Predominantly affects the peripubertal population.
Risk factors:
Regulation of the biological function of human sebaceous gland cells. Schematic overview. [LXR: liver X receptors, PPAR: peroxisome-proliferator activated receptors]. | Makrantonaki, E., Ganceviciene, R., & Zouboulis, C. (2011). An update on the role of the sebaceous gland in the pathogenesis of acne. Dermato-Endocrinology, 3(1), 41–49. https://doi.org/10.4161/derm.3.1.13900
The Calgary Guide | http://calgaryguide.ucalgary.ca/
Presentation
Clinically manifests as comedones, papules, nodules, pustules & cysts and heals with scars.
Hair follicle anatomy demonstrating a healthy hair follicle (pictured left), a whitehead or closed comedone (middle picture), and a blackhead or open comedone (pictured right) | Blausen.com staff. “Blausen gallery 2014”. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. – Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=30871454
Polymorphic, characterised by comedones, papules, pustules, nodules & cyst
Comedone (Pathognomic lesion of acne)
Open comedones (blackheads)
Closed comedones (whiteheads)
Sires of predilection (Regions of pilosebaceous hair follicles)
Face (Cheeks, chin, forehead), shoulders, upper chest & back
Pilosebaceous unit in facial skin of acne patients. Faintly hypertrophic sebaceous gland are observed. Dilated capillaries and perivascular lymphocytes (A and C) are early signs of inflammatory process in acne-involved skin. Dilated plugged orifice of hair follicle-sign of acne comedo (B). | Makrantonaki, E., Ganceviciene, R., & Zouboulis, C. (2011). An update on the role of the sebaceous gland in the pathogenesis of acne. Dermato-Endocrinology, 3(1), 41–49. https://doi.org/10.4161/derm.3.1.13900
Associated features of hyperandrogenism:
Hirsutism
Virilism
Irregular periods
Diagnosis
Grading:
Grade I (mild): Open and closed comedones with few inflammatory papules and pustules
Grade II (moderate): Papules and pustules, mainly on face
Grade III (moderately severe): Numerous papules and pustules, and occasional inflamed nodules, also on chest and back
Grade IV (severe): Many large, painful nodules and pustules
Grade I (mild) acne showing comedones with few inflammatory papules and pustules. | Kraft, J., & Freiman, A. (2011). Management of acne. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 183(7), E430–E435. https://doi.org/10.1503/cmaj.090374Grade II (moderate) acne showing papules and pustules. | Kraft, J., & Freiman, A. (2011). Management of acne. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 183(7), E430–E435. https://doi.org/10.1503/cmaj.090374Grade III (moderately severe) acne showing numerous large painful nodules and pustules as well as some inflamed nodules. | Kraft, J., & Freiman, A. (2011). Management of acne. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 183(7), E430–E435. https://doi.org/10.1503/cmaj.090374Grade IV (severe) acne showing many large inflamed nodules and pustules as well as scarring. | Kraft, J., & Freiman, A. (2011). Management of acne. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 183(7), E430–E435. https://doi.org/10.1503/cmaj.090374
Management
General measures
Hygiene
Antibacterial skin condenses (eg. Chlorhexidine)
Local treatment:
The main target of acne treatment is the microcomedone.
