Antiacne

• Acne vulgaris is a common dermatological disorder of the pilosebaceous unit that has a complex pathophysiology and can be triggered by a number of factors
• Acne causes whiteheads, blackheads, or pimples
• Acne primarily affects teenagers but can also affect adults, significantly higher in women than men in all age groups
• Acne primarily affects the skin but can cause stress and lower self-image in some individuals
• Acne occurs when hair follicles become clogged with oil and dead skin cells, can be persistent and triggered by many factors
• Acne vulgaris is often graded based on its severity, including the number of comedones, inflammatory lesions, total lesion count, and cysts
• Acne vulgaris primarily affects the face but in severe cases may affect the chest, neck, and back, with a clear detrimental psychosocial effect on the patient’s quality of life
• Major factors in acne development include increased sebum production, increased androgen activity, abnormally increased keratinocyte production, microbial colonization of Propionibacterium acnes, inflammation, and immune reactions
• Increased sebum production and androgen activity result in cells released into the follicles, leading to a sebum-rich, oxygen-poor environment ideal for the proliferation of Cutibacterium acnes (formerly Propionibacterium acnes)
• The draining duct widens, the sebaceous gland grows larger due to accumulated material, and Cutibacterium acnes produces enzymes that hydrolyze triglycerides in the sebum, leading to hyperkeratinization and inflammation
• The early stage of acne is referred to as microcomedo, the primary precursor lesion evolving into non-inflammatory or inflammatory lesions
• Comedones are small flesh-colored white or dark bumps caused by acne found in the opening of skin pores, often with a solid core in the middle
• Acne classification

  1. Non-inflammatory lesions

  2. Inflammatory lesions
• Comedones

  Small flesh-colored white or dark bumps that give the skin a rough texture
• Types of non-inflammatory lesions

  • Open comedones
  • Closed comedones
• Non-inflammatory lesions


  • Consist of open and closed comedones, which are not inflamed and red because follicle walls are intact
• Microcomedones


  The first step/phase of clogged pores due to overproduction of skin cells narrowing the pore opening and leading to clogging
• Microcomedones are invisible to the eye
• Microcomedones are referred to as the early stage of acne development that occurs under the skin and is small enough that the human eye cannot see
• Formation of later comedo

  1. Accumulation of shed keratin and sebum

  2. Formation of whorled lamellar concretions

  3. Comedo may be closed (no obvious follicular opening, referred to as whiteheads) or open (dilated follicular opening, keratin plug darkens due to oxidized lipids and melanin, referred to as blackheads)
• Inflammatory papule/pustule

  Propionibacterium acnes proliferation upregulates innate immune response, mild inflammation primarily neutrophils, sebaceous lobule regression
• Propionibacterium acnes proliferation

  Stimulates inflammation by producing proinflammatory mediators that diffuse to the follicle wall
• Hypersensitivity to Cutibacterium acnes may explain why some individuals develop inflammatory acne vulgaris while others do not
• Activation of TLRs by Cutibacterium acnes

  Leads to the production of proinflammatory cytokines such as IL12, IL8, and TNF
• Other mediators and receptors

  Including growth hormone, insulin-like growth factor, and peroxisome proliferator-activated receptors regulate sebaceous glands contributing to acne development
• Nodule/cyst

  Marked inflammation primarily T cells, may lead to scarring
• Microcomedones


  The first step/phase of clogged pores due to overproduction of skin cells narrowing the pore opening
• Formation of Acne

  Skin oil gets trapped inside pores leading to rapid reproduction of acne bacteria and acne formation
• Whiteheads

  Closed comedones that occur when pores become clogged with bacteria and sebaceous material, with the follicle opening closed
• Blackheads


  Open comedones that form when pores become clogged, darker due to oxidation of clogged buildup
• Inflammatory Lesion Development

  Closed comedo becomes larger and packed due to debris and inflammation, leading to the pore wall breaking and contents leaking into the surrounding skin, activating inflammatory cells
• Acne treatment does not work overnight. Improvement may be seen in 4 to 6 weeks
• Papules


  Primary inflammatory lesions, small, raised, usually red, and tender bumps under the skin without a white and yellow center
• Pustules


  Red, tender bumps with white pus at the tip
• Nodules


  Deep, fibrous lesions that are hard to touch, more painful, severe, and deep red or purple in color, large in size (> 5 mm wide) and not filled with pus
• Cysts

  Large (> 5 mm wide) pus-filled lesions
• Severity Levels of Acne

  • Mild
  • Moderate
  • Severe
• Acne treatment


  Targets precursor lesions (microcomedones) and active inflammatory lesions, managed with OTC and prescription-only regimens
• Topical Treatments

  • Benzoyl Peroxide
  • Salicylic Acid
  • Topical Retinoids
  • Topical Antibiotics
  • Resorcinol and Sulfur
  • Azelaic Acid
• Acne treatment

  1. Does not work overnight

  2. One may see the first signs of improvement in 4 to 8 weeks