Acne vulgaris | Acne Cleanser

Acne vulgaris.

This is a disorder characterised by chronic inflammation of blocked pilosebaceous follicles. It predominantly affects teenagers.

Aetiological factors

There is an increase in sebum excretion, which is probably androgen mediated.

Increased and abnormal keratinisation at the exit of the pilosebaceous follicle causes obstruction to the flow of sebum.

The sebum of patients with acne contains an excess of free fatty acids which may be responsible for triggering the inflammatory process.

Colonisation by pathogenic Propionobacterium acnes causing inflammation at a later stage of the disease.

Clinical features

Lesions are limited to the face, shoulders, upper chest and back.

Seborrhoea (greasy skin) is often present.

Open comedones (blackheads) are due to plugging of the pilosebaceous orifice by keratin and sebum.

Closed comedones (whiteheads) are due to accretions of sebum and keratin deeper in the pilosebaceous ducts.

Later in the course, inflammatory lesions occur that tend to lead to more scarring. The lesions may include papules, pustules, nodules and cysts, and any combination of these. Severe forms of inflammatory acne include nodular cystic disease with all its potentially destructive sequelae.

Management

General measures:

Regular washing with soap and water.

Antibacterial skin cleansers containing chlorhexidine.

Local measures:

Keratolytics include alpha- and beta-hydroxy acids, azelaic acid and retinoids. Tretinoin is the most potent keratolytic agent. Other retinoids include isotretinoin (less effective) and adapalene (less irritating). Topical retinoids may produce skin irritation, sun sensitivity and initial flaring of acne.

Reducing infection by P acnes by using benzyl peroxide and local antibiotics. Benzoyl peroxide commonly causes dry skin and occasionally allergy. It has mild but significant keratolytic effect. It inactivates topical retinoic acid when used concurrently and may cause skin bleaching. Topical antibiotics include clindamycin and erythromycin.

Usually, topical benzoyl peroxide or antibiotic is applied in the morning and a keratolytic preparation at night.

Systemic measures:

Long-tenn antibiotic therapy with oxytetracycline, minocycline or erythromycin for duration of 3 months to 2 years.

Isotretinoin (13-cis-retinoic acid) given in a 4-month course can reduce sebum excretion.

Hormonal treatment in the form of a combined anti-androgen (cyproterone acetate)/oestrogen pill can be given in courses as an oral contraceptive.

Physical measures:

Incision and drainage of cysts.

Intralesional injections of triamcinolone acetonide.