1 acne vulgaris

INTERNAL MEDICINE

Acne vulgaris

Def: Acne vulgaris is a disorder of the pilosebaceous

follicles found in the face and upper trunk. At puberty, androgens increase the production of sebum from enlarged sebaceous glands that become blocked and infected with Propionibacterium acnes (P. acnes) causing an inflammatory reaction

Acne vulgaris

Causes: Increased sebum secretion Hormones (endrogens) Increased keratinisation Bacteria Stress Familial

Acne vulgaris

Pathophysiology The pathogenesis of acne vulgaris is

multifactorial. The key factor is genetics.If both parents had acne, 3 of 4 children will have acne. If 1 parent had acne, then 1 of 4 of the children will have acne. However, similar to other genetic conditions, not every family will have the same pattern, with acne vulgaris sometimes skipping generations. What is inherited is the propensity for follicular epidermal hyperproliferation with subsequent plugging of the follicle. Additional aggravating factors include excess sebum, the presence and activity of Propionibacterium acnes, and inflammation.

Acne vulgaris

Clinical feature: Lesions are limited to the face, shoulder, upper

chest and back. Seborrhoea is often present Open comedones or close

comedones[blackheads & white heads] and keratin deeper in the pilosebaceous ducts are always evident.

Inflammatory papules, nodules and cyst occur.

Acne vulgaris

Investigation: Swab test Serum testosterone LH FSH Pelvic ultrasound

Acne vulgaris

Management: A)Local measures- Regular washing with soap and water Antibacterial skin cleanser B)Systemic measures- Antibiotics- Oxytetracycline 250 mg 6 hrly for 3

months to 2-3 yrs. Isotretinoin[retinol synthetic, vit. A(inhibit sebum

secretion )] in severe acne Hormone- combined

antiandrogen(Cyproterone acetate) or estrogen pill

C)Physical measures- cyst may be incised and drained under L/A.