Acne vulgaris

184 Acne vulgaris



Instruction


Look at this patient.



Salient features



History




• Steroid ingestion


• Isoniazid ingestion


• Occupational exposure to oils (oil-induced acne).



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)


• Cysts (larger, deeper masses of retained sebum)


• Greasy skin


• There may be associated scarring: ice-pick scars.


image

Fig. 184.1 Acne vulgaris.


Remember: Acne vulgaris is a multifactorial disease affecting the pilosebaceous follicle and characterized by open and closed comedones, papules, pustules, nodules and scars.



Diagnosis


This patient has blackheads on the face with greasy skin (lesions), which is acne vulgaris caused by Propionibacterium acnes (aetiology); it may be cosmetically unacceptable to the patient (functional status).



Advanced-level questions




What do you know about the pathogenesis of acne?


Follicular keratinization, seborrhoea and colonization of the pilosebaceous unit with P. acnes are central to the development of these lesions. Genetic and hormonal factors also play a role, possibly by optimizing the follicular environment suitable for the growth of P. acnes or by influencing the inflammatory response and thus the nature of these lesions.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Acne vulgaris

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