Definition

[1]
Acne (also Acne vulgaris, pimples) is a skin condition characterised primarily by papules and pustules on the face and trunk.

Incidence

[2]
Up to 85% between 12-24

Age

12-24

Gender

More common in males in adolescence
More common in females after adolescence

Risk Factors

[3]

Signs and Symptoms

[4]
  • Skin lesions
  • Skin tenderness

Pathophysiology

[5]
Acne begins when follicular keratinocytes do not shed normally which leads to retention and accumulation. This is known as a comedone (a clogged hair follicle). Androgens increased sebum production by enlarging glands. Abnormal keratinaceous material and sebum begin to collect causing an increase in pressure.
P acnes (normal flora) begins to proliferate in the collection. The triglyceride metabolism of P acnes ultimately leads to the release of pro-inflammatory mediators and neutrophil chemoattractants.
If the pimple bursts an even larger inflammatory response may result which can result in hyperpigmentation and scarring.

Investigations

[6]

Bloods

  • Hormone levels (rarely)

Diagnosis

[7]
Diagnosis is made clinically

Classification

  • Mild (<10 papules and pustules)
  • Moderate (10-40 papules and pustules)
  • Moderately Severe (Up to 100 papules and pustules and up to 100 comedones)
  • Very severe (Nodulocystic acne with severe lesions; many large, painful nodular and pustular lesions with many smaller papules, pustules, and comedones)

Differentials to rule out

  • Folliculitis
  • Rosacea

Treatment

[8]

Non-Pharmacological

  • Facial hygiene

Pharmacological

  • Topical retinoid (tretinoin, adapalene, tazarotene topical) or topical salicylic acid - 1st line
  • Topical antibiotic (if inflammation) - benzoyl peroxide or clindamycin or erythromycin or dapsone
  • Azelaic acid (if mild-moderate)
  • Oral corticosteroids (if severe)
  • Oral contraceptives or spironolactone (if female and hormonal)

Management

[9]
Patients on tretinoin should have their FBC, lipid panel, LFTs and pregnancy status monitored.

Complications

[10]

Prognosis

[11]
Acne often improves as patients progress through life. There are rarely and complications of the condition

See Also

BMJ Best Practice - Acne vulgaris
  1. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  2. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  3. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  4. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  5. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  6. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  7. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  8. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  9. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  10. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html
  11. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/101.html