ACNE

VULGARIS
 Definition

Acne vulgaris (AV) is a self

limiting disease, seen

primarily in adolescents

involving the sebaceous

follicles.
 Epidemiology

May be present at birth or

first 6 months of life.

In girls, the occurrence of

acne may precede

menarche (14 16 years).

 Boys tend to have a peak
incidence between ages 16 &
19 years.
Nodulocystic acne to be more
common in while males than
in black males.
Acne is more severe in
patient with xyy genotype
Etiology & Pathogenesis

Basic cause of acne in

unknown.

Acne is a multifactorial

disease.
 Four principal pathologic in
acne are :
1. Abnormal follicular
keratinization.
2. Increased sebum production.
3. Proliferation of
Propionibacterium acnes in
the sebum.
4. Inflammation.
 Androgen are known to
regulate the development of
the sebaceous gland & sebum
production.
Patient with acne may have
increased levels of circulating
androgens.
 Stress is known to increase

the output of adrenal steroids,

which may affect the

sebaceous glands.
Clinical Manifestations

Primary site face, upper

back, chest, shoulder.

Lesion may be non

inflammatory or inflammatory.
 Non-inflammatory lesion

comedones :

Open (blackheads).

Closed (whiteheads).
 Open comedo a flat or

slightly raised lesion with a

central dark colored

follicular impaction of keratin

& lipid.
 Closed comedo pale,

slightly elevated, small

papules & do not have a

clinically visible orifice.

 Inflammatory lesions vary
from small papules with an
inflammatory areola to
pustules to large, fluctuant
nodules.
Large nodules
nodulocystic (severe cases
of inflammatory acne).
 Patient may have scars of

varying size a sharply

punched out pit.

 Diagnosis
Finding of mixture of
lesions of acne :
Comedones.
Pustules.
Papules.
Nodules on the face.
Back.
Chest.
Differential Diagnosis

Folliculitis.

Rosasea.

Perioral dermatitis.
 Treatment

1. Topical therapy :
Tretinoin :
Cream : 0,025%, 0,05%,
0,1%.
Gel : 0,01%, 0,025%.
Liquid : 0,05%.
 Benzoyl peroxide : lotion,

creams, gels, washes

(2,5%, 5%, 10%

concentrations).
 Topical antibiotics :
Clindamycin : gel, lotion,
solution (1%).
Erythromycin in 1 2%
solution, ointment.
Azelaic acid : cream 20%.
Cleaning agents.
Astringents.
2. Physical therapy :
Cryoslush therapy.
Ultraviolet light.
Radiation therapy.
Acne surgery.
Intralesional
corticosteroid : 0,05 0,25
ml per lesion
(triamcinolone acetate).
3. Systemic therapy :
Antibiotic :
Tetracycline : 500 1000
mg/d for 4 5 weeks.
Dose can be reduced to a
maintenance level of 250
500 mg/d for several
months.
 Minocycline : 50 100 mg

once ro twice daily.

Doxycycline : 50 mg twice

daily, severe cases 100 mg

twice daily.
Sulfonamide.
 Hormonal therapy :
Estrogens : ethynil
estradiol 0,035 0,050 mg.
Oral contraceptives.
Glucocorticoids.
Gonadotropin-releasing
hormon agonists.
Antiandrogen.
 Retinoids :

Recommended dose 0.5

2 mg/kg for 15 20

weeks.
 Prognosis

Favorable with spontaneous

resolution.
Physical sequela : scar

special cure (peeling and

dermabration).