Acne Vulgaris
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Introduction
Acne vulgaris, or common acne, is indeed a common condition, affecting up to 75% of teenagers and young adults. Predominanty affecting the face, neck, back, and upper chest, acne is an inflammatory disease invloving sebaceous glands of the skin. It is characterized by papules, pustules, and comedones.
A comedone is a dilated hair follicle filled with keratin, bacteria, and sebum. Open comedones are blackheads, while closed comedones are whiteheads.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Excess sebum production, as can occur during puberty, creates excellent condtions for growth for Propionibacterium acnes.
Exacerbating factors include:
- oil-based makeup, hair gels and sprays, and cooking oil
- emotional stress
- menstruation and other hormonal factors
- medications such as steroids, lithium, phenytoin, androgens
- OCP containing high progestin doses
No particular foods have been shown to cause or worsen acne.
Pathophysiology
FFA and bacteria cause inflammation and a delayed hypersensitivity reaction.
Hyperkeratinization of the follicle occurs with plugging, resulting in papules and comedones
Signs and Symptoms
- history
- physical exam
History
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
General recommendations
Do not squeeze lesions, as this can cause further inflammation and scarring.
Limit face-washing to 2-3 times a day, and avoid abrasive soaps. Use water-based cosmetics instead of oil-containing products.
Topical Therapy
Firstline therapies include:
- topical retinoids: tretinoin, adapalene, tazarotene
- topical antimicrobials: benzoyl peroxide, clindamycin, erythromycin
- salicylic acid
Oral Therapy
Oral therapies may be useful for more difficult to treat acne. Options include:
- oral antibiotics: tetracycline, doxycycline, minocycline
- hormonal agents: estrogen-containing oral contraceptives
- oral retinoid - isoretinoin (Accutane)
- requites monthly bloodwork (CBC, LFT, lipids)
- teratogenic; women must use birth control, and men must not share with females
Consequences and Course
Resources and References
Topic Development
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