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  • 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.


  • 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 


  • 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:

  • Crusting of skin bumps.

  • Cysts. Red bumps (Papules). 

  • Red bumps with pus (Pustules). 

  • Scarring of the skin. Whiteheads. Blackheads.

Pharmacology treatments

 if over the counter failed:

  • Topical antibiotics 

  • Oral antibiotics 

  • Topical retinoids (Acne with scarring, see a dermatologist).

Lifestyle Changes:

  • Skin care/hygiene

  • Diet and exercise

  • Healthy habits (smoking cessation..)

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.


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