acne vulgaris - cosmetic

Acne Vulgaris

Reviewed By : Dr. Mohammad Baghaei

Pharm.D,MBA,Expert in Dermocosmetic FormulationCosmetic Researcher , Facedoux Co. R&D ,Iran

President of Middle Eastern Society Cosmetic Chemists

Acne Vulgaris

Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of pilosebaceous units.

Acne can present as noninflammatory lesions, inflammatory lesions, or a mixture of both, affecting mostly the face but also the back and chest.

FACEDOUXReviewed By : Dr. Mohammad Baghaei

Acne vulgaris

Acne vulgaris is characterized by comedones, papules, pustules, and nodules in a sebaceous distribution (eg, face, upper chest, back). A comedone is a whitehead (closed comedone) or a blackhead (open comedone) without any clinical signs of inflammation. Papules and pustules are raised bumps with obvious inflammation. The face may be the only involved skin surface, but the chest, back, and upper arms are often involved.In comedonal acne, patients develop open and closed comedones but may not develop inflammatory papules or nodules.


Frequency

United States:Acne vulgaris affects 80% of Americans at some time during their lives. Twenty percent have severe acne, which can result in permanent physical and mental scarring. International:Persons of some races are affected more than others. Cystic acne is prevalent in the Mediterranean region from Spain to Iran.


Race

Acne is common in North American whites. African Americans have a higher prevalence of pomade acne, likely stemming from the use of hair pomades. Ethnicities with darker skin are also more prone to postinflammatory hyperpigmentation.


Sex

• During adolescence, acne vulgaris is more common in males than in females. In adulthood, acne vulgaris is more common in women than in men


Age

Acne or acneform lesions, such as in neonatal cephalic pustulosis, may be present in the first few weeks and months of life, when a newborn is still under the influence of maternal hormones and when the androgen-producing portion of the adrenal gland is disproportionately large.This neonatal acne tends to resolve spontaneously. However, some neonates may require therapy (eg, topical retinoids). Adolescent acne usually begins with the onset of puberty, when the gonads begin to produce and release more androgen hormone.Acne is not limited to adolescence. Twelve percent of women and 5% of men at aged 25 years have acne. By age 45 years, 5% of both men and women still have acne.


Causes

Acne vulgaris has a multifactorial pathogenesis, of which the key factor is genetics


It develops as a result of interplay of the following four factors:

(1) follicular epidermal hyperproliferation with subsequent plugging of the follicle.(2) excess sebum production.(3) the presence and activity of the commensal bacteria Propionibacterium acnes.(4) inflammation.


Other CausesIn addition the following aggravating factors are recognized:

Cosmetic agents and hair pomades may worsen acne. Medications that can promote acne development include steroids,

lithium, some antiepileptics, and iodides Congenital adrenal hyperplasia, polycystic ovary syndrome, and other

endocrine disorders associated with excess androgens may trigger the development of acne vulgaris. Even pregnancy may cause a flare-up

Mechanical occlusion with headbands, shoulder pads, back packs, or under-wire bras can be aggravating factors

Excessive sunlight may either improve or flare acne. In any case, the ultraviolet exposure ages the skin.


Signs and symptoms

It is characterized by noninflammatory, open or closed comedones and by inflammatory papules, pustules, and nodules.


Acne vulgaris typically affects the areas of skin with the densest population of sebaceous follicles (eg, face, upper chest, back). Local symptoms of acne vulgaris may include :• Pain• Tenderness• or Erythema

Signs and symptoms


Examination in patients with acne vulgaris includes the following features:

Comedonal acne: Presence of open and closed comedones but usually no inflammatory papules or nodulesMild acne: Presence of comedones and a few papulopustulesModerate acne: Presence of comedones, inflammatory papules, and pustules; a greater number of lesions are present than in milder inflammatory acne Nodulocystic acne: Presence of comedones, inflammatory lesions, and large nodules greater than 5 mm in diameter; scarring is often evident


Treatment

Treatment of acne vulgaris should be directed toward the known pathogenic factors, including:Follicular hyperproliferation Excess sebumP acnesInflammation.


PharmacotherapyTreatment of Propionibacterium acne vulgaris

• Retinoid-like agents (eg, topical tretinoin, adapalene, tazarotene, isotretinoin)

• Antibiotics (eg, tetracycline, minocycline, doxycycline, trimethoprim/sulfamethoxazole, clindamycin, topical clindamycin, topical erythromycin, daptomycin)

• Selective aldosterone antagonists (eg, spironolactone)• Estrogen/progestin combination oral contraceptive pills (eg, ethinyl

estradiol, drospirenone, and levomefolate; ethinyl estradiol and norethindrone; ethinyl estradiol and norgestimate; ethinyl estradiol and drospirenone)

• Acne products (eg, erythromycin and benzoyl peroxide, clindamycin and tretinoin, clindamycin and benzoyl peroxide, azelaic acid, benzoyl peroxide)


Diet therapy as a Nonpharmacotherapy

Diet therapy, such as a low-glycemic diet and avoidance of “junk foods,” has been suggested as a nonpharmacologic measure to manage acne vulgaris.


Procedural treatments for acne vulgaris

Manual extraction of comedonesIntralesional steroid injectionsSuperficial peels that use glycolic or salicylic

acid


Prognosis

In male patients, acne generally clears by early adulthood. Five percent of men still have acne at age 25 years.

Female patients frequently have adult acne. Twelve percent of women still have acne at age 25 years. Five percent of women still have acne at age 45 years.

The overall prognosis for persons with acne is good. However, acne can result in long-lasting psychosocial impairment and physical scarring


Patient Education

• Patients should be instructed on their morning and evening treatment programs. Retinoid dermatitis may develop at approximately day 10 of therapy. Patients must be informed of this in advance so they will not consider this exfoliation an allergy.

• By skipping a day or 2 and restarting the program slowly, the skin can adapt to this irritation.

• Prescriptions should be accompanied by a discussion of the potential adverse effects.
