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Acne vulgaris (an inflammatory skin disease)

Acne vulgaris is a common facial rash occurring in adolescence & rarely in early & mid-adult life. The cause is multifactorial but the blockage of pilosebaceous units with surrounding inflammation is the main pathological process & this can occur because of a number of different factors.

Clinical features & cause of Acne vulgaris

Acne presents in areas rich in sebaceous glands such as the face, back & sternal area. The three cardinal features are:
open comedones (blackheads) or closed comedones (whiteheads)
inflammatory papules
pustules

The skin may be very greasy (seborrhoea). Rupture of the inflamed lesions may lead to deep-seated dermal inflammation & nodulocystic lesions, which are more likely to cause facial scarring. A premenstrual exacerbation of acne is sometimes noticed. There is a tendency for spontaneous improvement over a number of years but acne can persist unabated into adult life.

A number of clinical variants of Acne vulgaris exist:

Infantile acne

Facial acne is occasionally seen in infants & is sometimes cystic. It is thought to be due to the influence of maternal androgens & resolves spontaneously.

Steroid acne

Acne may occur secondary to corticosteroid therapy or Cushing's syndrome. Comedones & cysts are rare in this variant but involvement of the back & shoulders (rather than the face) is common. Clinically the rash often appears as a pustular folliculitis.

Oil acne

This is an industrial disease seen in workers who have prolonged contact with oils or other hydrocarbons & is common on the legs & other exposure sites.

Acne fulminans

This is a rare variant seen most commonly in young male adolescents. Severe necrotic & crusted acne lesions appear, associated with malaise, pyrexia, arthralgia & bone pain (due to sterile bone cysts). It requires urgent treatment with oral prednisolone (30-40 mg daily) & analgesics followed by a course of oral isotretinoin.

porous occlusion triad

This is a rare disorder most commonly seen in black Africans. It is characterized by the presence of severe nodulocystic acne, dissecting cellulitis of the scalp & hidradenitis suppurativa. It has been suggested that this is caused by a problem of porous occlusion rather than having an infective aetiology.

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