ACNE VULGARIS summary
Acne Vulgaris is an inflammation of the sebaceous gland. It’s the
most common skin disease in the US affecting more than 17
million Americans, typically presents at age 8-12- peaks at ages
15-18, affecting areas of the skin with the densest population of
sebaceous glands (face, neck, upper trunk and upper arms) (Ferri,
2016). Acne presents as: comedones (closed or open), papules-
pustules, cyst or nodules (Zaenglein et al., 2016). It involves
pathologically: an increased sebum production: Androgenic
activity drives sebum production alterations in follicular growth
and differentiation, abnormal follicular keratinization, formation of
Propionibacterium acnes (P. acnes) biofilms and colonies, release
of pro inflammatory mediators to the skin and heredity (Lavers,
2014). A variety of factors have been popularly identified as
contributors to or responsible for worsening acne:
genetic/heredity, presence of hormones (androgens), medications
and environment (Krutman et al.,2017; Kazandjieva, &
Tsankov,2017; Mazioti, 2017). The diagnosis of acne is based on
history and physical examination. Symptoms might include: pain,
tenderness, edema, and or erythema, oily, shiny skin, comedones
(blackheads, whiteheads), lesions to the face, shoulder, upper
chest and back (Titus, & Hodge, 2012). Acne vulgaris rarely
misdiagnosed. Acne rosacea, perioral dermatitis, steroid acne,
miliaria and pseudo folliculitis barbae can be misdiagnosed as
acne.
, Acne vulgaris is not curable and goals of therapy are long-term
control, slowing progression, limiting disease duration and
recurrence, alleviation of symptoms as well as prevention of
disfigurement, and avoidance of psychologic suffering. Treatment
includes benzoyl peroxide, topical and oral preparations of
retinoids and antibiotics (Zaenglein et al., 2016). Non
pharmacologic treatment includes: washing face twice a day with
mild soap- avoid scrubbing, rubbing, squeezing and picking,
prevention of cosmetic acne and maintaining a well-balanced diet
(Burns, Dunn, Brady, Starr, & Blosser, 2016).
Patients should eliminate aggravating factors, maintain a
balanced, low-glycemic load diet, and control stress for treatment
to be successful. Adherence to therapeutic regimen is key and
empathetic and informative counseling may help motivate the
patient to continue long-term therapy. Primary care physicians
can and should handle most cases of acne without referral.
Referral to a dermatologist should be made for: People who have
developed, or are at risk of, scarring despite treatment in primary
care- for people who have moderate acne which has persisted
after six months of treatment in primary care, or treatment failure
in concordance with the patient's wishes (Zaenglein et al., 2016).
Three questions about acne vulgaris were asked:
1. What is the effectiveness and what are the potential side
effects of isotretinoin in the treatment of adult acne and
acne vulgaris in adolescents to adults?
Acne Vulgaris is an inflammation of the sebaceous gland. It’s the
most common skin disease in the US affecting more than 17
million Americans, typically presents at age 8-12- peaks at ages
15-18, affecting areas of the skin with the densest population of
sebaceous glands (face, neck, upper trunk and upper arms) (Ferri,
2016). Acne presents as: comedones (closed or open), papules-
pustules, cyst or nodules (Zaenglein et al., 2016). It involves
pathologically: an increased sebum production: Androgenic
activity drives sebum production alterations in follicular growth
and differentiation, abnormal follicular keratinization, formation of
Propionibacterium acnes (P. acnes) biofilms and colonies, release
of pro inflammatory mediators to the skin and heredity (Lavers,
2014). A variety of factors have been popularly identified as
contributors to or responsible for worsening acne:
genetic/heredity, presence of hormones (androgens), medications
and environment (Krutman et al.,2017; Kazandjieva, &
Tsankov,2017; Mazioti, 2017). The diagnosis of acne is based on
history and physical examination. Symptoms might include: pain,
tenderness, edema, and or erythema, oily, shiny skin, comedones
(blackheads, whiteheads), lesions to the face, shoulder, upper
chest and back (Titus, & Hodge, 2012). Acne vulgaris rarely
misdiagnosed. Acne rosacea, perioral dermatitis, steroid acne,
miliaria and pseudo folliculitis barbae can be misdiagnosed as
acne.
, Acne vulgaris is not curable and goals of therapy are long-term
control, slowing progression, limiting disease duration and
recurrence, alleviation of symptoms as well as prevention of
disfigurement, and avoidance of psychologic suffering. Treatment
includes benzoyl peroxide, topical and oral preparations of
retinoids and antibiotics (Zaenglein et al., 2016). Non
pharmacologic treatment includes: washing face twice a day with
mild soap- avoid scrubbing, rubbing, squeezing and picking,
prevention of cosmetic acne and maintaining a well-balanced diet
(Burns, Dunn, Brady, Starr, & Blosser, 2016).
Patients should eliminate aggravating factors, maintain a
balanced, low-glycemic load diet, and control stress for treatment
to be successful. Adherence to therapeutic regimen is key and
empathetic and informative counseling may help motivate the
patient to continue long-term therapy. Primary care physicians
can and should handle most cases of acne without referral.
Referral to a dermatologist should be made for: People who have
developed, or are at risk of, scarring despite treatment in primary
care- for people who have moderate acne which has persisted
after six months of treatment in primary care, or treatment failure
in concordance with the patient's wishes (Zaenglein et al., 2016).
Three questions about acne vulgaris were asked:
1. What is the effectiveness and what are the potential side
effects of isotretinoin in the treatment of adult acne and
acne vulgaris in adolescents to adults?
