Acne Vulgaris
Definition
A follicular disorder
Affects hair follicles
Aetiology & Incidence
Both genders get it
Adolescents and young adults 12 -35 yrs - endocrine glands that influence the secretions of the sebaceous glands are functioning at peak activity
An interplay of genetic, hormonal and bacterial factors
Family history +
Pathophysiology
Childhood - sebaceous glands are small and nonfunctioning
During puberty androgens stimulate them - enlargement - secrete sebum - sebum rises to the top of the hair follicle and flows out onto the skin surface
Clinical Features
Comedones - primary acne lesions - closed and open
Papules
Pustules
Nodules
Cysts
Medical Management
Avoid food materials that aggravate the lesions - chocolate, cola, fried food, milk food
Mild cases - wash with soap twice a day
Improve psychological well being
Medications containing salicylic acid and benzoyl peroxide - remove sebaceous follicular plugs - Pernax AC
Topical antibiotics : Tetracycline, clindamycin, and erythromycin
Oral Antibiotics : Tetrocycline, doxycycline, minocycline - small doses - long time treatment
Tetracycline not used for children below 12 yrs - for pregnant women - affects development of teeth - permanent discoloration
Oral Retinoids - Synthetic vitamin A for unresponsive cases treated with conventional therapy
Hormone Therapy
Progesterone - estrogen preparations - not in men
Surgical Management
Comedo extraction - with a comedo extractor
Injections of corticosteroids into the inflamed lesions
I & D
Cryosurgery - freezing with liquid nitrogen
Deep abrasive therapy - for deep scars (dermabrasion)
Preventing Scarring
No manipulation of the comedones, papules and pustules
Dermabrasion may also increase scarring
all forms of friction and trauma to the area avoided - like proping the hands against the face, rubbing the face, wearing tight collars and helmets
Avoid cosmetics, shaving creams, and lotions
Preventing Infection
Female patients - receiving antibiotics - should report oral or vaginal candidiasis to the doctor.
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