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