All about Acne
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. Propionibacterium acnes is involved in lesion production although its exact role is unclear.[1]It is a skin commensural but in acne it colonises the follicles.[2]
Comedones (follicles impacted and distended by incompletely desquamated keratinocytes and sebum) may be open (blackheads) or closed (whiteheads). Inflammation leads to papules, pustules and nodules.
Acne can cause severe psychological problems, undermining self-assurance and self-esteem at a vulnerable time in life.
Epidemiology[1, 3]
Almost every teenager can expect to experience acne to some degree during the adolescent years although it is usually mild. Moderate-to-severe acne affects about 20% of young people.
Genetic factors play a part and a positive family history is often a factor; concordance among twins has been demonstrated. The heritability is almost 80% in first-degree relatives. A positive family history is linked to earlier and more severe acne.
Acne tends to affect boys more than girls.
Acne tends to occur in adolescence, when hormones are in a state of flux. Since puberty is starting earlier, acne is being seen in younger patients.
In girls it may flare up when they are premenstrual.
Acne may be associated with polycystic ovary syndrome.
Acne may result from abnormal production of androgens. This may occur in testosterone replacement therapy, abuse of anabolic steroids, Cushing's disease or in virilising tumours in women, such as arrhenoblastoma.
Presentation[4]
Acne usually presents with a greasy skin with a mixture of comedones, papules and pustules, which present just after puberty and continue for a variable number of years, usually stopping in late teens or early 20s but uncommonly continuing well into adulthood.
The face is affected in 99% of cases, the back in 60% and the chest in 15%.[3]
Acne runs a variable course with marked fluctuations.
Nodulocystic acne: severe acne with cysts. Cysts can be painful. They may occur in isolation or be widespread over the face, neck, scalp, back, chest and shoulders.
The severity of the condition varies enormously between individuals. It is unsightly but the degree of distress is sometimes disproportionate.
ACNE VULGARIS
Differential diagnosis[2]
Acne rosacea: usually presents in middle age or later in life.
Folliculitis and boils: may present with pustular lesions similar to those seen in acne.
Milia: small keratin cysts that may be confused with whiteheads. They tend to be whiter than acne whiteheads and are most commonly seen around the eyes.
Perioral dermatitis.
Pityrosporum folliculitis: predominates on the trunk.
Investigations[2]
Usually no investigations are required.
Investigations are occasionally required to explore a possible underlying cause - eg, virilising tumour.
Skin lesion culture may be warranted in patients who do not respond to treatment, to exclude Gram-negative folliculitis.
Management[2, 3]
Severe acne is a serious disease in that it is disfiguring, has enormous psychological impact and requires referral to a dermatologist.
Comedones (follicles impacted and distended by incompletely desquamated keratinocytes and sebum) may be open (blackheads) or closed (whiteheads). Inflammation leads to papules, pustules and nodules.
Acne can cause severe psychological problems, undermining self-assurance and self-esteem at a vulnerable time in life.
Epidemiology[1, 3]
Almost every teenager can expect to experience acne to some degree during the adolescent years although it is usually mild. Moderate-to-severe acne affects about 20% of young people.
Genetic factors play a part and a positive family history is often a factor; concordance among twins has been demonstrated. The heritability is almost 80% in first-degree relatives. A positive family history is linked to earlier and more severe acne.
Acne tends to affect boys more than girls.
Acne tends to occur in adolescence, when hormones are in a state of flux. Since puberty is starting earlier, acne is being seen in younger patients.
In girls it may flare up when they are premenstrual.
Acne may be associated with polycystic ovary syndrome.
Acne may result from abnormal production of androgens. This may occur in testosterone replacement therapy, abuse of anabolic steroids, Cushing's disease or in virilising tumours in women, such as arrhenoblastoma.
Presentation[4]
Acne usually presents with a greasy skin with a mixture of comedones, papules and pustules, which present just after puberty and continue for a variable number of years, usually stopping in late teens or early 20s but uncommonly continuing well into adulthood.
The face is affected in 99% of cases, the back in 60% and the chest in 15%.[3]
Acne runs a variable course with marked fluctuations.
Nodulocystic acne: severe acne with cysts. Cysts can be painful. They may occur in isolation or be widespread over the face, neck, scalp, back, chest and shoulders.
The severity of the condition varies enormously between individuals. It is unsightly but the degree of distress is sometimes disproportionate.
ACNE VULGARIS
Differential diagnosis[2]
Acne rosacea: usually presents in middle age or later in life.
Folliculitis and boils: may present with pustular lesions similar to those seen in acne.
Milia: small keratin cysts that may be confused with whiteheads. They tend to be whiter than acne whiteheads and are most commonly seen around the eyes.
Perioral dermatitis.
Pityrosporum folliculitis: predominates on the trunk.
Investigations[2]
Usually no investigations are required.
Investigations are occasionally required to explore a possible underlying cause - eg, virilising tumour.
Skin lesion culture may be warranted in patients who do not respond to treatment, to exclude Gram-negative folliculitis.
Management[2, 3]
Severe acne is a serious disease in that it is disfiguring, has enormous psychological impact and requires referral to a dermatologist.
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