1. INTERNAL MEDICINE

2. Acne vulgaris Def: Acne vulgaris is a disorder of the pilosebaceous follicles found in the face and upper trunk. At puberty, androgens increase the production of sebum from enlarged sebaceous glands that become blocked and infected with Propionibacterium acnes (P. acnes) causing an inflammatory reaction

3. Acne vulgaris Causes: Increased sebum secretion Hormones (endrogens) Increased keratinisation Bacteria Stress Familial

4. Acne vulgaris Pathophysiology The pathogenesis of acne vulgaris is multifactorial. The key factor is genetics.If both parents had acne, 3 of 4 children will have acne. If 1 parent had acne, then 1 of 4 of the children will have acne. However, similar to other genetic conditions, not every family will have the same pattern, with acne vulgaris sometimes skipping generations. What is inherited is the propensity for follicular epidermal hyperproliferation with subsequent plugging of the follicle. Additional aggravating factors include excess sebum, the presence and activity of Propionibacterium acnes, and inflammation.

5. Acne vulgaris Clinical feature: Lesions are limited to the face, shoulder, upper chest and back. Seborrhoea is often present Open comedones or close comedones[blackheads & white heads] and keratin deeper in the pilosebaceous ducts are always evident. Inflammatory papules, nodules and cyst occur.

6. Acne vulgaris Investigation: Swab test Serum testosterone LH FSH Pelvic ultrasound

7. Acne vulgaris Management: A)Local measures- Regular washing with soap and water Antibacterial skin cleanser B)Systemic measures- Antibiotics- Oxytetracycline 250 mg 6 hrly for 3 months to 2-3 yrs. Isotretinoin[retinol synthetic, vit. A(inhibit sebum secretion )] in severe acne Hormone- combined antiandrogen(Cyproterone acetate) or estrogen pill C)Physical measures- cyst may be incised and drained under L/A.