Acne vulgaris is one of the most common skin disorder affecting susceptible hair follicles, most commonly found on the neck, upper trunk, and face. It is described by comedones (which are primary lesions of acne) that are both open and closed, and by cysts, nodules, pustules, and papules.Causes of Acne VulgarisThe primary lesions of acne are comedones. Closed comedones (whiteheads) are obstructive lesions formed from impacted lipids or oils and keratin that plug the dilated follicle. They are small, whitish papules with minute follicular openings that generally cannot be seen. These closed comedones may evolve into open comedones, in which the contents of the ducts are in open communication with the external environment. The color of open comedones (blackheads) results not from dirt, but from an accumulation of lipid, bacterial, and epithelial debris.Although the exact cause is unknown, some closed comedones may rupture, resulting in an inflammatory reaction caused by leakage of follicular contents (e.g., sebum, keratin, bacteria) into the dermis. This inflammatory response may result form the action of certain bacteria, such as proprionibacterium acnes, that live in the hair follicles and break down the triglycerides of the sebum into free fatty acids and glycerin. The resultant inflammation is seen clinically as erythematous papules, inflammatory pustules, and inflammatory cysts. Mild papules and cysts drain and heal on their own without treatment. Deeper papules and cysts may result in scarring of the skin. Acne is usually graded as mild, moderate, or severe, based on the number and type of lesions (e.g., comedones, papules, pustules, cysts).The goals of management of acne are to reduce bacterial colonies, decrease sebaceous gland activity, prevent the follicles from becoming plugged, reduce inflammation, combat secondary infection, minimize scarring, and eliminate factors that predispose the person to acne. The therapeutic regimen depends on the type of lesion.
There is no predictable cure for acne vulgaris, but combinations of therapies are available that can effectively control its activity.
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