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Integumentary Disease: Acne Vulgaris

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.

Carpal TUnnel Syndrome
Genetic factors; occlusive cosmetic agents; medications: steroids, ACTH, androgens, danazol, iodides, lithium, antiepileptics, oral contraceptives; diseases: congenital adrenal hyperplasia (CAH), polycystic ovarian syndrome (PCOS); worse with emotional stress.

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.

Acne Vulgaris

Acne VulgarisLink

■ 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.
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