Acne

Overview:

Acne vulgaris is an inflammatory disorder of the pilosebaceous unit, which runs a chronic course and it is self-limiting. Acne vulgaris is triggered by Cutibacterium acnes in adolescence, under the influence of normal circulating dehydroepiandrosterone (DHEA).
It is a very common skin disorder which can present with inflammatory and non-inflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back.

Etiology

Acne occurs by hypersensitivity of the sebaceous glands to a normal circulating level of androgens, which are aggravated by P. acnes and inflammation. Causes of acne include the

following:

Use of medications like lithium, steroids, and anticonvulsants
Exposure to excess sunlight
Use of occlusive wear like shoulder pads, headbands backpacks, and underwire brassieres
Endocrine disorders like polycystic ovarian syndrome and even pregnancy
Genetic factors affect the percentage of branched fatty acids in sebum. Heritability estimates range from 50-90%
Acne is a disorder involving chronic inflammation of the pilosebaceous follicles.
It propbably involves an increase in androgenic hormones.
It usually occurs in adolescents and has a familial tendency.

Common Complaints:

Pharmacology treatments

if over the counter failed:

Lifestyle Changes:

More Information on Treatment / Management

Topical Therapy

Topical retinoids like retinoic acid, adapalene, and tretinoin are used alone or with other topical antibiotics or benzoyl peroxide. Retinoic acid is the best comedolytic agent, available as 0.025%, 0.05%, 0.1% cream, and gel.
Topical clindamycin 1% to 2%, nadifloxacin 1%, and azithromycin 1% gel and lotion are available. Estrogen is used for Grade 2 to Grade 4 acne.
Topical benzoyl peroxide is now available in combination with adapalene, which serves as comedolytic as well as antibiotic preparation. It is used as 2.5%, 4%,and 5% concentration in gel base.
Azelaic acid is antimicrobial and comedolytic available with 15% or 20% gel. It can also be used in postinflammatory pigmentation of acne.
Beta hydroxy acids like salicylic acid are used as topical gel 2% or chemical peel from 10% to 20% for seborrhoea and comedonal acne, as well as, pigmentation after healing of acne.
Topical dapsone is used for both comedonal and papular acne, though there are some concerns with G6PD deficient individuals.

Systemic Therapy

Doxycycline 100 mg twice a day as an antibiotic and anti-inflammatory drug as it affects free fatty acids secretion and thus controls inflammation.
Minocycline 50 mg and 100 mg capsules are used as once a day dose.
Other antibiotics such as amoxicillin, erythromycin, and trimethoprim/sulfamethoxazole are sometimes used, and if bacterial overgrowth or infection is masquerading as acne, other antibiotics such as ciprofloxacin may be used in pseudomonas related 'acne.'
An oral contraceptive containing low dose estrogen 20 mcg along with cyproterone acetate as anti-androgens are used for severe recurrent acne.
Spironolactone (25 mg per day) can also be used in males. It decreases the production of androgens and blocks the actions of testosterone.
If given to females, then pregnancy should be avoided because the drug can cause feminization of the fetus.
Scars are treated with submission, trichloroacetic acid, derma roller, microneedling, or fractional CO2 laser.

Retrieved from: