Acne Flashcards
(29 cards)
Acne Vulgaris
- inflammatory disease of the pilosebaceous follicles that are clogged with dead cells and oil
- the follicle becomes impacted with shed skin cells. The follicle may be blocked leading to comedone formation
Acne Vulgaris Characteristics
Black heads, white heads, pimples, greasy skin, and scarring
Epidemiology
- Typically presents at ages 8-12, peaks at ages 15-18, and resolves by age 25
- worse in males
Causes
- Genetic predisposition
- Raised hormone levels, especially testosterone
- Thickening of follicular wall due to hyperproliferation leading to more dead cells
- Blockages in the follicles by dead skin cells
- Increased production of sebum by sebaceous glands to mix up with dead cells
- Bacteria in the follicles (Propionibacterium acnes) are involved: overgrowth of p. acnes
- Inflammation in the skin surrounding the follicles
Factors that may exacerbate acne
- Emotional stress
- Premenstrual stress
- Mechanical Trauma
- Occlusive Clothing
- High humidity
- Harsh scrubbing of the skin
- Some cosmetic oils and topical products
- Various medications, especially steroids
- Psychological stress
- The role of diet is not clear
Infant acne
- typically shows up after a few weeks
- appears on cheeks, forehead, chin, and even back
- no clear cause (possibly hormones that babies receive from their mother)
- may occur for up to 3 months
- Clears spontaneously
Acne Vulgaris: The basics
- characterized by open & closed comedones, papules,pustules, cysts, nodules, and even scars
- primary sites are on the face, chest, back, and shoulders
- Severe acne should be treated to avoid permanent scars
Non-inflammatory lesions
- clogged hair follicles by skin cells & sebum
- Open comedone (black head - filled w/ blackened keratin)
- Closed comedone (white head - follicle is completely blocked)
Inflammatory Lesions
- Papules - elevated red bumps
- Pustules - elevated white pus bumps
- Nodules - elevated large and sometimes tender firm bumps
- “Cysts” - aka nodules, and if pus-filled called fluctuant nodule
Scars
- Usually sharply punched out pits or deeper furros
- Hypertrophic and keloids
- can have Post-inflammatory hyperpigmentation
Hypertropic Scars
thick scar same size as the lesion
Keloid Scar
Scar larger than the original lesion;
Post-Inflammatory Hyperpigmentation
Inflammation induces melanocyte to produce melanin
typically become lighter or go away in a few months
Acne Classification
Based on the morphology and severity (number of acnes)
Grade 1
Mild acne. The skin will display open and closed comedones and occasionally minor pimples. There is no inflammation.
Grade 2
Moderate acne. Greater number of comedones. Papules and pustules are more frequently found.
Grade 3
Moderate to severe acne. More inflammation present. Papules & Pustules are more numerous. Nodules are often present.
Grade 4
Severe acne, many pustules, nodules and cysts. Comedones are numerous. Pronounced inflammation and breakouts likely extend to areas other than the face. Often called Cystic Acne
Grade 1 Treatment
OTC treatments may be effective
Grade 2 Treatment
OTC may be effective but if no improvement in 6-8 weeks, consult a physician
Grade 3 Treatment
Referred to dermatologist
Grade 4 Treatment
Must be treated by a dermatologist
Four major treatment principles
- Correct follicular hyperkeratinization-comedolytics
- Decrease the follicular bacteria, particularly P. acnes population - antibiotics
- Produce an anti-inflammatory effect - antibiotics
- Decrease sebaceous gland activity - isotretinoin
Mild Comedone Treatment
Topical Retinoid
