Acne vulgaris is one of the most common skin problems affecting youth as a result of obstruction and inflammation of pilosebaceous units,and is thought to be caused by multiple factors. Excessive production of a normal oil on the skin, known as sebum. This, coupled with insufficient shedding of exfoliating dead skin cells, plugs hair follicles. The plugged follicles are inflamed and have an increase growth of bacteria, Propionibacterium acnes.
Acne – Who’s at risk?
Acne affects 85% of people at one point in their lives, and usually starts with puberty. Acne may last in the thirties and beyond. In fact, 5% of people over 45 still have acne. People of all ethnic backgrounds get acne
Signs & Symptoms
Acne vulgaris is characterized by non-inflammatory, open or closed comedones and by inflammatory papules, pustules and tubers. Acne vulgaris usually affects the areas of the skin with the closest population of sebaceous follicles (eg, face, upper chest, back). Local symptoms of acne vulgaris vary and may include pain, tenderness or erythema.
Systemic symptoms are usually absent in acne vulgaris. Severe acne with associated systemic symptoms, such as fever, is referred to as acne fulminans. Serious acne characterized by multiple comedones, without the presence of systemic symptoms, is known as acne conglobata. This severe form of acne often cures with disinfective scars. In addition, acne vulgaris may have a negative psychological impact on any patient, regardless of the severity or degree of disease
Acne vulgaris is a clinical diagnosis. Examination in patients with acne vulgaris includes the following characteristics:
Comedonal acne: presence of open and closed comedones, but usually no inflammatory pills or tubers
Mild acne: Presence of comedones with a few papulopustules
Moderate acne: Presence of comedones, inflammatory papules and pustules; A larger number of lesions are present than with mild inflammatory acne
Nodulocystic Acne: Presence of comedones, inflammatory lesions and large nodules greater than 5 mm in diameter; Scars are often deep
It is important to treat acne to reduce the extent of illness, scars and psychological distress. Treatment of acne includes a variety of topical and systemic agents aimed at reducing sebum production, comedonation, inflammation and bacterial counts and in normalization of keratinization.
A lower glycemic diet and moderation of milk intake can be considered for treatment-resistant adolescent acne.
Benzoyl peroxide and / or combinations with erythromycin or clindamycin have been found effective for acne treatment.Benzoyl peroxide is effective in preventing bacterial resistance and is recommended for patients in topical or systemic antibiotic therapy.Topical antibiotics (eg erythromycin and clindamycin) are effective acne treatments, but are not recommended as monotherapy due to the risk of bacterial resistance.Topical retinoids have been found effective and is recommended as monotherapy in predominantly comedonic acne, or in combination with topical or oral antimicrobial agents in patients with mixed or mainly inflammatory acne lesions.
The use of systemic antibiotics, other than the tetracyclines and macrolides, is discouraged as there are limited data for their use in acne. Systemic antibiotics are recommended in the management of moderate and severe acne, and forms of inflammatory pain that are resistant to current treatments.
Systemic use of antibiotics must be limited to the shortest possible duration, usually 3 months, to minimize the development of bacterial resistance. The use of trimethoprim sulfamethoxazole and trimethoprim should be restricted to patients who can not tolerate tetracyclines or treatment-resistant patients.
Doxycycline and minocycline are more effective than tetracycline, but not superior to each other.Although oral erythromycin and azithromycin may be effective in treating acne, its use should be limited to those who can not use the tetracyclines (i.e., pregnant women or children under 8 years of age). The use of erythromycin should be limited by the increased risk of bacterial resistance.
Oral estrogen-contraceptives are effective and are recommended in the treatment of inflammatory acne in women.Oral corticosteroid therapy may be of temporary importance in severe inflammatory acne while starting treatment with standard acne.In patients with well-documented adrenal hyperandrogenism, low doses of oral corticosteroids are recommended in the treatment of acne.
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