An inflammatory disease of the sebaceous follicles of the skin, marked by comedones, papules, and pustules. It is exceptionally common in puberty and adolescence. Acne usually affects the face, chest, back, and shoulders. In severe cases, cysts, nodules, and scarring occur.
ETIOLOGY: The cause is unknown, but predisposing factors include hereditary tendencies and disturbances in the androgen-estrogen balance. Acne begins at puberty, when the increased secretion of androgen in both males and females increases the size and activity of the pilo-sebaceous glands.
Specific inciting factors may include food allergies, endocrine disorders, therapy with adrenal corticosteroid hormones, and psychogenic factors. Vitamin deficiencies, ingestion of halogens, and contact with chemicals such as tar and chlorinated hydrocarbons may be specific causative factors. The fact that bacteria are important once the disease is present is indicated by the successful results following antibiotic therapy. The lesions may become worse in women and girls before the menstrual period.
SYMPTOMS: The face, neck, and shoulders are common sites. Acne may be obstinate and recurrent.
TREATMENT: Treatments include skin cleansing, topical agents (e.g. benzoyl peroxide or vitamin A derivatives), oral or topical antibacterial drugs, and oral isotretinoin, among others.
PATIENT CARE: The patient is instructed to wash the skin thoroughly but gently, avoiding intense scrubbing and skin abrasion; to keep hands away from the face and other sites of lesions; to limit the use of cosmetics; and to observe for, recognize, and avoid or modify predisposing factors that may cause exacerbations. The need to reduce sun exposure is explained, and the patient is advised to use a sunscreen agent when vitamin A acid or tetracycline is prescribed. Information is provided to fill knowledge gaps or correct misconceptions, and emotional support and understanding are offered, particularly if the patient is an adolescent.
