Acne Vulgaris

“Localised inflammation of the skin due to overactivity of the sebaceous glands”

Risk Factors

• Hormonal changes: puberty, pregnancy, periods, PCOS
• Family history
• Medications (e.g. oral contraceptives, corticosteroids, lithium)
• Use of oil-based cosmetic products

Aetiology

• Chronic inflammation within the pilosebaceous units of the skin
• +/- localised Propionibacterium acnes infection

Pathophysiology

• Results due to sebum overproduction and dead skin cells blocking the pilosebaceous unit, which leads to inflammation

Clinical Presentation

• Inflamed, red, painful spots, usually found on the face, chest and back
• Highly variable severity

Investigations

• Diagnosis is clinical, based on a detailed history and examination of lesions
• Blood tests may be used to determine an underlying cause (e.g. hormone levels for PCOS)

Management

• Mild: topical benzoyl peroxide, retinoids or antibiotics (e.g. clindamycin)
• Moderate: oral antibiotics (e.g. lymecycline) or OCP (e.g. Dianette) in females only
• Severe: oral retinoids (e.g. isotretinoin (Roaccutane)) – last line option

Complications

• Reduced self-esteem, anxiety and depression, acne excoriee
• Rare: pyogenic granulomas, osteoma cutis, acne with facial oedema