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What is Acne vulgaris? Cause | Symptoms | Types | Treatment

Definition :

 It is a common inflammatory disease of pilosebaceous follicles in which the pilosebaceous follicles become oversensitive to a normal level of testosterone. 

 Cause :
  • Androgens 
  • Follicular keratinisation 
  • Hereditary 
  • Propionic bacterium acnes 
  • Immunological factor
  • Environmental factor 
Exacerbating factor :

Peak severity of acne is in the late teenage years but acne may persist into the 3rd decade 
and beyond particularly in a female.

Factors :
  • Acne occurs with stress
  • Premenstrual period 
  • With aggressive acne or recalcitrant acne, the cause is virilising syndrome in female, acromegaly, Occupational exposure to an agent. 
  • A drug like steroids, hormones, anti-epileptic drugs, Iodine. 
  • Genetic & hormonal factor plays an important role. 
Pathogenetic factor :
  • Increase sebum excretion: Clear relation between severity of acne & sebum excretion. 
  • Main determinants of sebum excretion are hormonal accounting for the onset of acne in teenage years. 
  • Androgens are principle sebatrophic hormone also progesterone increase sebaceous secretion. 
  • Infection with propionibacterium acne.
  • Occlusion or blockage of the pilosebaceous ducts. 

Symptoms :
  • Site: In order of frequency face, neck, back, chest, arms, buttocks and legs may see anywhere in body accept palm and sole. 
  • Sebum excretion increase: Example - Seborrhoea greasy skin often clinically obvious. 
  • Microcomedone formation occurs with may be open. Open comedones ( blackheads ) due to plugging by keratin and sebum of pilosebaceous orifice. 
  • Microcomedone formation may be closed. Closed comedones ( whiteheads ) due to excretion of sebum and keratin deeper in pilosebaceous ducts. 
  • In the formation of comedones producing papules, pustules are cysts. 
  • In deeper inflammatory lesion damage to dermis may result in a hypertrophic scar. 
Types of acne :
  • Conglobate acne :
It refers to severe acne with many abscess and cysts marked scarring and sinus formation. 
  • Acne fulminans :
It refers to severe acne with fever. Its pain and marks of systemic inflammation such as increased ESR.
  • Acne exorcise :
It refers due to the effect of scratching and pricking. 
  • Infantile acne :
It is rare and is thought to be due to sebotrophic effect of the maternal hormone in an infant. 

Grading the severity :
  • Mild 
Open or closed comedones with sparse inflamed lesion due to chlorinated, HC and oily cosmetics. Such pustular rash may be due to an exogenous substance like corticosteroids, OCP ( Over Contraceptive Pills ), lithium and anti-convulsants. 
  • Moderate 
Numerous papules and pustules.
  • Severe 
The extensive lesion may include nodules and lead to scarring. Severe acne develops in a person with PCOD ( Poly Cystic Ovarian Disease ). 

 Treatment : 
  • It must be started early to avoid scarring.
General Treatment :
  • Anaemia
  • Hormonal imbalance
  • Due to drugs
  • Cleaning: Wash the face 2 to 3 time in a day with mild medicated soap. Shampoo the scalp in case of oily scalp at-least twice in a one week.
Local Treatment :
  • Local antibiotics: Minor disease systemic antibiotics. 
  • Oral antibiotics are taken an empty stomach, not with food. 
  • Therapy continuously for up to 3 months. 
  • Local cleansing.
  • Ointment applications. 
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