Definition:
Flaking is a symptom of seborrheic dermatitis. Joseph Bark notes that "Redness and itching is actually seborrheic dermatitis, and it frequently occurs around the folds of the nose and the eyebrow areas, not just the scalp.

Symptoms:
Dry, thick, well-defined lesions consisting of large, silvery scales may be traced to the less common psoriasis of the scalp.

Causes:
Seasonal changes, stress, and immuno-suppression seem to affect seborrheic dermatitis.

Treatment:
Soaps and detergents such as Sodium Lauryl Sulfate may precipitate a flare-up, as they strip moisture from the top layers of the skin, and the drying property of these can cause flare-ups and may worsen the condition. Accordingly a suitable alternative should be used instead.

Among dermatologist recommended treatments are:
► Shampoos containing coal tar, Ketoconazole e.g. Ketoderm cream, selenium sulfide, or zinc pyrithione.
► For severe disease, keratolytics such as salicylic acid e.g. Sorana ointment or coal tar preparations may be used to remove dense scale.
► Topical terbinafine solution (1%) has also been shown to be effective in the treatment of scalp seborrhea.
► Lotions containing alpha hydroxy acids or corticosteroids.
► Chronic treatment with topical corticosteroids may lead to permanent skin changes, such as atrophy and telangiectasia.
► UV-A and UV-B light inhibit the growth of M. furfur, although caution should be taken to avoid sun damage.

Acne vulgaris
Definition:
Acne is an inflammatory disease of the skin, caused by changes in the pilosebaceous units . Acne lesions are commonly referred to as pimples, spots or zits.

Causes:
It is considered an abnormal response to normal levels of the male hormone testosterone. The condition is most common in puberty and the response for most people diminishes over time and acne thus tends to disappear, or at least decrease, after one reaches their early twenties.

The pilosebaceous unit (PSU) of the skin consists of the sebaceous gland and the hair follicle.
The sebaceous gland secretes an oily substance called sebum which protects the hair and skin and prevents them from drying and irritation.

Sebum may collect excessively as a result of:
► Poor hygiene
► Genetic predisposition
► Diet
► Use of anabolic steroids
► Hormonal activity, such as menstrual cycles and puberty.
► Hyperactive sebaceous glands, secondary to the three hormone sources above.
► Accumulation of dead skin cells.
► Bacteria in the pores, to which the body becomes 'allergic'.
► Skin irritation or scratching of any sort will activate inflammation.
► Stress, through increased output of hormones from the adrenal (stress) glands.
► Any medication containing halogens (iodides, chlorides, bromides), lithium, barbiturates, or androgens.
► Exposure to high levels of chlorine compounds, particularly chlorinated dioxins, can cause severe, long-lasting acne, known as Chloracne.

Symptoms:
Overproduction of sebum is related to the disease called acne or commonly pimples. Commonly involved areas are the face, neck, chest, shoulders and upper back.
During an acne breakout, the pore of the hair follicle is plugged by a mixture of sebum and cells that line the hair follicle. The trapped sebum allows bacteria to grow in the plugged follicles. This forms the primary acne lesion called a comedone. There are of 2 types of comedones, whiteheads and blackheads. At times, these may develop into an infection in the skin pore (pimple).
Whiteheads: When the sebum and bacteria stay below the skin surface, a whitehead is formed.
Blackheads: Occurs when the trapped sebum and bacteria partially open to the surface and turn black due to melanin, the skin's pigment.

Severe acne can produce hundreds of pimples that cover large areas of skin. Cystic lesions are pimples that are large and deep. These lesions are often painful and can leave scars on your skin.
It can last for a few months, many years, or come and go your entire life.
These conditions need treatment along with the acne.
Aside from scarring, its main effects are psychological, such as reduced self-esteem and depression or suicide.

Timeline of acne treatment:
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: Benzyl Peroxide is used
1930s: Laxatives were used as a cure for what were known as 'chastity pimples'
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.
1960s: Tretinoin (original Trade Name Retin A) was found effective for acne. This proceeded the development of oral Isoretinoin (sold as Accutane and Roaccutane) since the early 1980s.
1990s: Laser treatment introduced
2000s: Blue/red light therapy
Some old treatments, like laxatives, have fallen into disuse but others, like spas, are recovering their popularity.

Treatment includes:
► Keratolytics (e.g. Sorana ointment)
► Antibiotics (Erythromycin tablets)
► Retinoids
► Isoretinoin in severe cases
► Hormone Therapy
► Spiromide (spironolactone) for women

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