Acne is one of the common skin condition affecting teenage years. Acne tends to resolve in the third decade of life but some can persist until 40 years old. The exact mechanisms of causing Acne are not fully understood. It is thought to be caused by familial tendency, exogenous and endogenous hormones, Propionibacterium acnes (acne bacteria), inflammation, distension and occlusion of hair follicles.

Flares of Acne are triggered by:

  • Polycystic ovarian syndrome
  • Certain medications such as steroids, hormones, anticonvulsants and etc
  • Applications of occlusive comestics
  • High environmental humidity
  • Diet high in dairy products and high glycaemic foods

Acne most commonly affects those areas of the body that have the largest, hormonally-responsive sebaceous glands, including the face, neck, chest, upper back and upper arms. Features include open comedones (blackheads), closed comedones (whiteheads), inflammed papules and pustules. In severe Acne, scarring and postinflammatory hyperpigmentation can occur, which can be greatly distressing for patients.

Coeliac disease is also known as gluten-sensitive enteropathy and nontropical sprue which affects approximately one in 70 Australians. Coeliac disease usually present between the ages of 10 and 40 years. Children with life-threatening malabsorption from coeliac disease are rarer nowadays due to longer periods of breast-feeding and the later introduction of gluten in the infant diet. Foods thats contain gluten caused damage to lining of small intestine and impair absorption of nutrients. This leads to malnutrition, osteoporosis, depression, infertility, iron deficiency anaemia and small increased risk of lymphoma of bowel. It also can cause skin rash such as dermatitis herpertiformis. Coeliac disease is closely associated with type 1 diabetes mellitus and polyglandular autoimmune syndrome type III (autoimmune thyroiditis).

Foods that contain gluten are as follows:

  • Barley
  • Rye
  • Oats - consumption should be limited to 50 to 60g/day in mild disease or those in remission. Patients with severe coeliac disease should avoid oats altogether
  • Wheat

 Many patients with coeliac disease can have secondary lactose intolerance.

Trigeminal neuralgia is characterised by recurrent brief episodes of one-sided electric shock-like pains, sudden onset and termination, in the distribution of one or more divisions of the trigeminal nerve that are typically triggered by light touch on face. Trigeminal neuralgia is a rare condition that affects women more than men. Trigeminal neuralgia is commonly seen more in the older adult population. The incidence increases gradually with age; most idiopathic cases begin after the age 50, although onset may occur in the second or third decades or, rarely, in children.

The trigeminal nerve is the 5th cranial nerve. It is the sensory supply to the face and the sensory and motor supply to the muscles of mastication (chewing). It has three major divisions:

  • Ophthalmic (V1)
  • Maxillary (V2)
  • Mandibular (V3)

 The nerve starts at the midlateral surface of the pons, and its sensory ganglion resides in Meckel's cave in the floor of the middle cranial fossa.

trigeminal nerve

Most common cause of trigeminal neuralgia is caused by compression of the trigeminal nerve root, usually within a few millimeters of entry into the pons. Compression by an artery or vein is thought to account for 80 to 90 percent of cases. Other causes of trigeminal nerve compression can be caused by vestibular schwannoma (acoustic neuroma), meningioma, epidermoid or other cyst, rarely, a saccular aneursym or arteriovenous malformation. The compression of the nerve leads to demyelination of the nerve causing the pain.