ACNE

Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-
induced increased sebum production, altered keratinisation, ,inflammation and bacterial
colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acne.
The distribution of acne corresponds to the highest density of pilosebaceous units (face, neck,
upper chest, shoulders, and back
SYMPTOMS
 The clinical features of acne include seborrhoea (excess grease),
 Non-inflammatory lesions (open and closed comedomes),
 Inflammatory lesions (papules and pustules), and various degrees of scarring.
AGE-WISE ACNE CLASSIFICATION
People of all ages are affected by acne, ranging from neonatal and infantile acne throughout adult
acne vulgaris.
Neonatal acne
Neonatal acne is characterized by multiple small closed comedomes on the nose, forehead, and
cheeks of a neonate, with an onset frequently between 0 and 6 weeks of age. Nearly 1 in 5
neonates exhibit mild neonatal acne
Neonatal acne lesions predominantly resolve spontaneously within 1 to 3 months, with no
scarring.
There does not appear to be any relationship between neonatal acne and the later development of
acne vulgaris.

Infantile acne
Acne that is seen later in infancy, with an onset beginning in months 3 to 6, is classified as
infantile acne. It is less common than neonatal acne and is characterized by more numerous
inflammatory papules and pustules, with occasional presentations of nodular acne. Scarring from
infantile acne is a risk.
Patients with infantile acne may have an increased risk of the development of severe acne
vulgaris during their teenage years.

Acne vulgaris
Hormonal surges before and during puberty are often related to the onset of typical acne vulgaris.
Teenaged boys are more frequently affected than teenaged girls, with some Hormonal surges
before and during puberty are often related to the onset of typical acne vulgaris. Teenaged boys
are more frequently affected than teenaged girls, with some estimates suggesting that 100% of
teenaged boys are affected by it.
CAUSES
There are many factors leading to acne vulgaris, these are described below,
 Hormones
Hormonal activity such as increased level of androgens e.g dihydrotestosterone (which is
responsible for secondary sexual characters in male on the onset of puberty ) and growth factor
hormones and testosterone etc activates the sebaceous glands to produce more and more sebum
That contributes to more bacterial flora and thus lead to acne via inflammation.
 Diet
Eating food containing more and more carbohydrates con lead to acne formation.It has also been
found that consuming dairy products have also lead to acne formation as milk contains whey
protein and hormones like bovine growth factor 1 that act as precursors for dihydrotestosterone
that stimulates sebaceous glands to secrete more and more sebum.
Improper cleaning of skin
It also leads to blockage of skin pores forming comdomes ( black heads and white heads).

Pathophysiology
The earliest pathological change is the formation of microcomdone that occurs in following
steps:-
 Incresead hyperkeratinization leading to more and more number of sloughed off of skin
cells
 These cells stick together inside follicle due to sufficient amount of sebum availability
caused by highly active sebaceous glands induced by androgens released in sufficient
amount during puberty rather than shedding outside the follicle
 The accumulation of dead skin cells and sebum results in blockage of pore resulting in
microcomdome formation
 This excessive sebum collected in clogged follicle act as food for that leads to infection
and thus inflammation.
Classification of acne vulgaris (based on severity of disease)
Acne has been classified into three types based upon severity:-
 Mild acne
It is classically defined by the presence of clogged follicles (microcomdomes) limited to face
with ocassionally inflammatory lesions.It includes white heads and black heads
 White heads:-Comdome in which contents of pilosebaceous unit is not in contact with
external environment
 Black heads :-Comdome in which contents of pilosebaceous unit is in direct contact with
air. They appear black.
 Moderate acne
This type includes formation of inflammatory acne lesions including papules and infected
pastules
 Severe nodulocystic acne
It includes formation of cysts and nodules
 Cysts: are the pus filled lesion.They are enlarge in size and are painful
 Nodules:are enlarge bump like lesions that feel hard when touch and formed deep
in the skin
TREATMENT
 Mild to moderate acne is treated by using a combination of antibiotics and topical therapy
including use of BENZOYL PEROXIDE, retinoids,
 Topical retinoids also affect the abnormal hyperkeratization and sebum production thus
effective in both comdomes and inflammatory acne lesions
 ISOTRETINOIN is found to be effective in 85% cases