Acne

ACNE VULGARIS
  • A self-limited disorder primarily of teenagers and young adults
  • The earliest feature is an increased rate of sebum secretion, making the skin look greasy (seborrhoea)
  • A disorder in which hair follicles develop obstructing horny plugs (comedones).
  • Small pseudocysts, called comedones, form in hair follicles due to blockage of the follicular orifice
  • The clinical hallmark is the comedone, which may be closed (whitehead) or open (blackhead)
  • The activity of bacteria (Propionibacterium acnes) within the comedones releases free fatty acids from sebum, causes inflammation within the cyst, and results in rupture of the cyst wall
  • The first lesions, usually comedones, develop on the forehead (pre-adolescent acne)
  • At its peak, acne covers the entire face (adolescent acne)
  • In mature adults (25 years plus) it settles on the jaw area and the adjacent neck (adult acne).
  • The scars formed after healing are often quite irregular and tend to form 'bridges'
  • Even the smaller inflamed papules can cause scars - pock-like or triangular indentations (ice-pick scars).
  • Acne fulminans
  • Lesions quite suddenly become very inflamed
  • Affected individual is unwell and develops fever and arthralgia.
Treatment:
  • Oral tetracycline or erythromycin.
  • Topical — retinoic acid (for nodulocystic acne), benzoyl peroxide, salicylic acid.
  • Sebum production is decreased by sebotrophic agents (directly) and antiandrogens (indirectly)
  • Tretinoin (all trans retinoic acid)-1st generation (1G)
  • Isotretinoin (13-cis isomer of tretinoin)-2G
  • Adapalene — 3G
  • Tazarotene — 4th generation
Exam Question
  • Acid that is increased in acne comedones is Palmitic Acid.
  • A teenager girl with moderate acne is also complaining of irregular menses. Drug of choice willl be Cyproterone Acetate.
  • Oral retinoid is indicated in the treat­ment of Acne Vulgaris.
  • A 17 year old girl with acne has been taking a drug for the last two years. She now presents with blue black pigmentation of nails. The likely medication causing the above pigmentation is: Minocycline.
  • Isotretinoin is the treatment for nodulocystic acne vulgaris.
  • Acne agminata also known as lupus miliaris disseminatus faciei or facial idiopathic granulomatous with regressive evolution is a disorder of uncertain etiology.It is not a variant of Acne . Varients of Acne,includes Acne conglobata , Acne fulminans , Pomade acne.
  • Cheilitis is the most common side effect of Isotretinoin used for acne vulgaris.
  • Acne Vulgaris is due to involvement of Pilosebacceous Gland.
  • Adapalene is used in treatment of Acne Vulgaris.
  • Causative factor for acne include Androgen , Bacterial contamination , Hypercornification of duct,Keratin,Cell nucleus.
  • Only food is not a causative factor for Acne.
  • Comedones are characteristics of Acne Vulgaris.
  • 19 years old girl has multiple papulo pustular erythe­matous lesions on face and neck, the likely diagnosis is Acne Vulgaris.
  • Treatment of Acne includes 13 cis retionol; Minocycline; Erytromycin;Cryotherapy ; Estrogens ; UV light.
  • Recalcitrant Pustular Acne is treated by Retinoid.
  • Minocycline is useful for inflammatory acne.
  • Retinoids is useful for comedonal acne.
  • A 24-year-old girl presented with complains of acne. On examination, multiple nodules, cysts and intercommunicating sinuses were seen.Oral Isotretinoin will be the treatment of choice.
  • SAPHO syndrome is manifested by synovitis, acne, pustulosis, hyperostosis, and osteitis.
  • Difference in acne rosacea & acne vulgaris is absence of comedone.
  • Testosterone hormone is responsible for acne.
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