Acne

Acne: Excerpt from In a Page: Signs and Symptoms

Acne, the most common of all skin disorders, is a disease of pilosebaceous follicles. It affects 17 million people in the U.S., including 85% of adolescents and young adults. A genetic predisposition exists, but the pathogenesis is multifactorial and includes sebum secretion and retention under androgen stimulus, overgrowth of Propionibacterium acnes bacteria, and obstruction of epithelial cells within follicles.

Differential Diagnosis

• Acne vulgaris
  –Common in adolescents, especially boys
  –Most common on face, chest, and upper back
  –Due to hormones, P. acnes, and comedogenic cosmetics
  –May be secondary to or exacerbated by medications (e.g., corticosteroids, phenytoin, lithium, isoniazid) and polycystic ovarian syndrome
• Rosacea
  –Middle-aged to older adults
  –Papules and pustules in middle third of face, telangiectasia, flushing, erythema
  –No comedones
  –Often associated with ingestion of hot beverages, alcohol, or vasodilating medications

• Miliaria (“heat rash”)
  –Burning, pruritic vesicles, papules, or pustules on covered areas, usually trunk and intertriginous areas

• Gram-negative folliculitis
  –Klebsiella, Enterobacter, E. coli –May develop during antibiotic treatment of
  acne

• Acne conglobata
  –Most severe form of acne
  –Deep nodules, cysts, ulcers, abscesses,
  sinus tracks, scars
  –Causes severe scarring and keloid formation if untreated

• Hidradenitis suppurativa
  –Pustules and cysts, often draining and very
  painful
  –Especially in axilla, groin

Workup and Diagnosis

• History and physical examination
  –Examination should include the face, chest, and back
  –Comedones are the hallmark of acne: Open comedones (blackheads) are follicles with dilated, black orifice; closed comedones (whiteheads) are white papules without surrounding erythema
  –Look for evidence of severe acne: Inflammatory papules, pustules, cysts, nodules, scars, pits
  –Document the number of comedones, inflammatory lesions, scars, and cysts
  –Assess acne severity (mild/moderate/severe) based on number, size, and extent of lesions and the presence/ absence of scarring

• Measurement of androgen levels (testosterone, DHEA-S, 17hydroxyprogesterone) for females with resistant acne and evidence of androgen excess (e.g., irregular menses, hirsutism, clitoromegaly)
• Malassezia infection may require biopsy for diagnosis
• Bacterial culture may be necessary to rule out folliculitis

Treatment

• Patient education: Dispel common myths (e.g., acne is not caused by dirt or diet); counsel against behaviors that may worsen acne (e.g., picking at lesions, using oil-containing cosmetics/moisturizers); assess level of psychological distress
• Topical therapies include benzoyl peroxide, antibiotics, retinoids, and salicylic acid
• Intralesional steroids may be used to transiently decrease inflammation in severe acne
• Systemic therapies include oral antibiotics and hormonal therapy (low-dose oral contraceptives)
• Isotretinoin (Accutane_^R ) may be used for severe cystic acne unresponsive to conventional therapy
  –Highly teratogenic; absolutely contraindicated in pregnancy

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Rosacea

• Back to disease: Rosacea: Introduction
• Next Book Extract About Rosacea: Butterfly rash (Handbook of Signs & Symptoms (Third Edition))
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Butterfly rash (Handbook of Signs & Symptoms (Third Edition))

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