Acne Vulgaris
Acne vulgaris is the most common skin condition that people seek treatment for by health-care providers, including dermatologists. It is a disorder of the pilosebaceous unit and affects the majority of adolescents but continues into adulthood in many peop
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Acne Vulgaris Diane Jackson-Richards
Contents
13.1
13.1
Epidemiology ....................................................................
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13.2
Pathophysiology ...............................................................
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13.3
Clinical Features ..............................................................
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13.4
Histopathologic Features.................................................
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13.5
Differential Diagnosis ......................................................
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13.6
Treatment .........................................................................
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References ....................................................................................
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Epidemiology
Acne is a multifactorial disorder of the pilosebaceous unit. It is one of the most common disorders that individuals seek dermatologic treatment for and is felt to affect 85 % of persons 12–24 years old. Although it starts during adolescence, many adults are affected by acne even in the fourth decade of life [1]. Acne affects all races and has been found to be the leading cause for visits to dermatologists by African Americans, Asians, and Hispanics [2–4].
13.2
Pathophysiology
The pathogenesis of acne begins with androgens stimulating sebaceous glands to increase sebum production. Hyperkeratosis of the follicular infundibulum along with increased sebum production leads to microcomedone formation. Rupture of microcomedones leads to an inflammatory response with influx of neutrophils and lymphocytes. There are increased levels of Propionibacterium acnes bacteria within the follicles. P. acnes also releases inflammatory mediators, IL-1, IL-8, and TNF-alpha [1]. More severe cases of nodulocystic acne may be familial [5].
D. Jackson-Richards, MD Department of Dermatology, Multicultural Dermatology Center, Henry Ford Hospital, 3031 West Grand Blvd., Detroit, MI 48202, USA e-mail: [email protected] D. Jackson-Richards, A.G. Pandya (eds.), Dermatology Atlas for Skin of Color, DOI 10.1007/978-3-642-54446-0_13, © Springer-Verlag Berlin Heidelberg 2014
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13.3
D. Jackson-Richards
Clinical Features
Acne affects the face, upper chest, and upper back, corresponding to the distribution of sebaceous glands. Lesions include comedones, inflammatory papules, and pustules (Figs. 13.1, 13.2, 13.3, 13.4, 13.5, and 13.6). In more severe acne there are tender nodules and cysts. Postinflammatory hyperpigmented macules, often lasting for months, are extremely common in darker-skinned individuals. The resultant postinflammatory hyperpigmentation (PIH) is often more distressing to the individual than the acne itself [7, 10]. Taylor et al. reported PIH occurring in 65 % of blacks, 52 % of Hispanics, and 47 % of Asians [7]. Pitted scarring is a common sequelae of acne as well as hypertrophic or keloidal scars. Keloidal scarring is more common in
patients with darker skin. Nodulocystic acne is felt to be less common in the African American population, but when nodules and cysts occur, they more often heal with hypertrophic scarrin
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