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Acne Vulgaris

In acne, there's blockage and chronic inflammation, +/- localised infection, in a pilosebaceous unit. A pilosebaceous unit contains a hair follicles and sebaceous gland (produce natural skin oils and waxy substance called sebum).

“Image of an 18 year old male with moderate acne vulgaris (white heads). His face appears to be very oily as well.” © Roshu Bangal CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

With acne, there's an increased production of sebum, which traps keratin (dead skin cells) and blocks the pilosebaceous unit. This leads to swelling and inflammation of the unit = Comedone.

  • This process is exacerbated during puberty as androgens cause hyperplasia of sebaceous glands → increased sebum production and blockage of the pilosebaceous units. This can therefore be improved with the use of anti-androgenic medication.

“Simplistic representation of the formation of acne comedones.” © BedrockPerson CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Management

1st line

  • Topical retinoid +/- benzoyl peroxide

  • Topical tretinoin + Abx


2nd line

  • Same as mild-moderate

  • Topical azelaic acid + Abx

    • COCP can be used instead of Abx in women


3rd line

  • Oral retinoid


N.B. Vitamin A acts as an antioxidant, protecting cells from damage due to free radicals. It also reduces sebum production and has anti-keratinisation properties.


Isotretanoin

This works to reduce inflammation, sebum production, and bacterial growth. However, it's very important to note that it's strongly teratogenic.


Side effects - Dry skin and lips, Photosensitivity of skin, Depression, Anxiety, SJS, TEN



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