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Placibo  given to you to make you think you’re getting treatment

During drug trials:

Placibo Effect  you think you’re taking the treatment, but actually not, you’ll
end up recovering

 If you can think it, you can do it.

 due to psychological response rather than response to the drug

Acne can be disfiguring  scars if no proper care

Acne problem  take drugs  cause depression

Dermatologist  specialised in taking care of skin

Acne problem why they squeeze:

- Impatient (dinner, dance, ball, etc)

- Irritating (looks unlike you)

- Painful (persisting)

- Frustrated


Compare and contrast  squeeze and don’t squeeze

Inflammation is before or after squeeze

Relationship between antibiotics, WBC and acne

Peripheral blood: Blood in vein (that is not central to the main artery)

Chronic: inflammation at the joint, damaged of tissues

Difference between chronic and acute:

- Time

- Destruction

Delayed recover and fast recover

Chronic destroys healthy tissues

Immunosuppressive drug to suppress chronic treatment

Why important

Why does infected site swelling

Chemotactic factors

Swell, red, warm, pain

Why WBC increase / decrease due to zit problem?

Extravasation: Migration of WBCs from blood vessels into the tissue spaces.

Angiogenesis: Formation of blood at places it shouldn’t be

Pressure on skin kills cells

Sebum spreads across the pore.

Clogged pore  sebum unable to come out  no place to expand  expand

sideways  physical damage by increase in pressure

No matter how flexible the shaft is, its flexibility is limited

Fatty acid  pH unnatural

Bacterial produce enzyme to produce sebum

 All lead to physical and/or chemical stress

 Damage to cell follicles and the pores

Analogy: filling balloon with water  bigger, burst

Acute: leukocytes

Chronic: T cells and B cells


Pathogens cannot be removed

Immune disorder

Hypersensitivity and allergy

Histamine aids in permeability of vascular  ease of chemotactic

Complement c3: a protein produced to focus the neutrophils to location of


One of the chemotactic factors that will guide the neutrophils to the site

(Get its attention and focus on something.)

Antigen presenting cell (APC)  removal of dead cells, etc

Ragweed pollen attaches to B cell

B cell produces antibodies


Recognise it and releases histamine etc

Mast cell

IgE  Immunoglobulin (protein, different sub-class of antibodies)

Free radical damage  physical damage

Virus replicate  lyse themselves

Prime mast cell responds to pathogens’ 2nd invade?

Acne is a bacterium (propionibacterium acnes)

Antibiotic will reduce / kill bacterial around follicle

Reduce concentration of free fatty acids in sebum and reduces inflammatory


Steroids can cause acne as a side effect

Some cosmetic products such as moisturisers (oil present)

Nonimflammatory acne: whitehead  trapped sebum and bacteria below skin

Blackhead  pore opens to surface, sebum contains skin pigment melanin

oxidizes and turns a brown/black colour

Pop acne  more dirt & bacteria introduced into wound  cause infection 
permanent scarring 

Squeeze unripe pimple, contents will not come out  delay healing process

Press the infected sebum…

Does drinking water reduces pimples:

Yes, but not directly, as water helps to flush out impurities in our body.

Water has an anti-inflammatory effect on the body  helps to carry oxygen to

every cell in our body
Why secrete sebum?

- Minimize unnecessary vaporization of (?)

- Moisturize skin

- Mild anti-microbial effect

Dehydrated  body produces lot of heat  lose a lot of water  sebum

production will be maximized / optimized

One way to cool down  drink more water

Pimple formed

Part of dried up sebum squeezed out while rest will be ‘pushed into
(subcutaneous tissue)

Pimple disappear, but open wound

Wound closes if you take good care of it

Passed into blood circulation  spread

Open wound invites bacteria in surrounding to enter

Wound starts to heal  scarring due to promotion to inflammation

 Darkening of skin around pimple (when exposed to UV rays)

Acne bacteria eat dead cells and dirt trapped in your pores

B cells produce antibodies which are in your bloodstream and used

internally in your body

Since acne grows on surface of the skin, and not internally, the
antibodies have no effect on it (acne will still appear!)
Acne formation:

Mast cells release histamine from their histamine granules into the surrounding

Histamine diffuses into capillaries, causing them to dilate and become leaky.

Capillaries dilate  area appears red (redness)

Plasma leaks into the tissue  area swells (swelling)

Acne recovery:

Activated proteins called complement proteins and other chemicals (histamine)

attract phagocytes to the area (neutrophils, etc)

Phagocytes engulf and digest dead cells and bacteria  area is clear for new
cells to grow

Histamine and complement signalling cease  phagocytes are no longer

attracted to the area  tissue returns to normal

Consequences of popping acne:

- Tearing of skin

- Allowing bacteria to spread

- Severe infection and delay the healing process

- Permanent scarring

Antibiotics: 1. Oral 2. Physical


- reduces no. of bacteria found on skin and in follicles

- reduces concentration of free fatty acids in the sebum

- reduces inflammatory response

Pop acne  Skin trauma  Skin tear  increase damage into a bigger area 
diluting the overall focus of damage control  may damage blood vessels 
opening holes for rubbish to enter the blood stream

 damage to side as well as in depth  increase the extent of damage

Skin stem cells damaged  insufficient to regenerate new skin cells 

hole in the new layer of skin (after it gets pushed upwards)

Bacteria triggers microphages

Cytokines and chemokines are released

Increase in vascular permeability

WBC travels in to tissues

Antibiotics kill bacteria  reduce inflammatory response from WBCs

Reduction of inflammatory response with destruction of bacteria

If you have a cut, straight away there will be blood, redness, swelling

Do it in the clean room: would inflammation still exist?