Acne vulgaris is an inflammatory disorder of pilosebaceous follicles with a 90% prevalence in adolescence and young adulthood.
Etiology: Abnormal follicular keratinization, increased sebum secondary to androgens, Propionibacterium acnes (bacteria), inflammation.
History: Often asymptomatic lesions (especially comedones), although can be tender (nodules).
Physical Examination:Two types of lesions, predominantly affect face, neck, chest and back.
a. Noninflammatory—open (“black heads”) and closed (“white heads”) comedones.
b. Inflammatory—papules, pustules, cysts, nodules; deep lesions leave scars, inflammatory papules, pustules & nodules on back and check with early scarring.
Diagnosis: Folliculitis, perioral dermatitis, rosacea
Investigations: If irregular periods, hirsutism, virilization, or not responding to conventional therapy, work-up to rule out virilizing tumor or PCOS.
■ Other options: comedone extraction, intralesional cortisone injection (for papulonodules, cysts), oral contraceptives (esp. anti-androgenic such as cyproterone acetate, Yasmin®), photodynamic therapy, spironolactone (reduces androgen production; 50–200 mg/day); dermabrasion, chemical peels
■ Treatment improves cosmesis and psychosocial well-being, and helps prevent further scarring and hyperpigmentation.
■ Patients should be forewarned of acne exacerbations in the first month of systemic therapy as deep-seated acne comes to the surface. Also, systemic therapy can require 6 wk before benefits are noted.
■ Isotretinoin should be taken with a fatty snack or meal that has some fat in it
■ Care plan for Acne Vulgaris.