Acne

From greek.doctor
  • Common acne = Acne vulgaris
  • (comedo/comedones = plugged hair follicle (pore))
  • Risk factors
    • Genetic predisposition
    • Hormonal changes
      • Puberty
      • Menstrual cycle
    • 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
        • Comedolytic
        • Bactericidal
      • 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
        • Oral retinoid