Ok, so as I've said, this is the most
common skin disease of young persons
and it occasionally develops in adulthood but most often
folks have experienced it during their adolescence.
It's associated with significant
because that's a difficult time for everybody
growing up in their adolescent years.
The etiology has to do with increased sebum
production which tends to accompany puberty.
Essentially, with that
increased sebum production,
proprionibacterium acnes starts
to colonize the hair follicles.
Now, this is an anaerobic diptheroid that
thrives on the nutirent rich sebaceous glands
so you start to increase sebum, this otherwise
benign pathogen, starts to colonize those follicles.
It's unfortunately a very inflammatory
type of bacteria and leads to a
local immune response which causes
and ultimately, papules start to form and
there's some downstream manifestations.
There are a number of different factors which have
been associated with developing acne vulgaris.
Genetics is definitely one of them, we know
that patients who have parents who had acne
are more likely to
develop acne themselves.
There have been a myriad of different factors that have
been associated with diet that have been described.
One of the ones that keeps coming
up is potentially, dairy exposure.
In addition there's a number of
medications which have been implicated.
Glucocorticoids to be one
of the primary ones.
But in addition, things like lithium and phenytoin have also
been shown to be associated with the development of acne.
Eventually what happens is those papules that we talked
about with follicular hyperkeratinizations can progress,
become more inflammatory and then you're
developing what's called comedones.
Open comedones called black heads and
closed comedones called white heads.
These are essentially clogged keratin
and sebum-filled hair follicles.
Ultimately overtime, those can
progress to pustules and nodules.
Now importantly, acne vulgaris is not really
associated with either telangiectasias
or any of this eyelid involvement
that we're getting from our patient.
Moving on though to talk about the management of acne
vulgaris, typically we wanna try and minimize frictions.
So if somebody wears a helmet and it has a chin
strap, that could contribute to the flares of acne.
You wanna avoid any particular triggers and there may be some
idiosyncrasies about which patients are susceptible to which triggers
but avoiding topical corticosteroids, avoiding oral contraceptive
pills, and medications like lithium and phenytoin can help.
And ultimately, in terms of treating the disease, we
start off with basic things like topical retinoids,
benzoyl peroxides, mixtures of topical antibiotics
like erythromycin and clindamycin can help.
For more advanced disease, we start to
add oral antibiotics like tetracycline.
And lastly, for severe cases
we can use isotretinoin.
A quick comment about isotretinoin, this drug is remarkably
effective for acne vulgaris but there's a catch.
Isotretinoin is notoriously teratogenic, so you have
to make sure if you're prescribing this medication
that your patient is in two
forms of birth control.
In fact, in many countries, you have to get special
licensure in order to even prescribe this medication.
So there are certainly some features that support acne
vulgaris but it still doesn't quite seem to fit the bill.
So I'm comfortable taking that one off and
let's move on to systemic lupus erythematosus.