Diagnosis
Acne
A disorder of the pilosebaceous apparatus characterized by comedones, papules, pustules, cysts and scars.
Also known as: Acne conglobata, Acne fulminans, Acne vulgaris
Etiology
Cause [xiu]
Genetics
Cosmetic agents
Drugs: steroids, lithium, antiepileptics, iodides
Endocrine disorders: congenital adrenal hyperplasia, polycystic ovary syndrome, pregnancy
Mechanical occlusion: headbands, shoulder pads, back packs
Pathogenesis [zwf]
Androgens stimulate sebaceous glands --> Increased sebum production (seborrhea)
Follicular epidermal hyperproliferation
Subsequent plugging of the follicle
Excess sebum production
Presence and activity of the commensal bacteria Propionibacterium acnes
Inflammation
Classification [xiu]
Acne vulgaris: most common skin disease typically affects the face, upper chest, and the back
Acne conglobata: severe acne with disfiguring scars
Acne fulminans: systemic signs/symptoms such as fever
Epidemiology
Incidence per 100.000 [rvo][awg][tn3][sdf]
Prevalence per 100.000 [rvo][awg][tn3][sdf]
Symptoms & findings
Symptoms
None listed.
Clinical findings
None listed.
Anamneses
None listed.
Localized findings
Approach
Clinical diagnosis
Treatment
Mild Acne Vulgaris: [xiu][zwf]
Benzoyl peroxide
Topical retinoids (vitamin A derivatives)
Topical clindamycin
Topical erythromycin
Azelaic acid
Topical salicylic acid
Moderate-to-Severe Acne Vulgaris:
Retinoid: oral isotretinoin
Antibiotics: tetracycline, doxycycline, trimethoprim/sulfamethoxazole, clindamycin
Hormonal therapies: oral contraceptives and aldosterone antagonists (spironolactone)
Procedures:
Manual extraction of comedones
Intralesional steroid injections
Superficial peels (glycolic or salicylic acid)
Photodynamic therapy
Laser treatment
Differential diagnoses
Acneiform eruptions, Acne keloidalis nuchae, Folliculitis, Hidradenitis suppurativa, Perioral dermatitis, Rosacea, Sebaceous hyperplasia, Syringoma, Tuberous sclerosis
References
[1] http://emedicine.medscape.com/article/1069804; [Medscape]
[2] Sutaria AH, Masood S, Saleh HM, et al. Acne Vulgaris. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459173/
[3] Lynn DD, Umari T, Dunnick CA, Dellavalle RP. The epidemiology of acne vulgaris in late adolescence. Adolesc Health Med Ther. 2016 Jan 19;7:13-25.
[4] Vos T et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2163-96.
[5] Augustin M, Herberger K, Hintzen S, Heigel H, Franzke N, Schäfer I. Prevalence of skin lesions and need for treatment in a cohort of 90 880 workers. Br J Dermatol. 2011 Oct;165(4):865-73.
[6] Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013 Mar;168(3):474-85.
[7] [Clinical Dermatology 4.th Edition by Weller, Hunter, Savin and Dahl]