Acne

Whether you call them blemishes, pimples, or zits, most of us experience mild acne at some point in our lives. More often a problem in the teen years, acne vulgaris, as it's known medically, starts when skin pores become blocked by excess oil and dead skin cells. Some people have severe acne resulting in hundreds of pimples across the face, chest, and back, although many treatments can help.

History

Local symptoms of acne vulgaris may include pain, tenderness, and/or erythema.

Systemic symptoms are most often absent in acne vulgaris. Severe acne with associated systemic signs and symptoms such as fever is referred to as acne fulminans. Severe acne, characterized by multiple connecting comedones and abscesses, without the presence of systemic symptoms, is known as acne conglobata. These severe forms of acne frequently heal with disfiguring scars. Additionally, acne vulgaris may have a psychological impact on any patient, regardless of the severity or the grade of the disease.

Management

Treatment of acne vulgaris should be directed toward the known pathogenic factors, including follicular hyperproliferation, excess sebum, P acnes, and inflammation. The most appropriate treatment is based on the grade and severity of the acne.

Pharmacotherapy

The following medications are used in the treatment of Propionibacterium acne vulgaris:

• Retinoid-like agents (eg, topical tretinoin, adapalene, tazarotene, isotretinoin)
• Antibiotics (eg, tetracycline, minocycline, doxycycline, trimethoprim/sulfamethoxazole, clindamycin, topical clindamycin, topical erythromycin, daptomycin)
• Selective aldosterone antagonists (eg, spironolactone)
• Estrogen/progestin combination oral contraceptive pills (eg, ethinyl estradiol, drospirenone, and levomefolate; ethinyl estradiol and norethindrone; ethinyl estradiol and norgestimate; ethinyl estradiol and drospirenone)
• Acne products (eg, erythromycin and benzoyl peroxide, clindamycin and tretinoin, clindamycin and benzoyl peroxide, azelaic acid, benzoyl peroxide)

When a topical or systemic antibiotic is used, it should be used in conjunction with benzoyl peroxide or topical retinoid to reduce the emergence of resistance.

Nonpharmacotherapy

Diet therapy, such as a low-glycemic diet and avoidance of “junk foods,” has been suggested as a nonpharmacologic measure to manage acne vulgaris.

Procedures

Procedural treatments for acne vulgaris include the following:

• Manual extraction of comedones
• Intralesional steroid injections
• Superficial peels that use glycolic or salicylic acid