Curriculum · ENT, Ophthalmology, and Dermatology
Acne vulgaris
What it is
Acne vulgaris is a common skin disorder of the pilosebaceous follicles which usually occurs in adolescence and affects 90% of adolescents. The pilosebaceous follicles are obstructed by keratin plugs, and this results in comedones, inflammation and pustules. It is distributed over the areas rich with sebaceous glands, and it affects mainly the face, the neck, the upper trunk, the back and the upper arms.
Causes and risk
Four factors make up the pathogenesis. Sebum production is increased. Keratin and sebum plug the hair follicle. Bacteria proliferate, that is cutibacterium acnes, known as propionibacterium acnes. An inflammatory response follows, and marked inflammation ends in scarring. There is no role for dietary modification in patients with acne, so chocolate, nuts and shellfish do not aggravate it. Three contributing factors are increased sebum, increased androgens and genetics. The aggravating factors are drugs, in particular steroids, irritants such as cosmetics, and picking and squeezing. Chocolate and coffee are not contributing or aggravating factors. So ask about steroid ingestion, isoniazid ingestion and occupational exposure to oils, which gives oil-induced acne, and ask about associated disease, since acne goes with PCOS, congenital adrenal hyperplasia and Cushing.