Acne vulgaris, also known as acne, is a common disorder of the pilosebaceous units Pilosebaceous Units Hidradenitis Suppurativa in adolescents and young adults. The condition occurs due to follicular hyperkeratinization, excess sebum Sebum The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. Infectious Folliculitis production, follicular colonization Colonization Bacteriology by Cutibacterium acnes, and inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation. Acne can present as open or closed comedones, papules, pustules, nodules, or cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change. The diagnosis is based on clinical exam. Management depends on the severity, but includes skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions care techniques, topical therapies, antibiotics, and retinoids Retinoids Retinol and derivatives of retinol that play an essential role in metabolic functioning of the retina, the growth of and differentiation of epithelial tissue, the growth of bone, reproduction, and the immune response. Dietary vitamin A is derived from a variety of carotenoids found in plants. It is enriched in the liver, egg yolks, and the fat component of dairy products. Fat-soluble Vitamins and their Deficiencies.
Last updated: 29 Nov, 2021
Acne vulgaris is a disorder of the pilosebaceous unit (which includes the hair follicle Hair follicle A tube-like invagination of the epidermis from which the hair shaft develops and into which sebaceous glands open. The hair follicle is lined by a cellular inner and outer root sheath of epidermal origin and is invested with a fibrous sheath derived from the dermis. Follicles of very long hairs extend into the subcutaneous layer of tissue under the skin. Cowden Syndrome and sebaceous gland Sebaceous Gland Small, sacculated organs found within the dermis. Each gland has a single duct that emerges from a cluster of oval alveoli. Each alveolus consists of a transparent basement membrane enclosing epithelial cells. The ducts from most sebaceous glands open into a hair follicle, but some open on the general surface of the skin. Sebaceous glands secrete sebum. Hordeolum (Stye)) and is characterized by 4 pathogenic factors:
Pathogenesis of acne vulgaris:
Image depicting the pathogenic factors leading to comedo,
pustule
Pustule
Blister filled with pus
Generalized and Localized Rashes, and
nodule
Nodule
Chalazion development. Plugging of the follicle by corneocytes results in
sebum
Sebum
The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris.
Infectious Folliculitis accumulation. C. acnes
colonization
Colonization
Bacteriology
triggers
Triggers
Hereditary Angioedema (C1 Esterase Inhibitor Deficiency) an inflammatory response, which may lead to follicular rupture.
Noninflammatory acne (comedones):
Open comedones on the nose Nose The nose is the human body’s primary organ of smell and functions as part of the upper respiratory system. The nose may be best known for inhaling oxygen and exhaling carbon dioxide, but it also contributes to other important functions, such as tasting. The anatomy of the nose can be divided into the external nose and the nasal cavity. Nose and Nasal Cavity: Anatomy
Image: “Blackheads” by Elecbullet. License: Public DomainClosed comedones at the nasolabial folds
Image: “Comedos Nose Nose The nose is the human body’s primary organ of smell and functions as part of the upper respiratory system. The nose may be best known for inhaling oxygen and exhaling carbon dioxide, but it also contributes to other important functions, such as tasting. The anatomy of the nose can be divided into the external nose and the nasal cavity. Nose and Nasal Cavity: Anatomy 01” by M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara. License: CC BY 2.0Inflammatory acne:
Acne vulgaris with typical lesions, such as comedones, papules, and pustules on the face
Image: “Clinical characteristics and epidermal barrier function of papulopustular rosacea Papulopustular Rosacea Rosacea: A comparison study with acne vulgaris” by Pakistan Journal of Medical Sciences. License: CC BY 3.0Severe acne vulgaris:
A cutaneous papular outbreak over the
neck
Neck
The part of a human or animal body connecting the head to the rest of the body.
Peritonsillar Abscess and lower
jaw
Jaw
The jaw is made up of the mandible, which comprises the lower jaw, and the maxilla, which comprises the upper jaw. The mandible articulates with the temporal bone via the temporomandibular joint (TMJ). The 4 muscles of mastication produce the movements of the TMJ to ensure the efficient chewing of food.
Jaw and Temporomandibular Joint: Anatomy, with a coalescence of numerous inflamed papules
Atrophic acne scarring Scarring Inflammation in a patient with severe acne vulgaris
Image: “Novel Technology in the Treatment of Acne Scars: The Matrix-tunable Radiofrequency Technology” by Ramesh M, Gopal M, Kumar S, Talwar A. License: CC BY 2.0The following variants are rare forms of acne that more often affect Affect The feeling-tone accompaniment of an idea or mental representation. It is the most direct psychic derivative of instinct and the psychic representative of the various bodily changes by means of which instincts manifest themselves. Psychiatric Assessment adolescent boys and men.
Large, hemorrhagic ulcerations on the face of a patient with acne fulminans
Image: “Successful Treatment of Facial Acne Fulminans: Antimicrobial Agents and Oral Prednisolone Prednisolone A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. Immunosuppressants as Promising Regimes” by Case Reports in Dermatological Medicine. License: CC BY 4.0Acne conglobata:
A rare form of acne vulgaris that causes extensive
scarring
Scarring
Inflammation, and a coalescence of developing inflammatory cutaneous nodules.
The diagnosis is clinical and based on the physical examination. No laboratory or skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma is required.
These treatments are indicated for all patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with inflammatory disease in order to prevent sequelae and complications.
In addition to the above measures, the following may be added: