Acne is a disease of the hair follicles. It
is a very common skin disorder, affecting around 85% of teenagers
worldwide. While the disease is most commonly associated with
adolescence, it can affect anyone at any age. The average acne
sufferer first seeks therapy at the age of 24.
Medically, acne vulgaris is the most common variation of acne.
A pleomorphic inflammatory disorder centered on the face, it
may spread to the neck, chest and back areas depending on the
disease’s type and severity.
Androgens stimulate sebocytes and follicular keratinocytes.
A hypersensitivity to this stimulation results in sebaceous
gland hyperplasia and seborrhea, which in turn manifests in
the form of acne. Other factors that cause the various types
of acne include heightened cornification of the ducts, colonization
of the follicles by the P acnes bacteria, inflammation, and
Acne is characterized by open or closed comedones (blackheads
and whiteheads), either individual or grouped with lesions such
as papules and pustules. These are found mainly on the face
and upper trunk, and their number, type, and distribution determines
the severity of the acne.
Acne is not directly life-threatening, but the disfiguration
it causes can put sufferers in emotional and psychological distress.
Cases of depression, anxiety, and social withdrawal are not
uncommon, especially in adolescents.
There are presently many proven and effective acne therapies
and treatments available. Appropriate treatment is specific
to the acne’s severity and type, as well as the patient’s
skin type and medical history. The severity of acne can be graded
through more than 25 known methods, and there are 19 methods
for counting lesions.
Severity of Acne
Acne vulgaris is easily diagnosed by the presence of comedones,
and can be divided into two major types of severity.
- Inflammatory acne, characterized by the presence of
nodules, papules or pustules (having “pus” cells).
- Non-inflammatory lesions, characterized by open or closed
comedones (blackheads or whiteheads).
Acne’s severity may also be categorized in this manner:
Mild Acne can either be mild comedonal acne, where the lesions
are mainly non-inflammatory comedones, or mild papopustular
acne, where few (ten or less) papules and pustules may be present.
Mild comedonal acne may be effectively treated by topical retinoid
therapy, while mild papopustular acne may require additional
antibacterial preparations and/or acetic acid. Mild acne attacks
are mostly limited to the face.
Moderate acne is characterized as having many comedones, a
number of pustules, a few nodules, but no scarring. Excessive
pigmentation of the skin may also be found on the face, shoulders,
back and chest. Oral antibiotics and retinoids are usually prescribed
for moderate acne, and women may also opt for hormonal therapy.
Moderately severe acne has erythematous papules, pustules and
nodules in moderate distribution on the face, and some scarring
may be evident.
Severe Acne. Painful inflammatory nodules may occur anywhere
on the body, and the number of papopustules may be too great
to count. Scarring is almost certain. Topical and oral antimicrobial
agents are often seen as appropriate treatment for severe acne.s
Very severe acne does not clear even with the combination of
oral and topical therapy. Sinus tracts, comedone clusters, a
great number of painful and deep-rooted nodules, excessive inflamation
and inevitable scarring. Patients with excessive seborrhea and/or
a gram negative folliculitis infection are most likely to develop
very severe acne. Isotretinoin treatment may be prescribed when
all other treatment methods have been found ineffective.
Treatment of Severe Acne
Dermatologists know the ins and outs treating the different
types of acne, but there is no cure-all for the severe, disfiguring
acne. Patients and their families must be aware that the treatment
of severe acne may span years, and the results may not always
be satisfactory. The support of family and friends will greatly
ease the emotional and psychological turmoil that most patients
with severe acne undergo.