fbpx

ADVERTISEMENT

ADVERTISEMENT

Acne vulgaris

Updated : August 22, 2023





Background

Acne vulgaris is a chronically recurring, self-limiting inflammatory condition of the pilosebaceous unit. Cutibacterium acnes causes acne vulgaris to appear throughout adolescence when dehydroepiandrosterone is naturally circulating in the blood.

It is a relatively typical skin condition that can manifest as both inflammatory and non-inflammatory blisters, mostly on the face but also on the forearms, back and trunk.

Epidemiology

Adolescence is when acne may first emerge, and it can last into the early 30s. Males are more likely than females to develop acne. Populations in urban areas are much more influenced than those in rural areas. 20 percent of those who have been impacted experience extreme acne that leaves scars.

It appears that certain races are more impacted than others. Extreme acne is much more frequent in Asians and Africans, whereas moderate acne is more prevalent in white people. People with a darker complexion, in general, also tend to acquire hyperpigmentation. Neonates can also get acne, although it typically goes away on its own.

Anatomy

Pathophysiology

As a result of androgens, 5-alpha reductase changes testosterone throughout puberty into more effective DHT, which attaches to specific targets in the sebaceous glands and increases sebum secretion. Sebum is retained as a result of the follicular epidermis’ enhanced hyperproliferation.

Inflammation is triggered when distended follicles burst and discharge pro-inflammatory substances into the epidermis. Staphylococcus epidermis, Malassezia furfur, and C. acnes all cause inflammation and promote the growth of follicular epidermal tissue.

Acne-causing factors include:

  • High-glycemic foods like junk food, chocolates, and dairy items (which also include hormones) produce insulin-like growth factors that promote follicular epidermal upregulation.
  • Face massage and cosmetics with oils.
  • Edema of the pilosebaceous duct appears to be followed by a premenstrual acne flare-up. 70 percent of patients who are female experience this.
  • Severe stress and rage may exacerbate acne, most likely by triggering stress hormones.

Etiology

Acne is caused by the sebaceous glands being oversensitive to a normal level of androgens in the blood, which P. acnes and inflammation exacerbate.

Acne can result from the following factors:

  • Utilization of drugs such as lithium, anticonvulsants, and steroids.
  • Excessive sun exposure
  • Utilization of occlusive clothing, such as headbands, shoulder pads, underwire brassieres, and backpacks.
  • Pregnancy and endocrine conditions like polycystic ovarian syndrome
  • The amount of branched fatty acids in sebum is influenced by genetics. Estimates of heritability range from 50 to 90%.

Genetics

Prognostic Factors

Although it may not be life-threatening, acne has psychosocial repercussions that last a lifetime. Acne sufferers and those with breakouts frequently experience anxiety and sadness. It’s almost impossible to remove acne scars.

According to a Swedish study, teenage guys’ acne might be at a higher risk for developing prostate cancer later in life. Overall, acne therapy has a good prognosis.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

trifarotene 

Apply a thin layer of the product on the affected area each day in the evening



tetracycline 

An initial dose of 1 gm/day orally
After the gradual improvement, reduce the dose to 125-500 mg/day



adapalene 

Indicated as topical administration for acne vulgaris
After washing the face, apply the dosage form as a thin film on the affected area of the skin every evening
A warm sensation may occur on the skin after applying the same
In case of apparent worsening, do not discontinue the treatment



isotretinoin 

Massage the topical dosage form on the affected area every 12 hours



azelaic acid 

Massage the topical dosage form on the affected area every 12 hours



azelaic acid 

Massage the topical dosage form on the affected area every 12 hours



salicylic acid acne 

Cleansers- Apply the product through gentle massage onto the wet face & neck until lather formation
Rinse thoroughly
Utilize it twice daily
Scrub- Use it the same way as the cleanser, but once daily
Cream/gel/foam- After clean-up, apply the product to the affected area thrice daily
Wipes/pads- After clean-up, wipe off the face & neck with them, do not rinse
Shower soaps/gels- utilize the product once daily, massage over the affected body, and rinse well



erythromycin topical 

Administer the medication topically twice daily, in the morning and evening, to the affected regions of the skin, following a thorough cleansing and gentle drying



erythromycin topical/benzoyl peroxide 


Acne Vulgaris
Apply topically two times in a day (morning & evening) near the affected areas after the skin is neatly washed and dried



drospirenone/ethinyl estradiol 

1 active tablet containing 3 mg drospirenone/ 0.02 mg ethinyl estradiol taken by mouth once daily for 24 days, followed by 1 placebo tablet taken by mouth once daily for 4 days
Dosage Modifications Renal impairment: not recommended
Hepatic impairment: not recommended
Dosing considerations For females it is recommended to utilize extra non-hormonal contraception throughout the initial 7 days of treatment.
Elevated possibility of venous thromboembolism (VTE) when using combined hormonal contraceptives after childbirth; chance decreases swiftly after 21 days but does not reach the usual level until 42 days after delivery.
For women who have given birth but do not breastfeed or have undergone a second trimester abortion: It is recommended to wait for at least four weeks before beginning therapy.
For women who have had a caesarean section delivery: It is recommended to wait for at least six weeks before beginning therapy.



tea tree oil 

It is recommended to apply a topical 5% gel daily topical 100% solution should be applied twice a day for six months



resorcinol/sulfur 

Following the process of cleaning, use a small amount of the solution on the impacted regions up to three times a day



sodium sulfacetamide/sulfur 

Cream: Administer a thin layer of the cream as required, either once daily or up to three times daily
Foam: This should be done once a day or twice a day
If necessary, rinse off the foam after 1-2 minutes
Cleanser: Apply the cleanser to damp skin and gently massage it either once a day or twice a day
Afterward, rinse your skin thoroughly and pat it dry
Cleansing Pads: Take a wet pad and apply it to wet skin Work the pad into a full lather, excluding the eye area, for 10-20 seconds
To cure potential dryness, it is advisable to commence with a single daily application and progressively recommend it to 2-3 times per day as deemed necessary



sulfur topical 

Cream/Ointment/lotion: After washing, apply gently to the affected area twice or thrice a day

Bar/Cleanser: Apply cleanser to a damp face and the neck, massaging it until lather forms. Rinse completely
Use once or twice daily



tretinoin topical 

Altreno, Avita,Tretin-X, Retin-A, Atralin, Retin-A Micro
Apply a little quantity topically to the skin every night before bed, wherever acne lesions occur. Use enough to cover the whole affected region softly.



drospirenone/ethinyl estradiol/levomefolate 

Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.



benzoyl peroxide and tretinoin topical 

Indicated for the treatment of acne vulgaris
Apply a bit of cream on the affected area each day



sulfacetamide topical 

Spread a thin layer of the medication topically to the impacted regions twice daily



cyproterone and ethinyl estradiol 

Administer one tablet daily once for 21 days, then skip the dosing for 7 days.
A new cycle should also begin when a woman's period initially begins.
Regardless of whether bleeding is associated with withdrawal, subsequent dose cycles should start around the same day of the week as the initial cycle did.
After 3–4 cycles, if your symptoms have improved enough, you may stop treatment.



diazolidinylurea 

1.5 mg of diazolidinylurea cream applied on the affected area once or twice a day



lymecycline 

408 mg per day for at least eight weeks is the dosage represented in terms of lymecycline (i.e., 408 mg of lymecycline equals 300 mg of tetracycline base)



benzoyl peroxide, clindamycin phosphate, adapalene 

A newly approved topical gel by the name Cabtreo is compounded by using three drugs, namely benzoyl peroxide (3.1%), which shows antibiotic action; clindamycin phosphate (1.2%), which shows antibacterial property; adapalene (0.15%) which is a retinoid
Cabtreo is a fixed dose FDA-approved topical treatment for Acne Vulgaris
This topical gel is applied to the affected skin areas as a thin layer daily once. It is only used on the skin as a topical agent



 

trifarotene 

Apply a thin layer of the product on the affected area each day in the evening



benzyl peroxide 

Apply the product onto the affected skin twice or thrice daily



adapalene and benzoyl peroxide 

<9 years: Safety and efficacy not established
>9 years: Apply a thin layer to the affected areas of the face and trunk every night after washing



doxycycline 

Children >8 years and adolescents: 50 to 100 mg orally once or twice a day (depends on the severity of infection and symptoms)



adapalene 

Apply the dosage form as a film on the affected area of the skin every evening
Not for children below 12 years



azelaic acid 

For >12 years
Massage the topical dosage form on the affected area every 12 hours
Apply the product gently and thoroughly on washed and dried skin



erythromycin topical/benzoyl peroxide 


Acne Vulgaris
Age >12 years
Apply topically two times in a day (morning & evening) near the affected areas after the skin is neatly washed and dried
Age >12 years
Safety and efficacy not established



drospirenone/ethinyl estradiol 

Safety and efficacy not determined in less than 14 years old
≥14 years
1 active tablet containing 3 mg drospirenone/ 0.02 mg ethinyl estradiol taken by mouth once daily for 24 days, followed by 1 placebo tablet taken by mouth once daily for 4 days



resorcinol/sulfur 

Adolescents: following the process of cleaning, use a small amount of the solution on the impacted regions up to three times a day



sodium sulfacetamide/sulfur 

Cream: Administer a thin coat of the cream to the impacted regions once per day or as required, with the option to increase the frequency up to three times daily
Foam: Massage the foam gently into the affected area once a day or twice a day
If you need to remove the foam, rinse it off after 1-2 minutes
Cleanser: Apply the cleanser to wet skin and gently massage it into the skin once a day or twice a day
Rinse your skin thoroughly and pat it dry afterward
Cleansing Pads: Take a wet pad and apply it to wet skin Work the pad into a full lather for 10-20 seconds, making sure to avoid the eye area
Rinse your skin thoroughly and pat it dry
Dispose of the used pad properly
To minimize the potential dryness It is advised to initiate with a single utilization per day and progressively escalate it to 2-3 instances on a daily basis, as deemed necessary



sulfur topical 

Adults
Cream/Ointment/lotion: After washing, apply gently to the affected area twice or thrice a day

Bar/Cleanser: Use once or twice daily; Apply cleanser to a damp face and neck, massaging it until lather forms. Rinse completely



tretinoin topical 

<9 years: Safety and efficacy not established (Altreno)
<10 years: Safety and efficacy not established (Atralin)
<12 years: Safety and efficacy not established (Retin-A Micro, Avita, Retin-A)
Apply a little quantity topically to the skin every night before bed, wherever acne lesions occur. Use enough to cover the whole affected region softly.



drospirenone/ethinyl estradiol/levomefolate 

<14 years: Safety and efficacy not established
≥14 years:
Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.



benzoyl peroxide and tretinoin topical 

Indicated for the treatment of acne vulgaris
For <9 years: Safety and efficacy are not seen in pediatrics
For >9 years: Apply a small amount of cream on the affected area each day



sulfacetamide topical 

Safety and efficacy not determined in less than twelve years
≥12 years: Spread a thin layer of the medication topically to the impacted regions twice daily



 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK459173/

ADVERTISEMENT 

Acne vulgaris

Updated : August 22, 2023




Acne vulgaris is a chronically recurring, self-limiting inflammatory condition of the pilosebaceous unit. Cutibacterium acnes causes acne vulgaris to appear throughout adolescence when dehydroepiandrosterone is naturally circulating in the blood.

It is a relatively typical skin condition that can manifest as both inflammatory and non-inflammatory blisters, mostly on the face but also on the forearms, back and trunk.

Adolescence is when acne may first emerge, and it can last into the early 30s. Males are more likely than females to develop acne. Populations in urban areas are much more influenced than those in rural areas. 20 percent of those who have been impacted experience extreme acne that leaves scars.

It appears that certain races are more impacted than others. Extreme acne is much more frequent in Asians and Africans, whereas moderate acne is more prevalent in white people. People with a darker complexion, in general, also tend to acquire hyperpigmentation. Neonates can also get acne, although it typically goes away on its own.

As a result of androgens, 5-alpha reductase changes testosterone throughout puberty into more effective DHT, which attaches to specific targets in the sebaceous glands and increases sebum secretion. Sebum is retained as a result of the follicular epidermis’ enhanced hyperproliferation.

Inflammation is triggered when distended follicles burst and discharge pro-inflammatory substances into the epidermis. Staphylococcus epidermis, Malassezia furfur, and C. acnes all cause inflammation and promote the growth of follicular epidermal tissue.

Acne-causing factors include:

  • High-glycemic foods like junk food, chocolates, and dairy items (which also include hormones) produce insulin-like growth factors that promote follicular epidermal upregulation.
  • Face massage and cosmetics with oils.
  • Edema of the pilosebaceous duct appears to be followed by a premenstrual acne flare-up. 70 percent of patients who are female experience this.
  • Severe stress and rage may exacerbate acne, most likely by triggering stress hormones.

Acne is caused by the sebaceous glands being oversensitive to a normal level of androgens in the blood, which P. acnes and inflammation exacerbate.

Acne can result from the following factors:

  • Utilization of drugs such as lithium, anticonvulsants, and steroids.
  • Excessive sun exposure
  • Utilization of occlusive clothing, such as headbands, shoulder pads, underwire brassieres, and backpacks.
  • Pregnancy and endocrine conditions like polycystic ovarian syndrome
  • The amount of branched fatty acids in sebum is influenced by genetics. Estimates of heritability range from 50 to 90%.

Although it may not be life-threatening, acne has psychosocial repercussions that last a lifetime. Acne sufferers and those with breakouts frequently experience anxiety and sadness. It’s almost impossible to remove acne scars.

According to a Swedish study, teenage guys’ acne might be at a higher risk for developing prostate cancer later in life. Overall, acne therapy has a good prognosis.

trifarotene 

Apply a thin layer of the product on the affected area each day in the evening



tetracycline 

An initial dose of 1 gm/day orally
After the gradual improvement, reduce the dose to 125-500 mg/day



adapalene 

Indicated as topical administration for acne vulgaris
After washing the face, apply the dosage form as a thin film on the affected area of the skin every evening
A warm sensation may occur on the skin after applying the same
In case of apparent worsening, do not discontinue the treatment



isotretinoin 

Massage the topical dosage form on the affected area every 12 hours



azelaic acid 

Massage the topical dosage form on the affected area every 12 hours



azelaic acid 

Massage the topical dosage form on the affected area every 12 hours



salicylic acid acne 

Cleansers- Apply the product through gentle massage onto the wet face & neck until lather formation
Rinse thoroughly
Utilize it twice daily
Scrub- Use it the same way as the cleanser, but once daily
Cream/gel/foam- After clean-up, apply the product to the affected area thrice daily
Wipes/pads- After clean-up, wipe off the face & neck with them, do not rinse
Shower soaps/gels- utilize the product once daily, massage over the affected body, and rinse well



erythromycin topical 

Administer the medication topically twice daily, in the morning and evening, to the affected regions of the skin, following a thorough cleansing and gentle drying



erythromycin topical/benzoyl peroxide 


Acne Vulgaris
Apply topically two times in a day (morning & evening) near the affected areas after the skin is neatly washed and dried



drospirenone/ethinyl estradiol 

1 active tablet containing 3 mg drospirenone/ 0.02 mg ethinyl estradiol taken by mouth once daily for 24 days, followed by 1 placebo tablet taken by mouth once daily for 4 days
Dosage Modifications Renal impairment: not recommended
Hepatic impairment: not recommended
Dosing considerations For females it is recommended to utilize extra non-hormonal contraception throughout the initial 7 days of treatment.
Elevated possibility of venous thromboembolism (VTE) when using combined hormonal contraceptives after childbirth; chance decreases swiftly after 21 days but does not reach the usual level until 42 days after delivery.
For women who have given birth but do not breastfeed or have undergone a second trimester abortion: It is recommended to wait for at least four weeks before beginning therapy.
For women who have had a caesarean section delivery: It is recommended to wait for at least six weeks before beginning therapy.



tea tree oil 

It is recommended to apply a topical 5% gel daily topical 100% solution should be applied twice a day for six months



resorcinol/sulfur 

Following the process of cleaning, use a small amount of the solution on the impacted regions up to three times a day



sodium sulfacetamide/sulfur 

Cream: Administer a thin layer of the cream as required, either once daily or up to three times daily
Foam: This should be done once a day or twice a day
If necessary, rinse off the foam after 1-2 minutes
Cleanser: Apply the cleanser to damp skin and gently massage it either once a day or twice a day
Afterward, rinse your skin thoroughly and pat it dry
Cleansing Pads: Take a wet pad and apply it to wet skin Work the pad into a full lather, excluding the eye area, for 10-20 seconds
To cure potential dryness, it is advisable to commence with a single daily application and progressively recommend it to 2-3 times per day as deemed necessary



sulfur topical 

Cream/Ointment/lotion: After washing, apply gently to the affected area twice or thrice a day

Bar/Cleanser: Apply cleanser to a damp face and the neck, massaging it until lather forms. Rinse completely
Use once or twice daily



tretinoin topical 

Altreno, Avita,Tretin-X, Retin-A, Atralin, Retin-A Micro
Apply a little quantity topically to the skin every night before bed, wherever acne lesions occur. Use enough to cover the whole affected region softly.



drospirenone/ethinyl estradiol/levomefolate 

Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.



benzoyl peroxide and tretinoin topical 

Indicated for the treatment of acne vulgaris
Apply a bit of cream on the affected area each day



sulfacetamide topical 

Spread a thin layer of the medication topically to the impacted regions twice daily



cyproterone and ethinyl estradiol 

Administer one tablet daily once for 21 days, then skip the dosing for 7 days.
A new cycle should also begin when a woman's period initially begins.
Regardless of whether bleeding is associated with withdrawal, subsequent dose cycles should start around the same day of the week as the initial cycle did.
After 3–4 cycles, if your symptoms have improved enough, you may stop treatment.



diazolidinylurea 

1.5 mg of diazolidinylurea cream applied on the affected area once or twice a day



lymecycline 

408 mg per day for at least eight weeks is the dosage represented in terms of lymecycline (i.e., 408 mg of lymecycline equals 300 mg of tetracycline base)



benzoyl peroxide, clindamycin phosphate, adapalene 

A newly approved topical gel by the name Cabtreo is compounded by using three drugs, namely benzoyl peroxide (3.1%), which shows antibiotic action; clindamycin phosphate (1.2%), which shows antibacterial property; adapalene (0.15%) which is a retinoid
Cabtreo is a fixed dose FDA-approved topical treatment for Acne Vulgaris
This topical gel is applied to the affected skin areas as a thin layer daily once. It is only used on the skin as a topical agent



trifarotene 

Apply a thin layer of the product on the affected area each day in the evening



benzyl peroxide 

Apply the product onto the affected skin twice or thrice daily



adapalene and benzoyl peroxide 

<9 years: Safety and efficacy not established
>9 years: Apply a thin layer to the affected areas of the face and trunk every night after washing



doxycycline 

Children >8 years and adolescents: 50 to 100 mg orally once or twice a day (depends on the severity of infection and symptoms)



adapalene 

Apply the dosage form as a film on the affected area of the skin every evening
Not for children below 12 years



azelaic acid 

For >12 years
Massage the topical dosage form on the affected area every 12 hours
Apply the product gently and thoroughly on washed and dried skin



erythromycin topical/benzoyl peroxide 


Acne Vulgaris
Age >12 years
Apply topically two times in a day (morning & evening) near the affected areas after the skin is neatly washed and dried
Age >12 years
Safety and efficacy not established



drospirenone/ethinyl estradiol 

Safety and efficacy not determined in less than 14 years old
≥14 years
1 active tablet containing 3 mg drospirenone/ 0.02 mg ethinyl estradiol taken by mouth once daily for 24 days, followed by 1 placebo tablet taken by mouth once daily for 4 days



resorcinol/sulfur 

Adolescents: following the process of cleaning, use a small amount of the solution on the impacted regions up to three times a day



sodium sulfacetamide/sulfur 

Cream: Administer a thin coat of the cream to the impacted regions once per day or as required, with the option to increase the frequency up to three times daily
Foam: Massage the foam gently into the affected area once a day or twice a day
If you need to remove the foam, rinse it off after 1-2 minutes
Cleanser: Apply the cleanser to wet skin and gently massage it into the skin once a day or twice a day
Rinse your skin thoroughly and pat it dry afterward
Cleansing Pads: Take a wet pad and apply it to wet skin Work the pad into a full lather for 10-20 seconds, making sure to avoid the eye area
Rinse your skin thoroughly and pat it dry
Dispose of the used pad properly
To minimize the potential dryness It is advised to initiate with a single utilization per day and progressively escalate it to 2-3 instances on a daily basis, as deemed necessary



sulfur topical 

Adults
Cream/Ointment/lotion: After washing, apply gently to the affected area twice or thrice a day

Bar/Cleanser: Use once or twice daily; Apply cleanser to a damp face and neck, massaging it until lather forms. Rinse completely



tretinoin topical 

<9 years: Safety and efficacy not established (Altreno)
<10 years: Safety and efficacy not established (Atralin)
<12 years: Safety and efficacy not established (Retin-A Micro, Avita, Retin-A)
Apply a little quantity topically to the skin every night before bed, wherever acne lesions occur. Use enough to cover the whole affected region softly.



drospirenone/ethinyl estradiol/levomefolate 

<14 years: Safety and efficacy not established
≥14 years:
Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.



benzoyl peroxide and tretinoin topical 

Indicated for the treatment of acne vulgaris
For <9 years: Safety and efficacy are not seen in pediatrics
For >9 years: Apply a small amount of cream on the affected area each day



sulfacetamide topical 

Safety and efficacy not determined in less than twelve years
≥12 years: Spread a thin layer of the medication topically to the impacted regions twice daily



https://www.ncbi.nlm.nih.gov/books/NBK459173/