Acne Flashcards
Acne Vulgaris
- inflammatory disease of the pilosebaceous follicles that are clogged with dead cells and oil
- the follicle becomes impacted with shed skin cells. The follicle may be blocked leading to comedone formation
Acne Vulgaris Characteristics
Black heads, white heads, pimples, greasy skin, and scarring
Epidemiology
- Typically presents at ages 8-12, peaks at ages 15-18, and resolves by age 25
- worse in males
Causes
- Genetic predisposition
- Raised hormone levels, especially testosterone
- Thickening of follicular wall due to hyperproliferation leading to more dead cells
- Blockages in the follicles by dead skin cells
- Increased production of sebum by sebaceous glands to mix up with dead cells
- Bacteria in the follicles (Propionibacterium acnes) are involved: overgrowth of p. acnes
- Inflammation in the skin surrounding the follicles
Factors that may exacerbate acne
- Emotional stress
- Premenstrual stress
- Mechanical Trauma
- Occlusive Clothing
- High humidity
- Harsh scrubbing of the skin
- Some cosmetic oils and topical products
- Various medications, especially steroids
- Psychological stress
- The role of diet is not clear
Infant acne
- typically shows up after a few weeks
- appears on cheeks, forehead, chin, and even back
- no clear cause (possibly hormones that babies receive from their mother)
- may occur for up to 3 months
- Clears spontaneously
Acne Vulgaris: The basics
- characterized by open & closed comedones, papules,pustules, cysts, nodules, and even scars
- primary sites are on the face, chest, back, and shoulders
- Severe acne should be treated to avoid permanent scars
Non-inflammatory lesions
- clogged hair follicles by skin cells & sebum
- Open comedone (black head - filled w/ blackened keratin)
- Closed comedone (white head - follicle is completely blocked)
Inflammatory Lesions
- Papules - elevated red bumps
- Pustules - elevated white pus bumps
- Nodules - elevated large and sometimes tender firm bumps
- “Cysts” - aka nodules, and if pus-filled called fluctuant nodule
Scars
- Usually sharply punched out pits or deeper furros
- Hypertrophic and keloids
- can have Post-inflammatory hyperpigmentation
Hypertropic Scars
thick scar same size as the lesion
Keloid Scar
Scar larger than the original lesion;
Post-Inflammatory Hyperpigmentation
Inflammation induces melanocyte to produce melanin
typically become lighter or go away in a few months
Acne Classification
Based on the morphology and severity (number of acnes)
Grade 1
Mild acne. The skin will display open and closed comedones and occasionally minor pimples. There is no inflammation.
Grade 2
Moderate acne. Greater number of comedones. Papules and pustules are more frequently found.
Grade 3
Moderate to severe acne. More inflammation present. Papules & Pustules are more numerous. Nodules are often present.
Grade 4
Severe acne, many pustules, nodules and cysts. Comedones are numerous. Pronounced inflammation and breakouts likely extend to areas other than the face. Often called Cystic Acne
Grade 1 Treatment
OTC treatments may be effective
Grade 2 Treatment
OTC may be effective but if no improvement in 6-8 weeks, consult a physician
Grade 3 Treatment
Referred to dermatologist
Grade 4 Treatment
Must be treated by a dermatologist
Four major treatment principles
- Correct follicular hyperkeratinization-comedolytics
- Decrease the follicular bacteria, particularly P. acnes population - antibiotics
- Produce an anti-inflammatory effect - antibiotics
- Decrease sebaceous gland activity - isotretinoin
Mild Comedone Treatment
Topical Retinoid
Mild papular/pustular Treatment
topical retinoid, topical antibiotics, topical benzoyl peroxide
Moderate papular/pustular Treatment
oral antibiotics with topical retinoid and benzoyl peroxide
Moderate nodular treatment
oral antibiotic with topical retinoid and topical benzoyl peroxide
Severe nodular treatment
Oral isotretinoin
Scarring and keloids treatment
oral isotretinoin
