| Acne VulgarisBasics  Description - Acne vulgaris is a disorder of the pilosebaceous units. It is a chronic inflammatory dermatosis notable for open/closed comedones and inflammatory lesions, including papules, pustules, or nodules.
- System(s) affected: Skin/Exocrine
ALERTGeriatric ConsiderationsFavre-Racouchot syndrome: Comedones on face and head due to sun exposure Pregnancy Considerations- May result in a flare or remission of acne
- Erythromycin can be used in pregnancy; use topical agents when possible.
- Isotretinoin is teratogenic; Class X
- Avoid topical tretinoin, although no good evidence exists that its use is teratogenic.
- Contraindicated: Isotretinoin, tazarotene, tetracycline, doxycycline, minocycline
Pediatric ConsiderationsRare in ages 1–7 years:
- Check for hyperandrogenemia of adrenal or ovarian origin.
- Do not use tetracyclines <8 years of age
Epidemiology - Predominant age: Early to late puberty, may persist into fourth decade
- Predominant sex:
- Male > Female (adolescence)
- Female > Male (adult)
Prevalence- Nearly 80–95% of adolescents affected. A smaller percentage will seek medical advice.
- 8% of adults aged 25–34 years, 3% of those aged 35–44 years
Risk Factors - Increased endogenous androgenic effect
- Oily cosmetics
- Rubbing or occluding skin surface (e.g., sports equipment such as helmets and shoulder pads), telephone, or hands against the skin
- Polyvinyl chloride, chlorinated hydrocarbons, cutting oil, tars
- Numerous drugs, including androgenic steroids (e.g., steroid abuse, some birth control pills)
- Endocrine disorders: Polycystic ovarian syndrome, Cushing syndrome, congenital adrenal hyperplasia, androgen-secreting tumors, acromegaly
- Stress
- High glycemic load diets may exacerbate acne (1).
Genetics- Familial association in 50%
- If a family history exists, the acne may be more severe and occur earlier.
Pathophysiology - Immune changes and inflammatory responses may predate hyperkeratinization.
- Androgens (testosterone and dehydroepiandrosterone [DHEA]) stimulate sebum production and proliferation of keratinocytes in hair follicles.
- Keratin plug obstructs follicle os, causing sebum accumulation and follicular distention.
- Propionibacterium acnes, an anaerobe, colonizes and proliferates in the plugged follicle.
- P. acnes promotes chemotactic factors and proinflammatory mediators, causing inflammation of follicle and dermis.
Commonly Associated Conditions - Acne fulminans
- Pyoderma faciale
- Acne conglobata
- Hidradenitis suppurativa
- Pomade acne
- SAPHO syndrome: Synovitis, acne, pustulosis, hyperostosis, osteitis
- PAPA syndrome: Pyogenic sterile arthritis, pyoderma gangrenosum, cystic acne
- Behçet syndrome
- Apert syndrome
- Dark-skinned patients: 50% keloidal scarring and 50% acne hyperpigmented macules
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