Acne vulgaris (the common acne) is very common malady of teenagers involving predominantly the face. Although many efforts have been tried to combat with this disease but still it exists as a troublesome problem in society. Modern science deals it mostly with a symptomatic approach. The disease requires correct and efficient long-term management, which produces social and psychological upset. Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous units and characterized by formation of comedones (blackheads & whiteheads), papules, nodules, pustules, cysts, abscesses and scars. Four major factors are involved in the pathogenesis of acne though all the factors may not be present in one patient. They are –
- 1. Increased sebum production: This can be due to increased levels of androgens or their active metabolites. Sebum disintegrates into free fatty acids, which are irritating.
- 2. Abnormal microbial flora: Increased levels of propionibacterium acne contribute to inflammation and irritation. But acne is not infectious.
- 3. Follicular wall and sebaceous duct hyperkeratinization: leads to blockage of retention of sebum.
- 4. Inflammation
Acne is common in both sexes after puberty. It is more severe in males. It is polymorphic disease involving mainly the face. Other seborrhoeic areas of body like back, chest and shoulders are involved in severe cases.
Emotional stress is known to aggravate acne. Sweating also aggravates them. Premenstrual flare up is known to occur in females but diet has not been proved to have any effect on acne. Familial predisposition is known.
Grading of acne:
- Grade I (Mild) – comedones and papules
- Grade II (Moderate) – papules, comedones and pustules
- Grade III (Severe) – pustules, nodules, abscesses
- Grade IV (Cystic) – cysts, abscesses, scars
- 1. Benzoyl peroxide
- 2. Retinoic acid
- 3. Topical antibiotics
- 4. Peeling agents
- 5. Others: 6.25% Aluminium chloride hexahydrate is used as abradent cleaner. Newer preparations are topical antiandrogens, 5% 5-Fluorouracil cream, 10-20% Azelaic acid cream etc.
All erroneous notions about the disease and its relation to diet, hygiene, bowel habits etc. should be clarified.1
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