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Acne is the result of a blockage of the hair follicles in the skin. This blockage usually involves oil or skin cells. You may notice one or more of the following symptoms:||||acne vulgaris

What is Acne Vulgaris ?

What is Acne Vulgaris ? 

 

Overview

Acne vulgaris is a disorder of the sebaceous units. It is a chronic inflammatory dermatosis that results in open and closed comedones, papules, pustules and nodules. It affects the exocrine part of the body which is the skin.

Epidemiology:

Predominant age from early to late puberty, it may persist in 20% to 40% of the affected individuals to the fourth decade. It’s also predominant in males more than females in adolescence. And in females more than males in adults.

Etiology:

  • androgens stimulate sebum production and proliferation of keratinocytes in hair follicle.
  • Keratin obstructs hair follicle causing sebum accumulation and follicular distention.
  • Propionibacterium acnes is an anaerobic bacterium that colonizes and proliferates in the plugged follicle. It promotes proinflammatory mediators causing inflammation of follicle and dermis.

Risk factors

  • Increased endogenous androgenic effect.
  • Oily comedogenic cosmetics.
  • Rubbing or occluding the skin surface with mobile phones and hands against the skin.
  • Numerous drugs including androgenic steroids, some birth control pills
  • Endocrine disorders like polycystic ovarian syndrome, Cushing syndrome, congenital adrenal hyperplasia, acromegaly and androgen secreting tumors.
  • Psychological distress
  • High glycemic load and high diary diets may exacerbate acne.

Diagnosis

History:

Ask about duration, medications, cleansing products, stress, smoking, exposures, diet and family history. Females may worsen 1 week prior to menses.

Physical examination: 

  • Closed comedones (whiteheads)
  • Open comedones (blackheads)
  • Nodules or papules
  • Pustules
  • Most common areas affected are face, chest, back and upper arms.
  • Tests are only indicated if additional signs of androgen increase, if so, test for free and total testosterone, LH and FSH.
  • Grading system are done according to:

Mild: few papules/ pustules with no nodules

Moderate: some papules/ pustules with few nodules

Severe: numerous papules/ pustules with many nodules

 

Treatment

  • Mild inflammatory acne: benzoyl peroxide or topical retinoid.
  • Moderate inflammatory acne: add systemic antibiotic to grade two regimen.
  • Severe inflammatory acne: as in grade three or isotretinion.
  • Avoid topical antibiotics as monotherapy.
  • Can use isotretinoin for treatment of resistant moderate acne.
  • Use mild soap daily to control oiliness and avoid abrasives.
  • Avoid drying agents with keratinolytic agents.
  • Use gentle cleanser and non-comedogenic moisturizer to help decrease irritation.
  • Use oil-free and non-comedogenic sunscreens.
  • Topical retinoids are first line agents for maintenance, avoid long term antibiotics for maintenance.
  • Keratinolytic agents (alpha-hydroxy acids, salicylic acid, topical retinoids, azelaic acid); side effects include dryness, erythema, and scaling; start with lower strength, increase as tolerated and tretinoin with varying strengths and formulations: Apply at bedtime; wash skin; let skin dry 30 minutes before application.
  • Oral antibiotics: use for shortest possible period, generally needs 8 to 12 weeks of therapy, indicated when acne is more severe, unresponsive to topical agents, or at greater risk for scarring
  • Tetracycline: 500 to 1,000 mg/day divided BID; high dose initially, side effects: photosensitivity, esophagitis
  • Minocycline: 100 to 200 mg/day, divided daily—BID; side effects include photosensitivity, urticaria, gray-blue skin, vertigo, hepatitis, lupus.
  • Doxycycline: 20 to 200 mg/day, divided daily—BID; side effects include photosensitivity.
  • Erythromycin: 500 to 1,000 mg/day; divided BID–QID; decreasing effectiveness as a result of increasing P. acnes resistance
  • Azithromycin 500 mg 3 days/week × 1 month, then 250 mg every other day × 2 months
  • Oral retinoids
    Isotretinoin: 0.5 to 1.0 mg/kg/day divided BID to maximum 2 mg/kg/day divided BID for very severe disease; 60–90% cure rate; usually given for 12 to 20 weeks. Side effects: teratogenic, pancreatitis, excessive drying of skin, hypertriglyceridemia, hepatitis, blood dyscrasias, hyperostosis, premature epiphyseal closure, suicidal ideation and psychosis.
  • Drospirenone/ethinyl estradiol or drospirenone/ethinyl estradiol/levomefolate.
  • Spironolactone at 25 to 200 mg/day; antiandrogen; reduces sebum production.

 

For further reading:

https://www.webmd.com/skin-problems-and-treatments/acne/acne#1

 

Don’t forget to check our website for the best oily skin care products.

https://gardeniapharmacy.com/product-category/skin-careanti-acne/

https://gardeniapharmacy.com/product-category/skin-careanti-acne/face-cleanser-skin-careanti-acne/

 

 

References
AL Chien, J Qi, B Rainer, et al. Treatment of acne in pregnancy. J Am Board Fam Med. 2016;29(2):254–262.

S Admani, VR Barrio. Evaluation and treatment of acne from infancy to preadolescence. Dermatol Ther. 2013;26(6):462–466.

AL Dawson, RP Dellavalle. Acne vulgaris. BMJ. 2013;346:f2634.

AL Zaenglein, AL Pathy, BJ Schlosser, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945.e33–973.e33.

 

 

 

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