Management of acne vulgaris
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Learning tasks
• Define Acne
• Explain aetiology of Acne
• Outline the epidemiology of Acne
• Explain clinical features of Acne
• Establish Provisional and Differential
Diagnoses of Acne
• Describe the treatment of Acne
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Activity: Brainstorming
• What is Acne?
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Acne
• Acne is a cutaneous disorder
characterized by chronic or recurrent
development of papules, pustules, or
nodules on the face, neck, trunk, or
proximal upper extremities
Epidemiology
• Acne vulgaris affects 85%–100% of
individuals to some degree during their
lifetime.
• Acne vulgaris is most frequent among
adolescents and young adults but is not
limited to these ages
Activity: Brainstorming
• What are the causes of Acne?
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Etiology
• Acne results from obstruction of sebaceous
follicles due to excessive sebum production by
sebaceous glands in combination with
excessive desquamation of the follicular
epithelium.
• Inflammatory changes noted in acne are linked
to the presence of Propionibacterium acnes,
• P. acnes proliferates in the microenvironment
created by excess sebum and desquamated
follicular cells.
Clinical Features
• Acne presents as follicular comedones with or
without inflammatory papules, pustules, and
nodules
• Sites of involvement include the face, neck,
chest, upper back, and upper arms
• The extent and severity of skin involvement
varies widely, ranging from the periodic
appearance of a few small comedones to the
chronic presence of numerous inflamed nodules
involving the majority of skin in an affected region
Clinical Features…
dermatology-atlas.asp.html
Teenage girl with multiple closed comedomes on the left
and both closed and open comedomes on the right
Diagnosis
• The diagnosis of acne vulgaris is clinical.
Differential diagnoses
• Inflamatory facial lesions like rosacea
• Folliculitis due to staphylococcal infection
• Keratosis pilaris caused by keratotic,
follicular plugging
Treatment
• Treatment is directed toward the
pathogenic factors involved, including
– follicular dyskeratinization,
– excess sebum production,
– hormonal influences, and
– P. acnes.
• The severity of the acne determines the
type and level of therapy
Treatment
• Topical retinoids are comedolytic and anti-
inflammatory.
• The most commonly prescribed topical
retinoids include adapalene
• Patients are advised to apply these in
small amounts at bedtime
Treatment
• Topical antibiotics targeting P. acnes like
erythromycin and clindamycin can be used
• Benzoyl peroxide which also has
antimicrobial properties against P. acnes
can be used.
• Benzoyl peroxide is available in a variety
of formulations, including soaps, washes,
lotions, creams, and gels
Systemic therapy
• Oral antibiotics effective against P. acnes
like tetracycline, doxycycline, and
minocycline can be prescribed for
inflammatory acne.
• Sytemic retinoids are also highly effective
but should NOT be offered at primary
health facilities
Key Points
• Acne vulgaris is a common disorder of the
sebaceous follicles
• Diagnosis is made clinically
• Treatment involves topical antibiotics,
topical retinoids and and systemic agents
depending on severity of the disease.
References
• Braunwald & Fauci (2001). Harrison’s
principles of internal medicine 15th Ed.
Oxford: McGraw Hill
• Davidson, S (2006). Principles and
practice of medicine 20th Ed. Churchill:
Livingstone.
• Kumar & Clark (2003) Textbook of clinical
medicine. Churchill: Livingstone.
References
• Douglas Model (2006): Making sense of
Clinical Examination of the Adult patient. 1st
Ed. Hodder Arnold
• Longmore, M., Wilkinson, I., Baldwin, A., &
Wallin, E. (2014). Oxford handbook of
clinical medicine. Oxford
• Macleod, J. (2009). Macleod's clinical
examination. G. Douglas, E. F. Nicol, & C. E.
Robertson (Eds.). Elsevier Health Sciences.
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References
• Nicholson N., (1999), Medicine of Non-
communicable diseases in adults. AMREF
• Stuart and Saunders (2004): Mental health
Nursing principles and practice. 1st Ed.
Mosby
• Swash, M., & Glynn, M. (2011).
Hutchison's clinical methods: An
integrated approach to clinical practice.
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