Acne vulgaris

АУС 502-р хэсэг

Б. Баярням, Р. Энхбат, А. Энхмарал, И. Энэрэл
Content

➢ About acne vulgaris

➢ Epidemiology
➢ Etiology
➢ Pathogenesis
➢ Clinical presentation
➢ Diagnosis
➢ Treatment
➢ Sources
ICD 10 L70.0

● Acne vulgaris is a chronic, recurrent

inflammatory disease of the sebaceous
glands.
● Acne can present as non inflammatory
lesions, inflammatory lesions, or a mixture of
both, affecting mostly the face but also the
back and chest.
● Acne vulgaris is the most common cutaneous
disorder. Patients can experience significant
psychological morbidity and, rarely, mortality
due to suicide.
Epidemiology
Acne vulgaris is more common in males than in
females.
Universal incidence, acne consistently represents
the top three most prevalent skin conditions in the
general population , as found in large studies
within the UK, France and the USA
85% of those between 15-24 years
Male: 12-18 and female: 15-17
Males clears by mid 20s, in females 3rd or 4th
decades and may worsen during menopause
CLINICAL MANIFESTATIONS

● Closed comedones – Noninflammatory; <5 mm;

dome-shaped; smooth; skin-colored, whitish, or

grayish papules

● Open comedones – Noninflammatory, <5 mm

papules with a central, dilated, follicular orifice

containing gray, brown, or black, keratotic material

● Papulopustular acne – Inflamed, relatively superficial
papules and pustules, typically <5 mm in diameter
● Nodular acne – Deep-seated, inflamed, often tender,
large papules (≥0.5 mm) or nodules (≥1 cm)
Pathogenesis
Pathogenesis
Pathogenesis
Dehydroepiandrosterone sulfate (DHEAS)

↓ Steroid sulfatase

Dehydroepiandrosterone (DHEA)

↓ 3-beta-hydroxysteroid dehydrogenase

Androstenedione

↓ 17-beta-hydroxysteroid dehydrogenase

Testosterone

↓ 5-alpha-reductase type I

Dihydrotestosterone (DHT)
Pathogenesis
Clinical presentation
Comedones
Nodulocystic acne
Acne papulopustular
Acne conglobata
Diagnosis
The diagnosis of acne vulgaris is generally made
based upon the physical examination. There are
no laboratory tests that confirm a diagnosis of
acne vulgaris. The need for laboratory or
radiologic tests is generally limited to patients for
whom the clinical evaluation suggests underlying
hyperandrogenism or other specific conditions
warranting additional testing. Skin biopsies are
not typically necessary.
Diagnosis
1. History
2. Physical examination
3. Laboratory tests
1. History
●Age of onset and current age
●Family history of acne
●Signs of virilization in young children or females
(hirsutism, male pattern hair loss, genital
enlargement, deepening of voice)
●Joint, bone, or systemic symptoms in patients with
severe acne
●Psychologic impact of acne
2. Physical examination
The diagnosis is based upon the recognition of characteristic lesions (closed
comedones, open comedones, inflammatory papules, inflammatory pustules,
inflamed nodules) in a characteristic distribution (eg, face, chest, shoulders, back,
or upper arms) during the skin examination.
2. Physical examination
●Lesion stages (monomorphous versus
polymorphous)
●Signs of hyperandrogenism in young children
and females (hirsutism, male pattern hair loss)
●Presence of sequelae of acne vulgaris,
including postinflammatory hyperpigmentation
and scarring
3. Laboratory tests
No laboratory examinations are required. In the
overwhelming majority of acne patients, hormone
levels are normal. If an endocrine disorder is
suspected, determine the free testosterone, follicle-
stimulating hormone, luteinizing hormone, and DHEAS
(dehydroepiandrosterone sulfate) to exclude
hyperandrogenism and polycystic ovary syndrome.
If systemic isotretinoin (a form of vitamin A) treatment
is planned, determine ALT, AST, triglyceride, and
cholesterol levels.
Differential diagnoses
Face: S. aureus folliculitis, pseudofolliculitis
barbae, rosacea, perioral dermatitis

Trunk: Malassezia folliculitis, “hot-tub

rash” pseudomonas folliculitis, S.
aureus folliculitis, and acne-like conditions.
Treatment
1. Skincare
2. Medication
Treatment
1. Mild acne: use topical antibiotics(clindamycin erythromycin) and benzoyl
peroxide gel (2%, 5%,10%) topical retinoids
2. Moderate acne: add oral antibiotics to the above regimen. Minocycline is
most effective 50-100mg, doxycycline 50-100 mg twice daily, tapered to
50mg as acne lessens.
3. Severe acne: in addition to topical treatment, systemic treatment with
isotretinoin is indicated for cystic or conglobate acne or for any other acne
refractory to treatment.
Sources
https://emedicine.medscape.com/article/1069804-overview#a1

https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-acne-vulgaris?
search=acne%20vulgaris&source=search_result&selectedTitle=3~150&usage_type=default&display_ran
k=3#H3852278797

Арьс судлал лекц, №8 Я. Энхтөр, http://elearning.mnums.edu.mn/mod/page/view.php?id=10150

Shimizu’s Textbook of Dermatology (Page 318-319)

Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology (Page 2-7)

Арьсны өвчин, Б. Хандсүрэн (хуудас 274-276)