ACNE VULGARIS summary

ACNE VULGARIS summary

Acne Vulgaris is an inflammation of the sebaceous gland. It’s the most common skin disease in the US affecting more than 17 million Americans, typically presents at age 8-12- peaks at ages 15-18, affecting areas of the skin with the densest population of sebaceous glands (face, neck, upper trunk and upper arms) (Ferri, 2016). Acne presents as: comedones (closed or open), papules- pustules, cyst or nodules (Zaenglein et al., 2016). It involves pathologically: an increased sebum production: Androgenic activity drives sebum production alterations in follicular growth and differentiation, abnormal follicular keratinization, formation of Propionibacterium acnes (P. acnes) biofilms and colonies, release of pro inflammatory mediators to the skin and heredity (Lavers, 2014). A variety of factors have been popularly identified as contributors to or responsible for worsening acne:

genetic/heredity, presence of hormones (androgens), medications and environment (Krutman et al.,2017; Kazandjieva, &

Tsankov,2017; Mazioti, 2017). The diagnosis of acne is based on history and physical examination. Symptoms might include: pain, tenderness, edema, and or erythema, oily, shiny skin, comedones (blackheads, whiteheads), lesions to the face, shoulder, upper chest and back (Titus, & Hodge, 2012). Acne vulgaris rarely misdiagnosed. Acne rosacea, perioral dermatitis, steroid acne, miliaria and pseudo folliculitis barbae can be misdiagnosed as acne.

Acne vulgaris is not curable and goals of therapy are long-term control, slowing progression, limiting disease duration and recurrence, alleviation of symptoms as well as prevention of disfigurement, and avoidance of psychologic suffering. Treatment includes benzoyl peroxide, topical and oral preparations of retinoids and antibiotics (Zaenglein et al., 2016). Non pharmacologic treatment includes: washing face twice a day with mild soap- avoid scrubbing, rubbing, squeezing and picking, prevention of cosmetic acne and maintaining a well-balanced diet (Burns, Dunn, Brady, Starr, & Blosser, 2016).

Patients should eliminate aggravating factors, maintain a balanced, low-glycemic load diet, and control stress for treatment to be successful. Adherence to therapeutic regimen is key and empathetic and informative counseling may help motivate the patient to continue long-term therapy. Primary care physicians can and should handle most cases of acne without referral. Referral to a dermatologist should be made for: People who have developed, or are at risk of, scarring despite treatment in primary care- for people who have moderate acne which has persisted after six months of treatment in primary care, or treatment failure in concordance with the patient's wishes (Zaenglein et al., 2016).

Three questions about acne vulgaris were asked:

1.     What is the effectiveness and what are the potential side effects of isotretinoin in the treatment of adult acne and acne vulgaris in adolescents to adults?

2.     What is the role of diet in adult acne in adolescents to adults?