Acne

Acne is a skin condition that causes whiteheads, blackheads, and inflamed red lesions to form on the face and body. These acne growths are commonly called pimples or “zits.” Acne is the result of excessive oil production in the skin. Acne is not the result of diet or hygiene, rather it is usually related to genetics. Every pore in the body contains a hair and oil gland. When glands produce too much oil, the excess oil attracts fragments of dirt, debris, and bacteria leading to infection or a blockage in the pore. When a plug has formed in a pore the top or head of the plug may be white (whitehead) or dark (blackhead). If the plug ruptures, the infectious contents can spread causing inflammatory reactions in other areas of the skin. The deeper the infection is in the skin, the more firm and cyst like the plug will become.

Affects
>80% of adolescents
>40% of adults over than 25
Genetics plays a role Associated with

• Disfigurement
• Pain
• Loss of confidence
• Depression

Effects on quality of life are comparable to those suffering from chronic diseases like asthma, seizures and diabetes

PATHOPHYSIOLOGY

• Typically begins at puberty.
• Disorder of the pilosebaceous unit (face, neck, chest, shoulders, back).
• Increased androgen production leads to increased sebum. Abnormal keratinization and desquamation obstructs the pilosebaceous duct and Propionibacterium acnes proliferates in excess sebum and breaks down sebum into free fatty acids. Proinflammatory mediators are activated and result in inflammatory acne.

EXTRINSIC INFLUENCES

• Friction and manipulation
• Occlusive products
• Close fitting sports equipment

Management

1. Steroids
2. Antiepileptics
3. Progestin only contraceptives

DIET, STRESS and ACNE

• Controversial link between diet and acne although many patients believe that their acne is influenced by certain foods
• Western diet may be associated with acne
• Skim milk is associated with acne in teenage girls
• Stress: acne among university students was associated with exam stress

CLINICAL FEATURES
Mild acne

• Comedomes:

1. Closed (whiteheads) are closed flesh colored papules 1-3mm in size
2. Open (blackheads) are open and the contents of the comedome oxidizes upon expose to the light (tyrosine is oxidized to melanin)

Moderate acne

• Comedomes/Papules/Pustules

Severe acne

• Papules/Pustules/Nodulocystic lesions
• Postinflammatory changes can occur with healing and resolve over time
• Risk of scarring
• Mild acne low risk
• Moderate acne medium risk
• Severe acne high risk  c/o punctate depressions (ice-pick scars), depressed scars (thumbprint scars), hypertrophic papular scars, keloids

DIFFERENTIAL DIAGNOSIS

• Keratosis pilaris
• Perioral dermatitis
• Angiofibromas
• Pseudofolliculitis barbae
• Acne keloidalis nuchae
• Folliculitis
• Hidradentis suppurativa

MANAGEMENT

• Basic skin care
• No washing, scrubbing or picking
• Cleanse with a gentle soap, may contain salicylic acid, glycolic acid or benzoyl peroxide
• If moisturize use noncomedogenic agent
• Based on skin type, choose appropriate vehicle for topical treatments
• Oily (solutions, gels, pledgets)
• Combination (lotions)
• Dry (cream, ointment)