Acne (Acne Vulgaris)

A chronic disorder of the pilosebaceous unit affects almost everyone at one time or another.

Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). Acne can present as noninflammatory lesions, inflammatory lesions, or a mixture of both, affecting mostly the face but also the back and chest.

What is Acne?
  • Acne (Acne Vulgaris), popularly known as pimples that you develop on your face is nothing but a disorder of the hair units. These hair units are found everywhere on your body except for your soles, palms, and lips. Each hair unit is made up of a hair follicle, hair strand, oil gland, and tiny muscles. In this article, you will get a complete overview of the causes of Acne vulgaris, the Signs and symptoms of acne vulgaris, and all other factors.
  • When these hair units become clogged or infected they result in the formation of small bumps which are many a time painful to touch and yellow to dark red in color.
  • Acne usually affects teenagers and some young adults. About 90% of people tend to develop acne during their adolescence which can have a cosmetic and psychological impact. 
  • About 12-14% of cases might linger into adulthood with social and psychological ramifications. The below image represents the types of Acne, to know the causes and all signs and symptoms of acne vulgaris keep reading the article.


  • Acne may present in different forms such as comedones, papules, pustules, nodules, and cysts. It may differ in numbers, severity, and extent.


Cause of Acne
  1. Excess sebum (oil) in the skin: The oil-producing glands in the skin are stimulated by hormones after the onset of puberty to produce more oil. The oil may also become thickened which promotes clogging of the hair unit.
  2. Clogged pores (hair unit): The excess oil together with dead cells and bacteria forms a plug at the outlet of your hair unit. This clogs its opening which appears as black on the surface and is called a blackhead (open comedones). If the plug remains below the surface of the skin, it appears as white or pale white in color and is thus called whitehead (closed comedones).
  3. Bacterial infection: The bacteria called Propionibacterium acnes (P.acnes) infects these clogged hair units and results in swelling (inflammation). This is when your clogged pore becomes swollen and painful. The bacteria also initiate clogging of your hair unit resulting in comedones formation which also initiates acne formation.
  4. Inflammation: As swelling advances, it leads to the formation of large solid bumps that may get filled with pus called pustules, or filled with a relatively clear fluid called cysts.

Medical History
  • Cleanser and Moisturizer use
  • Cosmetic use
  • Corticosteroid use
  • Skin reaction irritant
  • Increased androgen level
  • Oral contraception

Findings
  • Acne keloid
  • Acne nodule
  • Closed comedones
  • Ice-pick acne scar
  • Open comedones
  • Papular eruption
  • Post-inflammatory hyperpigmentation
  • Pustule


Differential Diagnosis
  • Rosacea
  • Folliculitis
  • Gram-negative folliculitis
  • Plane wart
  • Perioral dermatitis
  • Milia
  • Steroid acne
  • Chlorine acne
  • Pseudofolliculitis barbae
  • Acne fulminans
  • Hidradenitis suppurativa
  • Miliaria
  • Fibrous skin tumor of tuberous sclerosis
  • Nodular elastosis with cysts AND comedones of Favre and Racouchot
  • Acne cosmetica
  • Acne Mechanica
  • Neonatal acne
  • Acne conglobata
  • Excoriated acne
  • Pyoderma faciale

Signs and Symptoms of Acne Vulgaris
  1. Mild Acne: Small, non–inflamed blackheads and whiteheads. Mostly found on the nose and forehead.
  2. A greater number and extent: of blackheads and whiteheads, now on cheeks, chin & jaw. Mildlynoticeable with redness and/or small pustules.
  3. Severe Acne:  Worsening redness and skin involvement.Increased number of papules and pustules. Can be easily seen and difficult to cover up. Scarring now becomes a concern.
  4. The most severe: Now referred to as “cystic acne” – a painful condition involving pustules, papules & large cysts. Often spreads from the face to other areas of the body such as the back. Scarring is nearly invisible.

Treatment of Acne

Topical therapy:
  1. Topical retinoids like Retinoic Acid, Adapalene, and Tretinoin are used alone or with other topical antibiotics or benzoyl peroxide.
  2. Topical antibiotics like Clindamycin 1% to 2%, Nadifloxacin 1%, and Azithromycin 1% gel and Lotion are available. Estrogen is used for grade 2 to Grade 4 acne.

Drug Therapy

Mild to Moderate Acne

BENZOYL PEROXIDE
Adults: Apply to the affected area once or twice daily

TRETINOIN (Related toxicological information in TRETINOIN AND RELATED AGENTS)
Adults: Apply to the affected area once nightly


ADAPALENE
Adults: Apply to the affected area once daily

TAZAROTENE
Adults: Apply to the affected area once nightly

ERYTHROMYCIN
Adults: 250-500 mg orally two to four times daily

CLINDAMYCIN HYDROCHLORIDE
Adults: 150 mg orally once or twice daily

SALICYLIC ACID (Related toxicological information in SALICYLATES)
Adults: Apply to the affected area once or twice daily

AZELAIC ACID (Related toxicological information in AZELAIC ACID)
Adults: Apply to the affected area once or twice daily

SULFACETAMIDE SODIUM
Adults: Apply to the affected area once or twice daily

DOXYCYCLINE
Adults: 50-100 mg orally once or twice daily

MINOCYCLINE HYDROCHLORIDE
Adults: 50-100 mg orally once or twice daily

TETRACYCLINE
Adults: 250-500 mg orally once or twice daily

SULFAMETHOXAZOLE/TRIMETHOPRIM
Adults: 1 double-strength tab (trimethoprim 160 mg/sulfamethoxazole 800 mg) orally twice daily

SPIRONOLACTONE
Adults: 50-200 mg orally daily in divided doses


Nonpregnant patients with severe acne

ISOTRETINOIN (Related toxicological information in ISOTRETINOIN)
Adults: 0.5-1 mg/kg/day orally in divided doses

Acne vulgaris in patients 12 years and older

CLINDAMYCIN PHOSPHATE/TRETINOIN
Adults: At bedtime, place a pea-sized amount on one fingertip and dot onto the chin, cheeks, nose, and forehead, then rub over the entire face.

Pediatrics (12 years): At bedtime, place a pea-sized amount on one fingertip and dot onto the chin, cheeks, nose, and forehead, then rub over the entire face

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