An inflammatory disease of the sebaceous glands and hair follicles; also known as acne vulgaris.

The cause is unknown, but factors that may be predisposing are hereditary tendencies, and problems with the androgen-estrogen balance. Acne may occur as a result of interactions among hormones, keratin, sebum, and bacteria. The condition may begin at puberty due to an increase in hormones, such as androgens, which cause an increase in the size and activity of pilosebaceous glands. Other factors that may stimulate the development of acne include: food allergies; vitamin deficiencies; endocrine disorders; corticosteroid therapy; contact with chemicals; and psychogenic factors.

Acne may be superficial or deep. Blackheads; whiteheads; inflamed papules; pustules; and superficial cysts characterize superficial acne. Deep acne is characterized by the same findings with deep, canalizing, inflamed nodules and pus-filled cysts, which may rupture and form abscesses. Some of the abscesses may open on the surface of the skin and discharge their contents. Lesions are more common on the face, but the neck, chest, upper back, and shoulders may also be affected. Acne is worse in the winter, and improves in the summer possibly due to more sunlight. Menses precipitates outbreaks, and pregnancy may improve or worsen the condition.

Diagnosis of most skin condition occurs through physical examination of the skin and lesions alone. History and lesion distribution also provide clues, such as having a variety of lesions present at the same time. Complete blood count (CBC), cholesterol, triglyceride, and liver function tests should be done prior to initiating treatment.

Treatment for acne will depend on the severity of the lesions. Consultation with a dermatologist may be helpful in choosing the correct treatment. Washing the skin several times a day with any good soap will decrease the oily appearance of the skin, and may lessen superficial acne. If the superficial acne is pustular, topical antibiotics such as clindamycin (Cleocin HCl) or erythromycin, alone, or with topical follicular medications, such as topical tretinoin (vitamin A acid, retinoic acid) or benzoyl peroxide (Benzagel), may be useful in treatment. If the acne is deep, vigorous management is required to reduce scarring. Topical treatment may not be sufficient to treat deep lesions. A broad-spectrum antibiotic, such as tetracycline (Achromycin), may be effective because of its bactericidal action against bacteria. If antibiotic treatment is unsatisfactory, the next treatment choice may be oral isotretinoin (Accutane), which has many adverse effects and is disqualified in persons with history of psychiatric illness. Corticosteroid injection into an abscess may be helpful. Surgical incision and drainage may be necessary, but there is a significant possibility of scarring. Dermabrasion for scars has been helpful and, occasionally for women, an oral contraceptive may be tried for at least six months. Cholesterol, triglyceride, and liver function tests should be reassessed every month during treatment.

The prognosis for healing without scars in superficial acne is generally good, unless attempts are made to extrude blackheads or superficial cysts. Scratching of ruptured lesions may also increase scarring. Scarring of deep acne frequently occurs. Extensive facial scarring will alter a person's body image concept, and counseling may be needed. Relapses of deep acne may occur after short-term treatment, therefore therapy must be continued for months to years. Many of the oral broad-spectrum antibiotics have side effects related to photosensitivity, candidal vaginitis, esophageal erosion, dizziness, and dryness of the genital mucosa and conjunctiva. There are risks for women associated with taking isotretinoin and pregnancy. The drug is teratogenic and, before therapy is begun, two methods of contraception must be in place for at least a month prior to use and for a month after discontinuation.

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