Acne vulgaris

ACNE DISORDER – Acne vulgaris (Causes and Risk Factors, Types,

Clinical Manifestations and Management) 

Acne is a common disorder of pilosebaceous (hair and sebaceous) structure, as they opens to the skin surface through pore. These glands produce sebum, a lipid substance. Acne may be inflammatory and non inflammatory.

ACNE VULGARIS

Acne vulgaris is a common and chronic skin disorder of the pilosebaceous unit that primarily affects the face, chest and back. Onset typically occurs at puberty because of increased sebum production triggered by increased androgen levels, but acne may present earlier in childhood or persist throughout adulthood.

Acne vulgaris is most common type among all skin disorders. Acne, or acne vulgaris, is a skin problem that starts when oil and dead skin cells clog up pores. Acne starts when oil and dead skin cells clog the skin’s pores. If germs get into the pores, the result can be swelling, redness and pus.

CAUSES AND RISK FACTORS

• Excessive sebum production
  
  
• Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
  
  
• Buildup of bacteria
  
  
• Abnormal keratinization of follicular epithelium
  
  
• Increased androgen production
  
  
• Change in hormones during puberty, menstrual cycles
  
  
• Genetic – family history increase the occurrence of acne
  
  
• Overactivity/hyperresponsiveness of sebaceous glands in response to androgens
  
  
• Colonization of the follicles with Propionibacterium acnes
  
  
• Inflammation, including innate and induced immune responses
  
  
• Industrial exposure to halogenated hydrocarbons
  
  
• Adolescence
  
  
• Hair gels or oil-based cosmetics
  
  
• Sports equipment such as helmet straps rubbing and occluding skin
  
  
• Medications with iodine, found in some cough medicines
  
  
• Certain prescription drugs: lithium, isoniazid, phenytoin, corticosteroids, anabolic steroids, and oral contraceptives with high androgenic activity
  
  

TYPES OF ACNE VULGARIS

The most common form of acne in Acne Vulgaris, which comes in three forms:

Non-inflammatory Acne

• Very mild acne vulgaris
  
  
• Includes appearance of comedones (whiteheads and blackheads)
  
  

 
CLINICAL MANIFESTATIONS

• Lesions form on face, neck, back, chest and shoulders
  
  
• Spots that have become inflamed may be painful, tender to touch and affected skin feel hot
  
  
• Comedons: comedons appear as whiteheads or blackheads. Whiteheads (closed comedones) are flesh-colored/whitish palpable lesions 1 to 3 mm in diameter; blackheads (open comedones) are similar in appearance but with a dark center
  
  
• Papules and pustules: papules and pustules are red lesions 2 to 5 mm in diameter. In both, the follicular epithelium becomes damaged with accumulation of neutrophils and then lymphocytes. Relatively deep inflammation produces papules. Pustules are more superficial.
  
  
• Nodules: nodules are larger, deeper and more solid than papules. Such lesions resemble inflamed epidermoid cysts, although they lack true cystic structure. Nodules are the hall mark of serious acne and deep scarring may result.
  
  

 Severe cases

• Cysts formed, pigmentation changes occurs which lead to and darkening of skin and severe scarring also occurs.
  
  
• Abscesses, draining sinuses, fistulated comedones, and keloidal and atrophic scars
  
  

MANAGEMENT

Treatments are directed at reducing sebum production, comedone formation, inflammation, and bacterial counts. Selection of treatment is generally based on severity. Affected areas should be cleansed daily, use of antibacterial soaps and scrubbing confer no added benefit.

Types of acne treatments include:

1. Over-the-counter topical treatments: acne lotions may dry up the oil,  kill bacteria and promote sloughing of dead skin cells. OTC lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or sulfur as their active ingredient. These products can be helpful for very mild acne.
   
   
2. Topical treatments available to prescription: if acne doesn’t respond to OTC treatments, Tretinoin (avita, retin-A, others), adapalene (differin) and tazarotene (tazorac, avage) are examples of topical prescription products derived from vitamin A. they work by promoting cell turnover and preventing plugging of the hair follicles. A number of topical antibiotics also are available. They work by killing excess skin bacteria.
   
   
3. Antibiotics: for moderate to severe acne, need a short course of prescription oral antibiotics to reduce bacteria and fight inflammation
   
   
4. Isotretinoin: for deep cysts, antibiotics may not be enough. Isotretinoin (amnesteem, claravis, sotret) is a powerful medication available for scarring cystic acne or acne that doesn’t respond to other treatments. This medicine is reserved for the most severe forms of acne.
   
   
5. Oral contraceptives: oral contraceptives, including a combination of norgestimate and ethinyl estradiol (ortho Tri-Cyclen, Previfem, others), can improve acne in women.