In 1990, the American Academy of Dermatology developed a classification scheme for primary acne vulgaris.7 This grading scale delineates three levels of acne: mild, moderate, and severe. Mild acne is characterized by the presence of few to several papules and pustules, but no nodules. Patients with moderate acne have several to many papules and pustules, along with a few to several nodules. With severe acne, patients have numerous or extensive papules and pustules, as well as many nodules. Acne also is classified by type of lesion— comedonal, papulopustular, and nodulocystic. Pustules and cysts are considered inflammatory acne.
Archive for the ‘General information’ Category
Classification
Friday, July 3rd, 2009Definition of acne
Friday, July 3rd, 2009Acne is a disease of pilosebaceous units in the skin. It is thought to be caused by the interplay of four factors. Excessive sebum production secondary to sebaceous gland hyperplasia is the first abnormality to occur.1 Subsequent hyperkeratinization of the hair follicle prevents normal shedding of the follicular keratinocytes, which then obstruct the follicle and form an inapparent microcomedo. Lipids and cellular debris soon accumulate within the blocked follicle. This microenvironment encourages colonization of Propionibacterium acnes, which provokes an immune response through the production of numerous inflammatory mediators. Inflammation is further enhanced by follicular rupture and subsequent leakage of lipids, bacteria, and fatty acids into the dermis. The diagnosis of acne is based on the history and physical examination. Lesions most commonly develop in areas with the greatest concentration of sebaceous glands, which include the face, neck, chest, upper arms, and back. Acne vulgaris may be defined as any disorder of the skin whose initial pathology is the microscopic microcomedo. The microcomedo may evolve into visible open comedones (“blackheads”) or closed comedones (“whiteheads”). Subsequently, inflammatory papules, pustules, and nodules may develop. Nodulocystic acne consists of pustular lesions larger than 0.5 cm. The presence of excoriations, postinflammatory hyperpigmentation,
and scars should be noted. Acne may be triggered or worsened by external factors such as mechanical obstruction (i.e., helmets, shirt collars), occupational exposures, or medications. Common medications that may cause or affect acne are
Cosmetics and emollients may occlude follicles and cause an acneiform eruption. Topical corticosteroids may produce
perioral dermatitis, a localized erythematous papular or pustular eruption. Endocrine causes of acne include Cushing’s disease or syndrome, polycystic ovary syndrome, and congenital adrenal hyperplasia. Clinical clues to possible hyperandrogenism in women include dysmenorrhea, virilization (i.e., hirsutism, clitoromegaly, temporal balding), and severe acne.
What Is Acne?
Thursday, July 2nd, 2009Acne is a disease that affects the skin’s oil glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows.
Most pimples are found on the face, neck, back, chest, and shoulders. Acne is not a serious health threat but, it can cause scars.
Sometimes, the hair, sebum, and skin cells clump together into a plug. The bacteria in the plug causes swelling. Then when the plug starts to break down, a pimple grows. There are many types of pimples. The most common types are: l Whiteheads. These are pimples that stay under the surface of the skin.l Blackheads. These pimples rise to the skin’s surface and look black. The black color is not from dirt.l Papules. These are small pink bumps that can be tender. l Pustules. These pimples are red at the bottom and have pus on top.l Nodules. These are large, painful, solid pimples that are deep in the skin.l Cysts. These deep, painful, pus-filled pimples can cause scars. Acne is the most common skin disease. People of all races and ages get acne. But it is most common in teenagers and young adults. An estimated 80 percent of all people between the ages of 11 and 30 have acne outbreaks at some point. Some people in their forties and fifties still get acne.
Pathophysiology
Wednesday, July 1st, 2009The origin of acne vulgaris is complex and incompletely understood. At least 4 pathophysiologic events take place within acne-infected hair follicles:
(1) androgen-mediated stimulation of
sebaceous gland activity,
(2) abnormal
keratinization leading to follicular
plugging (comedo formation),
(3) proliferation
of the bacterium Propionibacterium
acnes within the follicle, and
(4) inflammation.
In addition to these
4 basic mechanisms, genetic factors,3
stress,4 and possibly diet may influence
the development and severity of acne.
Treatment of Acne Vulgaris
Wednesday, July 1st, 2009THE MANAGEMENT OF ACNE VULGARIS
by nondermatologists is increasing. In this blog we attempt to answer the question:
what treatments in acne vulgaris have proven efficacy and how are these treatments best administered and individualized to optimize results and minimize complications?We considered the efficacy and safety of topical retinoids, topical antimicrobials, systemic antibiotics, hormonal treatments for women, and oral isotretinoin.