Acne vulgaris , common skin disease

1. ACNE VULGARIS
DR SUBODH KUMAR SHAH

2. Defination:
■ Acne vulgaris is a disorder of pilosebaceous complex which predominantly affects
the peripubertal population and clinically manifests as comedones (open/closed),
papules, nodules, pustules, and cysts and heals with scars.

3. Pathogenesis:

4. ■ Occlusion of pilosebaceous orifice:
■ Increased sebum secretion:
■ Microbial colonization:Organisms implicated:
I. Propionibacterium spp. especially P. acnes.
II. Malassezia furfur.
III. Staph epidermidis.
■ Genetic predisposition:Acne vulgaris is familial.
■ Cosmetics:Acne is frequently seen who use oil-based cosmetics,facial massage.
■ Menstrual cycle:About 70% of the female patients complain of premenstrual aggravation of
acne.
■ Psychological factors:Severe acne is related to increased anger and anxiety

5. Epidemiology:
■ Prevalence: An extremely common disorder,mild acne affects almost all
adolescents.
■ Age: Age of onset of acne is 12–14 years, being earlier in females. In about 70%
of subjects, the lesions subside in the third decade.
■ Gender: Acne affects both sexes equally, but nodulocystic acne is almost 10 times
more frequent in males.

6. Morphology
■ Eruption is polymorphic, characterized by
■ comedones, papules, pustules, nodules, and cysts, all seen in the same patient at
the same time.
■ Open comedones (black heads): are due to plugging of the pilosebaceous orifice by
keratin and sebum on the skin surface.
■ Closed comedones (white heads): are due to keratin and sebum accretions
plugging the pilosebaceous ducts below the skin surface.
■ Some closed comedones are
deep seated (submarine comedones) and
are best seen by stretching the skin.

8. Sites of predilection
■ Lesions of acne vulgaris are seen predominantly on the face (forehead, cheeks,
and chin), shoulders, upper chest, and back.
■ Variants:
■ Acne conglobata,
■ occupational acne,
■ Drug induced acne, and
■ acne after massage.

9. acne conglobata: interconnecting abscesses,
cysts and sinuses. Note irregular bridges.
Acne vulgaris on trunk: patient has both comedones
and inflammatory lesions.

10. Treatment:

11. General measure
Local hygiene
■ Regular gentle cleansing (not overzealous) with soap and water should be
encouraged.
■ Application of oil-based cosmetics should be avoided as they may aggravate acne,
but waterbased cosmetics can be used.

12. Topical therapy:
■ Retinoids:
■ Mode of action: Increasing epidermal cell turnover. Increasing dehiscence of
stratum corneum.
■ Preparations available:
■ retinoic acid (RA), 0.025%, 0.05%, 0.1%, cream and gel formulations.
■ Adapalene 0.1% cream is less irritating.
■ Other retinoids available include isotretinoin gel, 0.05% and tazarotene gel, 0.05%
and 0.1%.
■ Benzoyl peroxide (BP)
■ Mode of action:Is a powerful antimicrobial, decreasing population of P. acnes.Also
has anti-inflammatory effect.
■ Available: In concentrations of 2.5%, 4%, 5%, and 10%, either alone or in
combination with sulfur..

13. Topical antibiotics
■ clindamycin(1–2%) and erythromycin (2–4%).
Systemic treatment: Antibiotics
■ Drugs used: Doxycycline and minocycline are most commonly used. Less frequently,
erythromycin and azithromycin.
■ Isotretinoin (13-cis-retinoic acid), a retinoid management of severe intractable acne
■ Others :
■ Hydroxy acids: e.g., glycolic acid, 6–12%.
■ Azelaic acid (10–20%):