vị pilosebaceous (và insulin ở nồng độ cao cũng gắn vào các thụ thể IGF-1), từ đó đã kích thích tăng nang và tăng sinh biểu bì. Điều này đã tạo điều kiện cho sự hình thành mụn. Sự tiêu dùng đường cũng có thể ảnh hưởng đến hoạt động của Androgen thông qua giảm nồng độ globulin gắn hormone sinh dục.
In support of this hypothesis, a randomized controlled trial of a low glycemic-load diet improved acne and reduced weight, androgen activity and levels of insulin-like growth factor binding protein-1. High IGF-1 levels and mild insulin resistance (which causes higher levels of insulin) had previously been observed in patients with acne. High levels of insulin and acne are also both features of polycystic ovarian syndrome.	Để hỗ trợ cho giả thuyết này, một thử nghiệm ngẫu nhiên với một chế độ ăn uống có tải Glyccemic thấp đã cải thiện mụn trứng cá và giảm trọng lượng, hoạt động của Androgen và nồng độ của protein-1 gắn yếu tố tăng trưởng giống insulin. Nồng độ IGF-1 tăng cao và đề kháng với insulin nhẹ (mà nguyên nhân là tăng nồng độ insulin) trước đây đã được quan sát ở bệnh nhân mụn trứng cá. Nồng độ cao insulin và mụn trứng cá là đặc điểm của bệnh buồng trứng đa nang.
According to this hypothesis, the absence of acne in some non-Westernized societies could be explained by the low glycemic index of these cultures' diets. It is possible that genetic reasons account for there being no acne in these populations, although similar populations (such as South American Indians or Pacific Islanders) do develop acne. Note also that the populations studied consumed no milk or other dairy products.	Theo giả thuyết này thì mụn trứng cá không xuất hiện ở các cộng đồng người phương Tây không thể được giải thích bởi chỉ số Glycemic thấp hay chế độ ăn uống của nền văn hoá. Có thể là lí do di truyền đã làm một nguồn gen không có mụn trứng cá trong quần thể, mặc dù những quần thể giống nhau (như là người Anh-điêng hay dân đảo Thái Bình Dương) lại có mụn trứng cá. Lưu ý rằng những quần thể được nghiên cứu không tiêu thụ sữa và các sản phẩm từ sữa.
Further research is necessary to establish whether a reduced consumption of high-glycemic foods, or treatment that results in increased insulin sensitivity (like metformin) can significantly alleviate acne, though consumption of high-glycemic foods should in any case be kept to a minimum, for general health reasons. Avoidance of "junk food" with its high fat and sugar content is also recommended.	Nghiên cứu thêm là cần thiết để xác định liệu rằng một loại thực phẩm tiêu thụ làm giảm lượng đường huyết cao, hoặc điều trị có kết quả nhạy với sự tăng lên của insulin một cách đáng kể (như metformin) có thể làm giảm mụn trứng cá. Mặc dù mức tiêu thụ các loại thực phẩm giàu Glycemic trong các trường hợp nên được giữ ở mức tối thiểu, vì lí do sức khoẻ nói chung. Tránh “ăn vặt” với các thức ăn giàu chất béo và đường.
Vitamins A and E Studies have shown that newly diagnosed acne patients tend to have lower levels of vitamin A circulating in their bloodstream than those who are acne free. In addition people with severe acne also tend to have lower blood levels of vitamin E.	Vitamin A và E. Các nghiên cứu cho thấy rằng ở những bệnh nhân mới được chẩn đoán bị mụn trứng cá thì có khuynh hướng có nồng độ vitamin A trong máu thấp hơn những người không bị mụn trứng cá. Ngoài ra ở những người bị mụn trứng cá nặng thì có nồng độ vitamin E trong máu cũng thấp hơn.
Hygiene Acne is not caused by dirt. This misconception probably comes from the fact that blackheads look like dirt stuck in the openings of pores. The black color is not dirt but simply oxidised keratin. In fact, the blockages of keratin that cause acne occur deep within the narrow follicle channel, where it is impossible to wash them away. These plugs are formed by the failure of the cells lining the duct to separate and flow to the surface in the sebum created there by the body. Built-up oil of the skin can block the passages of these pores, so standard washing of the face could wash off old oil and help unblock the pores.	Vệ sinh Mụn trứng cá không phải do bụi bẩn. Quan niệm sai lầm này có lẽ xuất phát từ thực tế là mụn đầu đen thì trông giống như là bụi bẩn bị mắc kẹt trong các lỗ chân lông. Màu đen này không phải là đất mà đơn giản là Keratin bị oxy hoá. Trong thực tế những tắc ngẽn của keratin xảy ra ở sâu bên trong các nang lông hẹp là nguyên nhân gây nên mụn trứng cá, nơi mà không thể được rửa sạch. Các nút ngẽn được hình thành do các tế bào niêm mạc bị đào thải đã làm tắc các kênh và dòng chảy riêng biệt vận chuyển các chất nhờn trên bề mặt của cơ thể. Nếu lượng dầu của da tăng thêm có thể sẽ làm bít các lỗ chân lông do đó việc rửa mặt có thể làm sạch lượng dầu này đi và ngăn sự bít các lỗ chân lông.
Translated by Đoàn Tôn Lĩnh, Class Y2B- Group 4	Dịch giả: Đoàn Tôn Lĩnh, Lớp Y2B- nhóm 4