🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Acne vulgaris

Specialties > Dermatology

Background knowledge 🧠

Definition

  • Acne vulgaris is a chronic inflammatory skin condition affecting the pilosebaceous unit (hair follicles and sebaceous glands).
  • Characterized by comedones (blackheads and whiteheads), papules, pustules, and, in severe cases, nodules and cysts.
  • Primarily affects areas with high density of sebaceous glands: face, back, and chest.

Epidemiology

  • Common in adolescents; affects approximately 80% of individuals aged 11 to 30 years.
  • Peak incidence during puberty due to hormonal changes.
  • Affects both genders, but tends to persist longer in females.
  • Can also affect neonates, children, and adults.

Aetiology and Pathophysiology

  • Increased sebum production due to androgen stimulation of sebaceous glands.
  • Hyperkeratinization of the follicular epithelium leading to comedone formation.
  • Colonization by Cutibacterium acnes (formerly Propionibacterium acnes), a skin commensal that contributes to inflammation.
  • Inflammatory response due to breakdown of sebum into fatty acids, leading to irritation.
  • Genetic predisposition plays a significant role.

Types

  • Non-inflammatory: open comedones (blackheads) and closed comedones (whiteheads).
  • Inflammatory: papules, pustules, nodules, and cysts.
  • Severe variants include nodulocystic acne and acne conglobata.
  • Acne fulminans: a rare, severe form with systemic symptoms such as fever and malaise.

Clinical Features 🌡️

Symptoms

  • Pain or tenderness, particularly in inflammatory lesions.
  • Itching or burning sensation, especially in severe cases.
  • Psychological distress, including low self-esteem and anxiety.
  • Scarring and post-inflammatory hyperpigmentation.

Signs

  • Presence of comedones, papules, pustules, nodules, and cysts on affected areas.
  • Distribution commonly on the face, back, and chest.
  • Erythema around inflammatory lesions.
  • Scarring and pitting in chronic or severe cases.
  • Possible post-inflammatory hyperpigmentation, particularly in darker skin types.

Investigations 🧪

Tests

  • Diagnosis is primarily clinical based on history and examination.
  • Consider hormone levels (e.g., testosterone, LH, FSH) in cases of suspected endocrine abnormalities (e.g., polycystic ovary syndrome).
  • Microbial swabs are rarely indicated but may be considered in cases unresponsive to standard treatment.

Management 🥼

Management

  • Topical therapies: benzoyl peroxide, retinoids, and antibiotics (e.g., clindamycin).
  • Systemic therapies: oral antibiotics (e.g., tetracyclines), hormonal treatments (e.g., combined oral contraceptives), and oral retinoids (e.g., isotretinoin).
  • Consider lifestyle advice: diet, stress management, and skincare routine.
  • Referral to dermatology for severe, refractory, or scarring acne.
  • Patient education on adherence and potential side effects.

Complications

  • Scarring: atrophic (ice-pick), hypertrophic, or keloid scars.
  • Post-inflammatory hyperpigmentation or hypopigmentation.
  • Psychological impact: depression, anxiety, and social withdrawal.
  • Possible side effects of treatments (e.g., teratogenicity of isotretinoin).

Prognosis

  • Generally good with appropriate treatment.
  • May persist for years, particularly in females.
  • Early treatment can reduce the risk of scarring.
  • Chronicity and recurrence are common; maintenance therapy may be needed.

Key Points

  • Acne vulgaris is a common condition with significant psychosocial impact.
  • Early and appropriate management is crucial to prevent complications.
  • A multidisciplinary approach may be required in severe cases.
  • Patient education and reassurance are key components of management.

No comments yet 😉

Leave a Reply

Dermatology