AcnEe

Introduction

• Description: Acne is an inflammatory disorder of the sebaceous glands that results in comedones, papules, inflammatory pustules, and scarring. The significance of acne often exceeds that dictated by medical considerations. For a woman, it is often a reason to either choose or discontinue the use of oral contraceptives. Acne, or the fear of it, is a major factor in poor compliance with oral contraceptives.

• Prevalence: Most adolescents; 15% seek care. (Eighth most common disease and most common skin disease worldwide).

• Predominant Age: Early teens to 20s; may persist into 40s (4%).

• Genetics: A genetic predisposition may be present in as many as 80% of cases. The genetics of acne susceptibility is likely polygenic as the disease does not follow a classic mendelian inheritance pattern. Women generally have milder forms of acne than men, although the social consequences are often greater.

Etiology and Pathogenesis

• Causes: Increased turnover of keratin in sebaceous glands under the influence of androgens. This results in a keratin plug (comedone) that obstructs sebum drainage from the gland. Infection by Propionibacterium acnes results in inflammation and pustule formation.

• Risk Factors: Increased androgen of adolescence, oily cosmetics or moisturizers, virilizing conditions, medications (oral contraceptives, iodides, bromides, lithium, phenytoins, corticosteroids), and poor local hygiene. Cigarette smoking increases the risk of developing acne and worsens its severity.

Signs and Symptoms

• Closed comedones (whiteheads)

• Open comedones (blackheads; black because of oxidation of sebum)

• Nodules and papules

• Pustules and cysts, with or without erythema and edema, may result in scarring (most extensive in severe nodular acne)

• Most lesions concentrated over the forehead, cheeks, nose, upper back, and chest

Diagnostic Approach