ACNE VULGARIS
Information & Treatment


Consultations for acne are more frequent than for any other skin disease.
Acne is a disorder of the pilosebaceous follicles that primarily affects adolescents and young adults. It may be divided into non-inflammatory and inflammatory types. Non-inflammatory acne is characterized by open and closed whiteheads and blackheads (comedones), consisting of compact masses of keratin, sebum, and bacteria dilating the follicular duct. In inflammatory acne, the skin is inflamed, and there are papules, pustules, and nodulocysyic lesions with a tendency for destructiveness and scarring. The lesions are found in areas of greatest concentration of the sebaceous glands---the face, neck, and upper trunk.

Casual Factors. A convenient working hypothesis for the production of acne lesions is as follows:

Increased androgenic influence (or perhaps increased end-organ responsiveness) produces sebaceous gland hyperplasia and seborrhea. Comedo formation results from an abnormality of the keratinization of the follicular mouth. Follicular damage occurs mainly in follicles with large sebaceous glands and weak hair growth and in follicles that have small blocked openings. Fatty acids are freed by hydrolysis from triglycerides in the sebum along with bacterial esterases from Propionibacterium acnes high in the follicles. (It is possible that Staphylococcus epidermidis contributes to the lipolysis.) The fatty acids diffuse through the follicular walls and cause inflammation and follicular destruction. Keratin freed from the injured follicles produces a granulomatous response in the dermis.

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