Acne Vulgaris
Definition: Acne Vulgaris is a common, chronic, inflammatory condition affecting the pilosebaceous unit and is caused as a result of increased sebum production, hyperkeratinization of the follicle, bacterial colonization and inflammation. It mostly affects the face but can spread to other parts of the body. In the skin of colour, acne vulgaris typically shows less noticeable redness and more post-inflammatory hyperpigmentation, resulting in pigmented macules that persist long after the acne lesions have resolved.
Epidemiology: Acne Vulgaris typically develops during puberty with a reduction with increased age. In adolescence, acne is more prevalent in males, especially in its severe forms. Conversely, in adulthood, the condition occurs more frequently in women than in men.
Signs: The disease begins with the formation of a comedone, a clogged follicle that can be closed (whitehead) or open (blackhead). A whitehead appears as a white or flesh-coloured dome-shaped papule without visible inflammation. It is flask-shaped and connected to the skin surface. As the follicle opening enlarges due to keratin and sebum buildup, it becomes an open comedo, or blackhead, which is a flat or slightly raised black lesion with a central dilated orifice.
Symptoms: Symptoms include skin lesions that can be tender or painful, red, and hyperpigmented, particularly with nodular or cystic acne. Patients may also experience psychological distress due to cosmetic concerns.
Differentials: The differential diagnosis includes acne cosmetica, drug-induced acne, folliculitis, hidradenitis suppurativa, Miliaria, Perioral dermatitis, Pseudofolliculitis barbae, Rosacea and seborrheic dermatitis.
Diagnosis: Diagnosis is mainly clinical, relying on the appearance and distribution of the lesions.
Treatment: Acne Vulgaris can be treated with oral, topical, and procedural therapy as well as good skin care. For mild-to-moderate acne, topical medications are the primary line of treatment. For more severe cases of acne, combination therapy may be employed. When topical medications fail to control moderate-to-severe acne, systemic medicines are typically recommended as a first line of treatment.
References: (AMA)
- Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021;10:2021-8-6. Published 2021 Oct 11. doi:10.7573/dic.2021-8-6
- Jiao R, Zhai X, Zhang X, Xiong Z, Liu Z. Efficacy of acupuncture in improving symptoms and quality of life of patients with acne vulgaris: a randomized sham acupuncture-controlled trial. Acupuncture in Medicine. Published online April 18, 2022:096452842210765. doi:https://doi.org/10.1177/09645284221076506
- Ogé LK, Broussard A, Marshall MD. Acne Vulgaris: Diagnosis and Treatment. American Family Physician. 2019;100(8):475-484. https://www.aafp.org/pubs/afp/issues/2019/1015/p475.html#afp20191015p475-t1
- Yin NC, McMichael AJ. Acne in Patients with Skin of Color: Practical Management. American Journal of Clinical Dermatology. 2013;15(1):7-16. doi:https://doi.org/10.1007/s40257-013-0049-1