Acne
From Anvita Health Wiki
Contents |
More Specific Terms
Etiology
- inflammation of the pilosebaceous unit
- factors influencing incidence & severity of acne
- genetic factors, cosmetics, microflora, endocrine status, immune status,
- occupational: oils, greases, chlorinated hydrocarbons
- pharmacologic causes:
Epidemiology
- extremely common among teenagers & remains a problem until the fifth decade of life
- keratinization is influenced by genetic factors, thus acne tends to run in families
Pathology
- altered keratinization of epithelial cells in the hair follicle infundibulum
- the resulting plug along with free fatty acids released with infection by Propionibacterium acnes, results in inflammation
- the initial lesion is a comedone
Clinical-manifestations
-
- true cysts do not occur with acne
- cystic lesion represent advanced lesions with foreign material & inflammatory cells in the dermis
- distribution: face upper torso
Laboratory
-
- may be useful in assessing a systemic basis
Differential-diagnosis
- primary skin disorders
-
- hair-associated skin
- common in athelets
- results from prolonged systemic antibiotics for acne
- presents as exacerbation of pre-exisiting acne
- acute pustular eruption on areas other than face, upper trunk
- cultures often positive for E coli
- appendageal & adnexal tumors
- basal cell carcinoma
- osteoma cutis
- epidermal cysts
- sebaceous hyperplasia
- rosacea: > 18 years, erythematous lesions of the central face
- glucocorticoid associated [2]
- occurs after topical glucocorticoid use
- eruption lacks comedones
- systemic disorders
-
- severe, cyclical, unresponsive to therapy [2]
Management
- topical therapy
- benzoyl peroxide most cost effective treatment [4,5,7]
- 2.5%, 4%, 5%, 10%
- bactericidal & keratolytic
- many preparations are drying to skin
- salicylic acid [2]
- azelaic acid [2]
- topical retinoid [2]
- 13-cis retinoic acid ( Accutane)
- all-trans retinoic acid ( Retin-A)
- comedolytic
- 1st line agent for mild to severe acne [2]
- erythromycin topical
- 1.5-3%
- may be used in combination with benzoyl peroxide ( Benzamycin)
- clindamycin topical
- up to 1%
- rarely associated with pseudomembranous colitis
- may be used in combination with benzoyl peroxide ( Benzaclin)
- tetracycline less effective than erythromycin
- dapsone ( Aczone) not recommended [7]
- oral agents
- effective in management of moderate to severe acne
- antibiotics
- tetracycline 500 mg - 2 g QD divided BID
- erythromycin 1 g QD divided BID
- doxycycline 100 mg BID
- minocycline 50 - 100 mg BID
- treatment of recalcitrant acne
- 0.5-1.0 mg/kg/day for 16-20 weeks
- mandatory risk management program ( iPLEDGE) [2]
- prednisone 5 mg QD (suppresses adrenal androgens)
- spironolactone 150-200 mg BID ( androgen antagonist)
- estrogens suppress adrenal androgens
- avoid progesterone
- intralesional injection of triamcinolone acetonide 2.5 mg/mL
- reduces size & inflammation of large lesions
- skin atrophy is side effect
More General Terms
Additional Terms
- 13-cis retinoic acid; isotretinoin (Accutane)
- benzoyl peroxide (Panoxyl, Theraderm, Acetoxyl, Asidopan, Persadox, Benoxyl, Lucidol, Mytolac, Oxylite)
- benzoyl peroxide/clindamycin (BenzaClin)
- benzoyl peroxide/erythromycin (Benzamycin)
- clindamycin (Cleocin, Cindesse, ClindaMax)
- comedone (pimple)
- doxycycline (Vibramycin, Doryx, Periostat, Oracea)
- epidermoid cyst (wen, sebaceous cyst, infundibular cyst)
- erythromycin (Eryc, Eryctte, E-mycin, Ilotycin, AK-Mycin, A/T/S, T-stat)
- estrogen
- folliculitis
- minocycline (Minocin, Solodyn)
- prednisone (Deltasone, Orasone, Liquid Pred, Meticortin)
- Propionobacterium acnes
- rosacea
- sebaceous gland
- spironolactone (Aldactone)
- tetracycline (Achromycin, Sumycin, Bristacycline)
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 932
- Medical Knowledge Self Assessment Program (MKSAP) 14, 15, American College of Physicians, Philadelphia 2006, 2009
- Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 294
- Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39 - Journal Watch 25(4):32, 2005 Ozolins M, Eady EA, Avery AJ, Cunliffe WJ, Po AL, O'Neill C, Simpson NB, Walters CE, Carnegie E, Lewis JB, Dada J, Haynes M, Williams K, Williams HC. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet. 2004 Dec 18;364(9452):2188-95. PMID: [1]
- Prescriber's Letter 12(3): 2005 Comparison of Antimicrobial Treatments for Mild to Moderate Acne Detail-Document#: [2] (subscription needed) [3]
- Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC, Thiboutot DM, Van Voorhees AS, Beutner KA, Sieck CK, Bhushan R; American Academy of Dermatology/American Academy of Dermatology Association. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007 Apr;56(4):651-63. Epub 2007 Feb 5. Review. <PubMed> PMID: &dopt=Abstract <Internet> [4]
- Prescriber's Letter 16(1): 2009 COMMENTARY: New Drug: Aczone (Dapsone) Gel 5% GUIDELINES: Acne Vulgaris Management GUIDELINES: Recommendations for Acne Management Detail-Document#: [5] (subscription needed) [6]
- NIH Institute and Center Resources [7]
- National Guideline Clearinghouse Acne (Finnish Medical Society Duodecim) ngc-guideline: [8]
- Acne management. Institute for Clinical Systems Improvement ngc-guideline: [9]
- Guidelines of care for acne vulgaris management. American Academy of Dermatology ngc-guideline: [10] - Guideline synthesis: New synthesis on the Management of Acne Aug 2007,includes recommendations from AAD, FMSD, and ICSI [11]
