Online Medic - Acne Vulgaris
Online Medic – Acne Vulgaris
What is acne vulgaris ? Acne vulgaris is an inflammation of the unit of the pilosebaceous of the skin.
It is caused by increased production of and impairment of the normal flow of the sebum. This happens due to the follicular hyperkeratinization and pilosebaceous’ duct obstruction. It leads to inflammation and formation of open and closed comedones. The infection by bacteria such as Staphylococcus epidermidis and Propionibacterium acne lead to acne. This may also include yeast infection such as Pityrosporum yeast.
Acne vulgaris is associated with premenstrual, puberty, Cushing’s syndrome, polycystic ovarian syndrome, late onset of adrenal hyperplasia and prolactinoma.
It is usually self diagnosed. Presented with greasy skin. There will be open comedones and closed comedones.
The open comedones also known as white heads. It is a flesh coloured papules. The closed comedones known as black heads. Black heads occur due to the oxidation of the melanin pigment. Besides that, pustules, papules, cysts, seborrhea and cysts also present mostly in the back, upper torso, face and neck.
Micropathologically, it is characterized by gross distention of the pilosebaceous follicle.There will be infiltration of the neutrophil. Serous fluid is associated with blackheads/ closed comedones. Scarring occurs in severe cases of acne where there are fistulas between inflamed glands.
Investigations are rarely performed. If performed this may include measurements of FSH level and LH level with the aim to exclude polycystic ovarian syndrome. Others may include testosterone level, prolactin level, sex hormone binding globulin level and 17 –OH progesterone level.
Urinalysis in the form of 24 hour urinary cortisol is performed along to exclude Cushing syndrome and pelvic ultrasound to exclude polycystic ovarian syndrome.
Early treatment is considered to prevent further scarring. In cases of mild to moderate acne, the treatment consists of over the counter preparations containing azelaic acid and benzoyl peroxide.
In cases of moderate and severe acnes, topical antibiotics in the form of erythromycin and clindamycin are considered. It is chosen if no response to other topical preparations after 2 months. Local irritation is associated with this topical preparation.
Besides that, topical vitamin A derivatives in the form of tretinoin is used which takes 3-4 months to work.
Combined topical treatments include benzoyl peroxide and erythromycin or erythromycin and tretinoin.
In cases, where treatment is not effective or unable to be tolerated or difficult to apply at a particular site, systemic antibiotics are used. Systemic antibiotics include minocycline, oxytetracycline and erythromycin.
In cases of severe acne, oral vitamin A derivative known as isotretinoin is considered. However due to its side effect of causing teratogenic reaction and hyperlipidemia, it is only available by prescription from specialist.
Oral contraceptive pill will be sued for female patients. Additional supports are in the form of advices regarding the need to wash the face on daily basis and to use non greasy cosmetics.
The complications of acne vulgaris include facial scaring known as “ice pick” , atrophic, hypertrophic and keloid scaring, psychological impact, secondary infection and hyperpigmentation.
In terms of prognosis, it will generally improves over months or years.
What is acne vulgaris ? Acne vulgaris is an inflammation of the unit of the pilosebaceous of the skin.
It is caused by increased production of and impairment of the normal flow of the sebum. This happens due to the follicular hyperkeratinization and pilosebaceous’ duct obstruction. It leads to inflammation and formation of open and closed comedones. The infection by bacteria such as Staphylococcus epidermidis and Propionibacterium acne lead to acne. This may also include yeast infection such as Pityrosporum yeast.
Acne vulgaris is associated with premenstrual, puberty, Cushing’s syndrome, polycystic ovarian syndrome, late onset of adrenal hyperplasia and prolactinoma.
It is usually self diagnosed. Presented with greasy skin. There will be open comedones and closed comedones.
The open comedones also known as white heads. It is a flesh coloured papules. The closed comedones known as black heads. Black heads occur due to the oxidation of the melanin pigment. Besides that, pustules, papules, cysts, seborrhea and cysts also present mostly in the back, upper torso, face and neck.
Micropathologically, it is characterized by gross distention of the pilosebaceous follicle.There will be infiltration of the neutrophil. Serous fluid is associated with blackheads/ closed comedones. Scarring occurs in severe cases of acne where there are fistulas between inflamed glands.
Investigations are rarely performed. If performed this may include measurements of FSH level and LH level with the aim to exclude polycystic ovarian syndrome. Others may include testosterone level, prolactin level, sex hormone binding globulin level and 17 –OH progesterone level.
Urinalysis in the form of 24 hour urinary cortisol is performed along to exclude Cushing syndrome and pelvic ultrasound to exclude polycystic ovarian syndrome.
Early treatment is considered to prevent further scarring. In cases of mild to moderate acne, the treatment consists of over the counter preparations containing azelaic acid and benzoyl peroxide.
In cases of moderate and severe acnes, topical antibiotics in the form of erythromycin and clindamycin are considered. It is chosen if no response to other topical preparations after 2 months. Local irritation is associated with this topical preparation.
Besides that, topical vitamin A derivatives in the form of tretinoin is used which takes 3-4 months to work.
Combined topical treatments include benzoyl peroxide and erythromycin or erythromycin and tretinoin.
In cases, where treatment is not effective or unable to be tolerated or difficult to apply at a particular site, systemic antibiotics are used. Systemic antibiotics include minocycline, oxytetracycline and erythromycin.
In cases of severe acne, oral vitamin A derivative known as isotretinoin is considered. However due to its side effect of causing teratogenic reaction and hyperlipidemia, it is only available by prescription from specialist.
Oral contraceptive pill will be sued for female patients. Additional supports are in the form of advices regarding the need to wash the face on daily basis and to use non greasy cosmetics.
The complications of acne vulgaris include facial scaring known as “ice pick” , atrophic, hypertrophic and keloid scaring, psychological impact, secondary infection and hyperpigmentation.
In terms of prognosis, it will generally improves over months or years.
