Introduction:
Acne vulgaris (Pimples) is a disorder of sebaceous gland (its pilosebaceous unit) common in adolescents. Though a self-limiting disorder, complications such as scarring can arise. Also, it usually has a negative impact on the quality of life of individuals with it.
Epidemiology: As said earlier, acne is common in puberty due to the hormonal changes that occur. Mild transient form can be seen in babies. Sometimes, it may persist in some women into their third decade of life or even longer.Causes/Aetiology: There are four basic factors identified in the pathogenesis of acne and these are; 1. Follicular epidermal hyperproliferation 2. Inflammation 3. Excess sebum production 4. Colonisation with the organism Propionibacterium acnes All these key elements are intertwined steps that produce the clinical characteristics seen in acne. Also, therapeutic measures are directed at these causative factors.Signs and Symptoms:
Acne manifest in a polymorphic way. That is, lesions present at different levels of development. It occurs mainly on the face. It can also be found on other sebum producing areas in the body such as back, chest and shoulders. Lesions appear as either inflammatory or non-inflammmatory. The non-inflammatory type appear as comedones while the inflammatory type appear from small papules to pustules and then nodules especially in severe forms.
Scarring can also occur especially with individuals that pick on the lesions.
Management:
As said earlier, the mechanism of actions of the medications for acne is based on the four key elements of its pathogenesis. Also, more than one class of drug is usually needed to achieve a favourable response.
Principles of management include
• Degreasing the face – Regular washing of the face with lukewarm water and mild soap.
• Use of Keratolytics – This include benzoyl peroxide and salicylic acid. Isotretinoin is especially useful in severe cases. It is anticomedogenic and also has anti-inflammatory properties.
• Use of antibiotics – This can be topical or systemic. Topical antibiotics include clindamycin and erythromycin. Systemic antibiotics include tetracyclines and its derivatives such as doxycycline, macrolides (such as azithromycin) and trimethoprim-sulphamethoxazole.
• Use of hormonal therapy – this include oral contraceptives, antiandrogens like spironolactone and gonadotrophin releasing hormones such as leuprolide.
Other treatment options include phototherapy and Lasers especially in severe cases and those with scarring.
Conclusion:
In conclusion, patients with acne should be reassured and given psychological support as needed. Use of topical steroids by these patients for acne should be discouraged as it only worsens the acne on the last run.
References:
Zaenglein A.I et al: Acne Vulgaris and Acneiform Eruptions, in Fitzpatrick’s Dermatology in General Medicine 7th ed. Mc Graw Hill Professional, 2008, p690-700