Acne
Definition
Chronic inflammatory skin condition characterised by spots and looking like a teenager (especially if you are).
Epidemiology
Affects >80% of teenagers; peak 18y; male=female
Pathophysiology
Complicated but the biggest factor is thought to be androgens causing an increase in sebum secretion. The sebum flows out from follicles and coats skin (this is a reason that eczema gets better in lots of teenagers).
This blocks the pilosebaceous duct (found in the hair follicle). Sometimes the follicle roots get overlarge, and form comodones, (the sebum on top can oxidise, meaning they are commonly referred to as a "blackhead").
In some people, the sebum gets colonised with bacteria and forms pus. In some people, the inflammation surrounding this process can be a scarring event.
Clinical Features
The main types of rash found are comedones, papules, pustules, cysts and scars.
Investigations
Rarely needed to be further investigated.
Management
Mild acne
In mild disease: just comedones - Benzoyl peroxide or Topical retinoids. Start using a weaker mixture, every other day. If there is no irritation after this, you can increase it to every day, then a stronger one. Its better to do this than risk a stronger amount and causing irritation, leading to the patient losing faith.
If you see no improvement, try adding a topical antibiotic - this can resolve the colonisation.
Moderate acne
In moderate disease, with papules and pustules - Try a regular oral antibiotic - a tricyclic. This works by reducing inflammation. You can also consider Dianette (a combined oral contraceptive) in women.
Severe acne
By this point 66% of people will have had the acne cured. At this point, a Dermatologist may use isotretinoin - which can cure 85% of the remaining acne patients, and keep them cured for 5 years.
Isoretinoin causes lots of fun side effects:
- Dry mouth
- Depression
- [[Increased lipids
- 50-60% Teratogenicity
They have to avoid alcohol, which goes down well with teenagers. Females also have to have monthly supervised pregnancy tests.
Prognosis
Around 5% of women and 1% of men still have acne aged 40, but this will also be responsive to treatment.