Acne

Acne is a common skin condition that typically affects adolescents and young adults, but can persist into adulthood. It’s characterized by pimples, blackheads, and cysts, mainly on the face, neck, back, and shoulders. It can have a significant psychological impact on adolescents.

Causes:

• Hormonal Changes: Especially during puberty, leading to increased sebum production.
• Excess Sebum Production: Overactivity of sebaceous glands.
• Clogged Hair Follicles: Due to oil and dead skin cells.
• Bacterial Infection: Propionibacterium acnes (P. acnes) can colonize the sebum, causing inflammation.
• Genetic Factors: Family history of acne increases susceptibility.
• Diet: High glycemic index foods and dairy might aggravate acne in some individuals.
• Stress: Can exacerbate acne, although it’s not a direct cause.

Diagnosis:

• Clinical Examination: Identification of different types of acne lesions – comedones (blackheads and whiteheads), papules, pustules, nodules, and cysts.
• Severity Assessment: Mild, moderate, or severe, based on lesion type and distribution.
• Patient History: Hormonal influences (like menstrual cycle in women), family history, lifestyle, diet, and any medication use.

Differential Diagnosis:

• Rosacea: Chronic skin condition causing redness and pimples, typically on the face.
• Folliculitis: Inflammation of hair follicles often mistaken for acne.
• Drug-induced acne: Steroid acne or acne caused by other medications.
• Keratosis Pilaris: Small, rough bumps, usually on arms and thighs.
• Perioral Dermatitis: Red, scaly rash around the mouth.
• Sebaceous Hyperplasia: Enlarged sebaceous glands presenting as yellowish bumps on the face.

Management:

• Mild Acne (Comedonal):
  • Topical retinoids (e.g., tretinoin, adapalene).
  • Topical benzoyl peroxide.
  • Salicylic acid preparations.
  • Topical azelaic acid.
• Mild to Moderate Inflammatory Acne:
  • Combination therapy
    • Topical retinoids and benzoyl peroxide.
    • Topical antibiotics (e.g., clindamycin, erythromycin) combined with benzoyl peroxide to reduce antibiotic resistance.
  • Oral antibiotics (e.g., doxycycline, minocycline) for more extensive cases.
• Moderate to Severe Inflammatory Acne:
  • Oral antibiotics continued for a limited duration (3 to 6 months).
  • Hormonal treatments like combined oral contraceptives or spironolactone for females with hormonal fluctuations.
  • Isotretinoin for severe, scarring, or refractory acne, with strict monitoring due to its teratogenic potential and side effect profile.
• Cystic and Scarring Acne:
  • Isotretinoin is often considered the most effective treatment.
  • Intralesional corticosteroid injections for rapid reduction of inflammation and pain in acute cysts.
  • Surgical interventions like drainage or extraction for large cysts.
• General Care:
  • Gentle Skin Care: Using non-comedogenic products.
  • Dietary Adjustments: If certain foods are identified as triggers.
  • Avoiding Picking or Squeezing Lesions: To prevent scarring.
• Adjunctive Therapies:
  • Chemical Peels
  • Comedone Extraction
  • Laser and Light Therapy: In certain cases, under professional guidance.
• Lifestyle and Home Remedies:
  • Regular cleansing with a mild cleanser.
  • Non-oily, non-comedogenic skincare products.
  • Maintaining a balanced diet and staying hydrated.
• Psychological Impact:
  • Effective treatment can help mitigate the adverse psychological impact of acne on adolescents

Follow-Up:

Regular follow-up is important to assess the effectiveness of treatment, manage side effects, and make necessary adjustments. The management of acne is often a long-term process and may require changes in treatment strategies over time.