ACNE

Acne is a common chronic skin disease involving blockage and/or inflammation of hair follicles and sebaceous glands. It commonly occurs in puberty and adolescence and is associated with hormonal changes.

Causes

Acne develops as a result of the following four factors:

  • Release of inflammatory mediators into the skin
  • Follicular hyperkeratinization with subsequent plugging of the follicles
  • Excess sebum production

Clinical features

  • Typically affects face, and upper part of chest and back
  • Inflammatory papules, pustules and nodules
  • Infected parts may be painful
  • Cysts and scars in severe cases
  • May worsen during menstruation

Differential diagnosis

  • Carbuncles

Investigations

  • Clinical features are largely diagnostic

MANAGEMENT

General measures

  • Reassure patient. Inform him or her that diet plays no role in acne
  • Drink water regularly
  • Clean face twice daily with mild soap and water
  • Do not use strong soap
  • Commercial facial wash cleansers can decrease skin oiliness
  • Do not use oil, cream or petroleum jelly
  • Do not touch or press the foci
  • Sunshine is helpful, but avoid sunburn
  • If acne is getting worse or pustular, refer to a dermatologist

Topical medicine treatment

  • Benzoyl peroxide 2.5% to 10%, applied at night for not more than 4 months

Systemic antibacterials

  • Only use if acne is severe and creams are unavailable
  • Duration of treatment depends on response. May last 6 months to one year
  • Doxycycline 100 mg once daily for 6-12 months. Review treatment monthly to ascertain response
  • OR erythromycin 500 mg every 6 hours for 1 month, during pregnancy or breastfeeding
  • Refer to dermatologist if no response occurs

Oral contraceptives