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- Common acne = Acne vulgaris
- (comedo/comedones = plugged hair follicle (pore))
- Risk factors
- Genetic predisposition
- Hormonal changes
- Certain foods
- Smoking
- Skin products that block pores
- Pathomechanism
- Hyperactivity of sebaceous glands
- Hyperkeratosis of follicular keratinocytes
- Bacterial hypercolonization
- Propionibacterium acnes (= cutibacterium acnes)
- Inflammation
- Clinical features
- On face, shoulders, upper chest, back
- Primary lesions
- Non-inflammatory acne – comedonal acne
- Closed comedones = whiteheads
- Small papules that contain whitish material
- The whitish material is keratin and sebum
- Open comedones = blackheads
- Small papules with black material
- The black material is oxidized keratin and sebum
- Inflammatory acne
- Papular acne
- Pustular acne
- Nodular acne (> 5 mm)
- Secondary lesions
- Erythema
- Hyperpigmentation
- Scarring
- Hypertrophic scars
- Depressed scars
- Pitted scars
- Special types of acne
- Acne inversa = hidradenitis suppurativa
- Inflammation of hair follicles due to physical blockage by skin folds, etc
- Acne fulminans
- Sudden onset, very severe acne
- In teenage boys
- Diagnosis
- Anamnesis
- Clinical examination
- Laboratory examinations
- Exclude hyperandrogenism, like PCOS, CAH, androgen-producing tumors
- Treatment
- Options
- Topical benzoyl peroxide
- Retinoids
- Oral or topical
- Tretinoin, isotretinoin, adapalene
- Normalize keratinocyte differentiation
- Decrease sebum production
- Highly teratogenic
- Females must produce negative pregnancy test and use at least one, optimally two methods of contraception
- Hepatotoxic
- Liver enzymes, cholesterol must be monitored
- Antibiotics
- Oral (doxycycline, minocycline)
- Topical (erythromycin, clindamycin)
- Bactericidal
- Decrease inflammation
- Oral contraceptives
- In females
- Can be added in treatment failure
- Topical combination therapy
- Benzoyl peroxide + topical retinoid
- Benzoyl peroxide + topical antibiotic
- Benzoyl peroxide + topical retinoid + topical antibiotic
- Treatment algorithm
- Mild cases
- Topical benzoyl peroxide
- Topical retinoid
- Topical combination therapy
- Moderate cases
- Topical combination therapy
- Oral antibiotic + topical combination therapy
- Severe cases