Acne Vulgaris - A Skin Disorder
Acne vulgaris, or common acne, is a skin disorder of the pilosebaceous
follicles. Acne is not a species but a family of disorders that varies greatly in their pathogenesis and clinical manifestations. It is the most common skin disorder seen by doctors. In fact, it will affect almost every one of us at some time in our lives. It can happen at any time, but teenagers are the ones who get it most often. Acne can cause a great deal of embarrassment and anxiety.
Acne is thought to be caused by the interplay of four factors. Excessive sebum production secondary to sebaceous gland hyperplasia is the first abnormality to occur. Subsequent hyperkeratinization of the hair follicle prevents normal shedding of the follicular keratinocytes, which then obstruct the follicle and form an inapparent microcomedo. Lipids and cellular debris soon accumulate within the blocked follicle. This microenvironment encourages colonization of Propionibacterium acnes, which provokes an immune response through the production of numerous inflammatory mediators. Inflammation is further enhanced by follicular rupture and subsequent leakage of lipids, bacteria, and fatty acids into the dermis.
Acne accounts for a tremendous number of office visits to both family physicians and dermatologists. According to the statistics, nearly 85% of people aged 12–25 years, approximately 8% of adults aged 25–34 years, and 3% of adults aged 35–44 years experience some degree of acne. In the US alone, between 40 and 50 million people are estimated to be affected by some form of acne, with approximately 17 million having clinical acne. Although acne is not a life-threatening disease, it has signify cant physical and psychological ramifi cations such as permanent scarring, poor self-image, social inhibition, depression, anxiety and suicidal tendency. Therefore, acne should be regarded as a serious medical disorder.
Classicists divide the varieties that make up the family of acnes into two categories: 1) acne, and 2) acneiform. The latter refers to acnelike lesions that are frequently precipitated by exogenous agents such as systemic drags. Ache, itself, is far more common and important and will occupy center stage in this presentation. It is a two-stage process that begins with a noninflamed horny impaction, the comedo. Rupture of the comedo initiates the inflammatory phase, variably expressed in the form of pustules, papules, and nodules.
Acne varies enormously in its clinical signs, course, and intensity. Accordingly no simple recipe for treatment can be given. Physicians differ greatly in their therapeutic strategies, according to their experience and training. Effective treatment of acne vulgaris can prevent emotional and physical scarring. Therapy varies according to the severity of the disease. Topical medication is generally adequate in clearing comedonal acne, while inflammatory acne usually requires the addition of oral medication.