Acne vulgaris

Acne vulgaris is common in teenagers and young adults and hence is responsible for every damsel and young lad in distress!

And may lead to scarring (not only physically, but also emotionally), nonetheless it is a self limiting disorder.


PATHOGENESIS

Increased Sebum production after puberty ——>Retention of sebum and keratinous material in hair follicles ——->Blockage of follicular orifice——> Formation of comedones in follicles(small cysts) ———->Inside the comedones, Propionibacterium acnes release free fatty acids from sebum ——–>Inflammation in cysts ———–> Rupture of cyst wall ——–>Extrusion of oily and kerationous debris from cyst ——–>Inflammatory foreign body reaction.

There are 2 types of comedones:

Whitehead/ Closed: 1-2 mm pebbly white papules

Blackhead/ Open: Have a dilated follicular orifice and are filled with oily debris


COMMONLY AFFECTED PARTS: Face (Forehead, cheeks, nose, chin), Chest and Back.


AGGRAVATING FACTORS:

1)Friction and trauma

2)Comedogenic topical agents (hair preparations)

3)Glucocorticoids

4)OC Pills, Androgenic steroids, Phenytoin, Phenobarbitone

5)Genetic factors, PCOS


TREATMENT

Elimination of comedones forms the mainstay of treatment of acne vulgaris. It can be done by either of the following four ways:

1)Normalisation of follicular keratinisation: Retinoic acid, Bemzoyl peroxide or Salicylic acid

2)Decrease sebaceous gland activity

3)Decreasing the population of P.acnes: Erythromycin, Clindamycin or Azelaic acid.

4)Decreasing Inflammation: Tetracycline(250-500 mg bid), Doxycycline(100 mg bid) or Minocycline

*Females unresponsive to Oral Antibiotics may be recommended Hormonal therapy (OC Pills are now FDA approved for the treatment of acne).

*For patients with severe nodulocystic acne where above treatment does not work, Synthetic retinoid isotretinoin is used.


* Side effects of isotretinoin:

Extremely dry skin

Cheilitis

Hypertriglyceridemia

Teratogenic

Hairfall

So, acne vulgaris is characterised by presence of three types of lesions:

Comedones, Papules, Pustules


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