Acne Vulgaris

– An inflammatory disease of the sebaceous glands and hair follicles characterized by comedones, papules, pustules, nodules, and pus-filled cysts on or under the skin on the face, neck, chest, or upper back.

Causes and Incidence

The etiology is unknown, although genetics, hormonal dysfunction, and oversecretion of sebum are strongly implicated. Predisposing factors include cosmetics, stress, steroids and other drugs, oral contraceptives, mechanical skin irritants, and climate. Acne usually begins in puberty and affects about 80% of adolescents in some form. Males are affected more often, but females have more severe and more prolonged cases.

Disease Process

Androgenic activity increases oil production and the size of the sebaceous glands. Intrafollicular hyperkeratosis occurs, and the hair follicles in the sebaceous gland are blocked as comedones (blackheads and whiteheads) consisting of sebum, keratin, and microorganisms are formed. As these comedones enlarge, they become visible and palpable on the skin’s surface, often forming cysts. The enlarged follicle eventually ruptures and the contents are released into the dermis, setting up an inflammatory reaction and forming abscesses. Chronic and recurring lesions form distinctive acne scars.

Symptoms

Typical presenting signs of superficial acne include comedones and pustules. Deep acne is characterized by inflamed nodules, pus-filled cysts, abscesses, and sometimes scarring.

Potential Complications

Permanent scarring is the most common complication.

Diagnostic Tests

Diagnosis is by physical examination.

Treatments

Treatment varies, depending on the severity of the acne. Mild cases are often self-treated with over-the-counter preparations.

Surgery
Excision of large cysts and abscesses; cryosurgery to freeze cysts and nodules; dermabrasion for scarring.

Drugs
Topical antimicrobial and antiinfective drugs, as well as comedolytics, for pustules; oral antiinfective drugs to reduce and prevent pustules; isotretinoin if antibiotics are unsuccessful; oral estrogenprogesterone for unresponsive, menses-related acne.

General
Extraction of comedones; instruction not to pick or squeeze comedones or pustules; emotional support to boost self-esteem.

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