Acne is caused by chronic inflammation with out without localised infection within pockets of skin - pilosebaceous units that contain the fair follicles and sebaceous glands
The inflammation comes from increased sebum production trapping dead skin cells (keratin). Androgenic hormones increase the production of sebum. Swollen and inflamed units are called comedones.
- Mild acne — predominantly non-inflamed lesions (open and closed comedones) with few inflammatory lesions.
- Moderate acne — more widespread with an increased number of inflammatory papules and pustules.
- Severe acne — widespread inflammatory papules, pustules and nodules or cysts. Scarring may be present.
Clinical Presentation:
- Macules - flat marks on skin
- Papules - small Lumps on skin
- Pustules - small Lumps containing pus
- Comedomes - skin coloured papules - blocked pilosebaceous units
- Blackheads - open comedones with black pigmentation
- Ice pick scars - small indentations in the skin that remain after acne lesions heal
- Hypertrophic scars - small Lumps in skin that remain…
- Rolling scars are irregular wave like irregularities
Management
Aim of treatment is to reduce the symptoms, risk of scaring and psychosocial impact.
Warning
Always explore the psychosocial burden and any potential anxiety and Depression that may be associated with the condition
- If mild no treatment may be an option
- Topical benzyol peroxide - reduces inflammation, helps unblock the comedomes and is toxic to the P. acnes bacteria
- Topical retinoids - chemicals related to vitamin A that slow the production of sebum
- Topical antibiotics - Clindamycin
- Oral antibiotics - lymecycline
- Oral contraceptive pill - can help female patients stabilise hormones to slow production of sebum
Isotretinoin (Roaccutane)
- Very effective at clearing the skin - but with very harsh side effects
Danger
It is so strongly teratogenic patients must use at least 2 forms of contraception before prescribing it They must stop isotretinoin for at least a month before becoming pregnant
Other side effects
- Dry skin and lips
- Photosensitivity
- Depression, anxiety, aggression and suicidal ideation. Patients need to be screen for mental health issues prior to treatment