184 Acne vulgaris
Salient features
Examination
• Comedones or blackheads (Fig. 184.1), caused by plugging of hair follicles by keratin; these are hallmarks of acne.
• Generally found over the chin, face, neck, chest, upper back and upper arms (areas which have the most and the largest sebaceous glands)
• Whiteheads (i.e. distended sebaceous glands without a pore)
Advanced-level questions
How is the severity of acne graded?
Lesions can be inflammatory or non-inflammatory and are graded by severity (Fig. 184.2):
How would you manage acne?
• Wash affected parts with soap not more than twice a day
• Avoid steaming: saunas, Turkish baths
• Dietary restriction has no role in therapy (N Engl J Med 1997;336:1156).
• Reduce P. acnes proliferation:
• Reduce sebum overproduction with systemic agents: oestrogens, anti-androgens, spironolactone, isotretinoin
• Reduce abnormal desquamation of follicular epithelium:
• Physical or surgical methods: comedo extraction, dermabrasion, chemical peeling, laser resurfacing, pulsed-dye laser treatment and punch grafts.