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Acne Vulgaris

Acne is the common word for Acne Vulgaris. This medical condition is a very common condition of the skin. It is very widespread and can affect almost any age.

But it is most often seen in Adolescence – affecting 80%+ of the teenagers in the Western World. Acne Vulgaris – means common acne and usually means comedones.

Acne can be exceedingly different from person to person. The severity of this condition often is difficult to understand. Skin affected often has a large number of sebaceous follicles. Acne can be seen in Inflammatory and Non-inflammatory forms.

Androgens or Testosterone production during the teenage years is a large cause of acne. 50%+ of those with acne will see a disappearance or improvement of acne by age 25-30. But for some, the condition will continue into the thirties, forties, fifties, and maybe beyond.

Patients can have areas of the skin that can have some or all of the following:

–  Scaly and red (Seborrhea)
–  Blackheads and Whiteheads (Comedones)
–  Pinheads  (Papules)
–  Pimples
–  Cysts  (Nodulocystic acne)
–  Scaring
–  Others

Skin Areas Most Commonly Affected:

–  Face
–  Top of head
–  Back
–  Shoulders
–  Chest
–  Others

Causes of Acne Vulgaris:

1.)  Blockage of Hair Follicles – a plug

–  Open Comedones (Blackhead)
–  Direct result of sebaceous glands’ becoming clogged with sebum and dead skin cells
–  + bacteria called Propionibacterium acnes causes inflammation
–  This can lead to papules, infected pustules, or nodules

2.)  Hormonal

–  Activities such as Menstrual Cycles and Puberty contribute to the formation of acne.
–  During puberty, an increased amount of sex hormones (androgens) causes the follicular gland to grow larger and make more sebum.
–  Anabolic steroid use may cause similar effects.
–  Hormones linked:  dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEAS), insulin-like growth factor 1 (IGF-1), testosterone, estrogen, progesterone.
–  Can also be seen in Pregnancy, Polycystic Ovary Syndrome, Hirsutism, Cushing’s syndrome

3.)  Genetic

–  There is a predisposition for some individuals, like twins, to have a higher rate of acne among relatives.
–  Difficult to find an exact pattern.
–  Possible genes are being studied currently for further understanding.

4.) Infectious

–  As mentioned before, Propionibacterium acnes is an anaerobic bacterium that is widely concluded to cause acne.
  –  Staphylococcus aureus has also been discovered to play some role – though unknown.
–  For this reason, one method of treatment, are antibiotics
–  Increasing findings that P. acnes antibiotic resistance is being found.

5.)  Diet

–  Diet and acne relationship is still unclear
–  High Glycemic load diet is associated with worsening acne.
–  Milk consumption and higher acne are theorized.
–  Chocolate does have a higher Glycemic load and can be made with or without milk.
–  Obesity and higher insulin metabolism are also being studied.

6.)  Psychological

–  Possible connections between stress and acne are being considered.
–  It has been long assumed that stress can worsen acne.
–  The National Institutes of Health indicate that acne can flare due to stress.

7.)  Others

–  Parasitic
–  Dirt or sweat  (Though both may be more associated with blockage of hair follicles already discussed.)

Some lesions on the skin can be caused by changes to the following:

–  Skin structures consisting of Hair Follicle
–  Changes in structures involving Sebaceous glands
–  There can also be changed in the Pilosebaceous units
–  Changes in Androgen Stimulation

Nodulocystic Acne Vulgaris

–  Large nodules called cysts or boils
–  Associated with inflammatory acne
–  Can be found on the buttocks, groin, armpit, and where sweat collects in hair follicles and perspiration ducts.
–  Tissue affected seems deeper than common acne.

What Are Some of the Complications of Acne?

–  Scarring – (The scar is created by the wound trying to heal itself. Essentially there is too much collagen in one spot.)
–  Self-esteem
–  Depression
–  Suicide thoughts or actions

Management of Acne

4 main ways to help treat acne

1.)  Normalize shedding and production of Sebum
2.)  Prevent Anti-inflammatory effects of acne.
3.)  Hormonal manipulation
4.)  Killing Propionibacterium acnes

Treatment of Acne

Medications

Benzoyl Peroxide

–  First-line Treatment
–  Helpful for mild to moderate acne.
–  Stops P. acnes, prevents the formation of comedones and has anti-inflammatory properties.
–  Causes some dryness, the slight pinkness of skin, and peeling as side effects.
–  Increases sensitivity to the sun
–  Nearly as effective as Antibiotics.
–  No real concern for bacterial resistance
–  Can be combined with other antibiotics.

Antibiotics

–  For more severe cases
–  Stops P. acnes and has anti-inflammatory properties.
–  Overall are becoming less effective
–  Can be used orally or topically
–  Erythromycin
–  Clindamycin
–  Tetracyclines  – Doxycycline and Minocycline
–  Bactrim
–  Others

Salicylic Acid

–  Decreases acne as bactericidal and keratolytic properties
–  Can open obstructed skin pores and promote shedding so skin cells.
–  Stops P. acnes, prevents the formation of comedones and has anti-inflammatory properties.
–  Hyperpigmentation can be seen in patients with darker skin who uses this type of treatment.

Topical Retinoids

–  Medications with anti-inflammatory processes.
–  Can normalize follicle cell life cycle
–  Includes: Tretinoin, Adapaline, and Tazarotene
–  Administered topically
–  Have fewer side effects, but can irritate the skin
–  Retinol, a form of vitamin A, has a similar but milder response.

Oral Retinoids

–  Medications with anti-inflammatory processes.
–  Is often called Accutane
–  Can normalize follicle cell life cycle
–  Use for moderate acne to severe acne – or refractory acne.
–  Takes a few months to several months to see improvement.
–  Many side effects were seen: muscle pains, changes in Liver enzymes and lipid levels, dry skin, nose bleeds and more.
–  ***If used during pregnancy – high risk of embryo abnormalities***
–  Women need to use birth control while on these medications.

Procedures that may help control or treat acne

1.)  Comedo extraction – helps with comedones that don’t improve with treatment.
2.)  Corticosteroid into inflamed acne comedones
3.)  Microdermabrasion  (though has not been found to be effective)
4.)  Light Therapy  (have not been found to be effective for routine use and is very expensive)
5.)  Laser surgery  (can be used to reduce scars from acne)
6.)  Surgical lancing  (Can help with cystic acne and boils – drains the area)

Alternative Medicine

–  Azelaic acid  – for mild to moderate
–  Tea Tree oil  – no confirmation of effectiveness