Acne vulgaris

Posted by e-Medical PPT Friday, October 15, 2010
Acne vulgaris is a common human skin disease, characterized by areas of skin with seborrhea ,comedones (blackheads and whiteheads), papules, pustules,nodulesand possibly scarring. Acne affects mostly skin with the densest population of sebaceous follicles including the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.The lesions are caused by changes in pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes that require androgen stimulation.Acne occurs most commonly during adolescence, and often continues into adulthood.
Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (milia). Comedones are the direct result of sebaceous glands' becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions, the naturally occurring largely commensal bacterium Propionibacterium acnes can cause inflammation, leading to inflammatory lesions in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation.
Many different treatments exist for acne including benzoyl peroxide, antibiotics, retinoids, antiseborrheic medications, salicylic acid, alpha hydroxy acid, azelaic acid, nicotinamide, and kera-tolytic soaps.They are believed to work in at least 4 different ways including: normalising shedding into the pore to prevent blockage, killing Propionibacterium acnes, anti-inflammatory effects, hormonal manipulation.

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