Acne Vulgaris – Dermatologic Disorders – Professional Version

Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). Acne develops on the face and upper trunk. It most often affects adolescents. Diagnosis is by examination. Treatment, based on severity, can involve a variety of topical and systemic agents directed at reducing sebum production, comedone formation, inflammation, and bacterial counts and at normalizing keratinization.

Jonette E. Keri , MD, PhD
Acne is the most common skin disease in the US and affects 80% of the population at some point in life.

Pathophysiology

Acne happens through the interaction of four major factors:

  • Excess secretion production
  • Follicular plugging with secretion and keratinocytes
  • Colonization of follicles by Propionibacterium acnes (a traditional human anaerobe)
  • A release of multiple inflammatory mediators

Acne may be classified as

  • Noninflammatory: characterized by comedones
  • Inflammatory: characterized by papules, pustules, nodules, and cysts

Noninflammatory acne

Comedones square measure fatty plugs wedged at intervals follicles. they’re termed open or closed reckoning on whether or not the vesicle is expanded or closed at the skin surface. Plugs square measure simply extruded from open comedones however square measure tougher to get rid of from closed comedones. Closed comedones square measure the precursor lesions to inflammatory acnes.

Inflammatory acne     

Papules and pustules occur once P. acnes colonizes the closed comedones, breaking down secretion into free fatty acids that irritate the vesicle animal tissue ANd eliciting an inflammatory response by neutrophils and so lymphocytes, that more disrupts the animal tissue. The inflamed vesicle ruptures into the corium (sometimes precipitated by physical manipulation or harsh scrubbing), wherever the comedone contents elicit an extra native inflammatory reaction, manufacturing papules. If the inflammation is intense, grossly putrid pustules occur.

Nodules and cysts square measure alternative manifestations of inflammatory acnes. Nodules square measure deeper lesions that will involve > one vesicle and cysts square measure giant fluctuant nodules.

Etiology

The most common trigger is

  • Puberty

During pubescence, surges in androgenic hormone stimulate secretion production and hyperproliferation of keratinocytes.

Other triggers include

  • Hormonal changes that occur with physiological state or the oscillation
  • Occlusive cosmetics, cleansers, lotions, and covering
  • High wetness and sweating

Associations between acne exacerbation and diet, inadequate face laundry, autoeroticism, and sex square measure unsupported. Some studies counsel an attainable association with milk production and high-glycemic diets. acne might abate in summer months as a result of sunlight’s medication effects. projected associations between acne and hyperinsulinism need more investigation. Some medication and chemicals (eg, corticosteroids, lithium, phenytoin, isoniazid) worsen acne or cause acne eruptions.

Symptoms and Signs

Skin lesions and scarring may be a supply of serious emotional distress. Nodules and cysts may be painful. Lesion varieties oft exist at completely different stages.

Read more:  What Is Cystic Acne and How Is It Treated?

Comedones seem as whiteheads or blackheads. Whiteheads (closed comedones) square measure flesh-colored or whitish palpable lesions one to three metric linear unit in diameter; blackheads (open comedones) square measure similar in look however with a dark center.

Papules and pustules square measure red lesions two to five metric linear unit in diameter. Papules square measure comparatively deep. Pustules square measure a lot of superficial.

Nodules square measure larger, deeper, and a lot more solid than papules. Such lesions jibe inflamed epidermoid cysts, though they lack true cystic structure.

Cysts square measure bodily function nodules. Rarely, cysts kind deep abscesses. long cystic acne will cause scarring that manifests as little and deep pits (icepick scars), larger pits, shallow depressions, or hypertrophic scarring or keloids.

Acne conglobata is that the most severe style of acne, touching men over girls. Patients have abscesses, exhausting sinuses, fistulated comedones, and keloidal and symptom scars. the rear and chest square measure severely concerned. The arms, abdomen, buttocks, and even the scalp could also be affected.

Acne fulminans is an acute, febrile, lesion acne, characterized by the fast look of convergent abscesses resulting in hurt gangrene. leucocytosis and joint pain and swelling may additionally be a gift.

Pyoderma faciale (also known as acne fulminans) happens suddenly on the midface of young girls. it’s going to be analogous to acne fulminans. The eruption consists of erythroderma plaques and pustules, involving the chin, cheeks, and forehead. Papules and nodules might develop and become convergent.

Diagnosis

  • Assessment for conducive factors (eg, hormonal, mechanical, or drug-related)
  • Determination of severity (mild, moderate, severe)
  • Assessment of psychosocial impact

The diagnosis of acne is by examination.

Differential diagnosis includes acne (in that no comedones square measure seen), corticosteroid-induced acne (which lacks comedones and during which pustules square measure typically within the same stage of development), perioral eczema (usually with a lot of perioral and periorbital distribution), and acne drug eruptions (see Table: varieties of Drug Reactions and Typical conducive Agents). acne severity is stratified gentle, moderate, or severe supported the amount and kind of lesions; a consistent system is made public in table Classification of acne Severity.

Prognosis

Acne of any severity typically remits ad lib by the first to middle 20s, however a considerable minority of patients, typically girls, might have acne into their 40s; choices for treatment could also be restricted as a result of childbearing. several adults sometimes develop gentle, isolated acne lesions. unprovoking and gentle inflammatory acne typically heal while not scars. Moderate to severe inflammatory acne heals however typically leaves scarring. Scarring isn’t solely physical; acne could also be an enormous emotional agent for adolescents WHO might withdraw, exploitation the acne as AN excuse to avoid troublesome personal changes. confirmative content for patients and oldsters could also be indicated in severe cases.

Read more:  Acne Vulgaris - Practice Essentials

Treatment

  • Comedones: Topical tretinoin
  • Mild inflammatory acne: Topical retinoid alone or with a topical antibiotic, peroxide, or both
  • Moderate acne: Oral antibiotic and topical medical care as for gentle acne
  • Severe acne: Oral isotretinoin
  • Cystic acne: Intralesional Kenalog

It is vital to treat illness|disease of the skin|skin disorder|skin problem|acne|inflammatory disease} to scale back the extent of disease, scarring, and psychologic distress.

Treatment of acne involves a range of topical and general agents directed at reducing secretion production, comedone formation, inflammation, and microorganism counts and at normalizing biological process (see Figure: however varied medication add treating a acne.). choice of treatment is usually supported severity; choices square measure summarized in table medication wont to Treat acne. cf pointers of look after the management of acne from the yank Academy of medicine.

Affected areas ought to be clean daily, however further laundry, use of antibacterial drug soaps, and cleanup confer no additional advantage.

A lower glycemic diet and moderation of milk intake could be thought of for treatment-resistant adolescent acnes.

Peeling agents like sulfur, 2-hydroxybenzoic acid, acid, and phenol may be helpful therapeutic adjuncts however are not any longer usually used.

Oral contraceptives square measure effective in treating an inflammatory and unprovoking acne, and Aldactone (beginning at fifty mg PO once/day, magnified to one hundred mg PO once/day when a couple of mo if needed) is another anti-androgen that’s sometimes helpful in girls. varied lightweight therapies, with and while not topical photosensitizers, are used effectively, largely for an inflammatory acne.

Treatment ought to involve educating the patient and craft the arrange to one that’s realistic for the patient. Treatment failure will oft be attributed to a lack of adherence to the arrange and additionally to lack of follow-up. Consultation with a specialist could also be necessary.

How various drugs work in treating acne

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