Come Do Genic

Acne Vulgaris
By:
Mr. M. Shivananda Reddy
Introduction
• Acne vulgaris is a common follicular disorder
affecting susceptible hair follicles, most
commonly found on the face, neck, and upper
trunk.
Incidence
• Acne is the most commonly encountered skin
condition in adolescents and young adults between
ages 12 and 35.
• Both genders are affected equally, although onset is
slightly earlier for girls.
• Acne becomes more marked at puberty and during
adolescence because the endocrine glands that
influence the secretions of the sebaceous glands are
functioning at peak activity
Etiology
Genetic
Hormonal
Bacterial factors
Family history of acne

Pathophysiology
• During puberty, androgens stimulate the sebaceous glands,
causing them to enlarge and secrete a natural oil, sebum,
which rises to the top of the hair follicle and flows out onto
the skin surface.
• In adolescents who develop acne, androgenic stimulation
produces a heightened response in the sebaceous glands so
that acne occurs when accumulated sebum plugs the
pilosebaceous ducts.
• This accumulated material forms comedones.
Pilosebaceous Unit
Clinical Manifestations
• The primary lesions of acne are comedones.
• Closed comedones (i.e, whiteheads) are obstructive
lesions formed from impacted lipids or oils and
keratin that plug the dilated follicle.
• They are small, whitish papules with minute follicular
openings that generally cannot be seen.
• These closed comedones may evolve into open
comedones, in which the contents of the ducts are in
open communication with the external environment.
• The color of open comedones (ie, blackheads) results not from
dirt, but from an accumulation of lipid, bacterial, and epithelial
debris.
• Some closed comedones may rupture, resulting in an
inflammatory reaction caused by leakage of follicular contents
(eg, sebum, keratin, bacteria) into the dermis due to the action
of certain skin bacteria, such as Propionibacterium acnes
• The resultant inflammation is seen clinically as erythematous
papules, inflammatory pustules, and inflammatory cysts.

White Heads
Black Heads
Diagnostic studies:
• History Collection
• Physical Examination
• Biopsy Of Lesions
Medical Management
The goals of management are:
• To reduce bacterial colonies
• To Decrease sebaceous gland activity
• To Prevent the follicles from becoming plugged
• To Reduce inflammation
• To Combat secondary infection
• To Minimize scarring
• To Eliminate factors that predispose the person to acne
• There is no predictable cure for the disease,
but combinations of therapies are available
that can effectively control its activity.
• Topical treatment may be all that is needed to
treat mild to moderate lesions and superficial
inflammatory lesions
• Systemic treatment may be necessary for
severe and extensive acne
NUTRITION AND HYGIENE THERAPY
• Diet is not believed to play a major role in
therapy.
• Avoid chocolate, cola, fried foods, or milk
products which are considered to increase the
acne development.
• Maintain good nutrition to equip the immune
system for effective action against bacteria and
infection.
• For mild cases of acne, wash the face twice with
a cleansing soap. These soaps can remove the
excessive skin oil and the comedo in most cases.
• Acne medications contain salicylic acid and
benzoyl peroxide, which are effective at
removing the sebaceous follicular plugs.
• The patient should be instructed to discontinue
their use if severe irritation occurs.
• Oil-free cosmetics and creams should be chosen.
TOPICAL PHARMACOLOGIC THERAPY
• Benzoyl Peroxide. Benzoyl peroxide preparations
are widely used because they produce a rapid
and sustained reduction of inflammatory lesions.
• They depress sebum production and promote

breakdown of comedo plugs.
• They also produce an antibacterial effect by

suppressing P. acnes.
• Benzoyl peroxide, benzoyl erythromycin, and
benzoyl sulfur combinations are available over
the counter and by prescription.
• Vitamin A acid (Tretinoin) applied topically is
used to clear the keratin plugs from the
pilosebaceous ducts.
• Vitamin A acid speeds the cellular turnover,
forces out the comedones, and prevents new
comedones.
Topical Antibiotics:
• Topical antibiotic treatment for acne is common.
• Topical antibiotics suppress the growth of

P. acnes; reduce superficial free fatty acid levels;
decrease comedones, papules, and pustules.
• Common topical preparations include

tetracycline, clindamycin, and erythromycin.
SYSTEMIC PHARMACOLOGIC THERAPY
• Antibiotics:
• Oral antibiotics, such as tetracycline,

doxycycline, and minocycline, administered in
small doses over a long period are very effective
in treating moderate and severe acne, especially
when the acne is inflammatory and results in
pustules, abscesses, and scarring.
Oral Retinoids:
• Synthetic vitamin A compounds (ie, Retinoids) are used in
patients who are unresponsive to conventional therapy.
• Isotretinoin is used for active inflammatory papular
pustular acne that has a tendency to scar.
• Isotretinoin reduces sebaceous gland size and inhibits
sebum production.
• It also causes the epidermis to shed, thereby unseating and
expelling existing comedones.
Hormone Therapy:
• Estrogen therapy (including progesterone–
estrogen preparations) suppresses sebum
production and reduces skin oiliness.
• Estrogen in the form of estrogen-dominant oral
contraceptive compounds may be administered
on a prescribed cyclic regimen.
• Estrogen is not administered to male patients
because of undesirable side effects.
SURGICAL MANAGEMENT
• Extraction Of Comedo Contents
• Drainage Of Pustules And Cysts
• Excision Of Sinus Tracts And Cysts
• Intralesional Corticosteroids For Antiinflammatory
Action
• Cryotherapy
• Dermabrasion For Scars
• Laser Resurfacing Of Scars
Nursing Management
• Major nursing activities include patient

education, particularly in proper skin care
techniques, and managing potential problems
related to the skin disorder or therapy.
PREVENTING SCARRING
• Patients should be warned that discontinuing
these medications can exacerbate acne, lead to
more flare-ups(sudden out burst), and
increase the chance of deep scarring.
• Manipulation of the comedones, papules, and

pustules increases the potential for scarring
PREVENTING INFECTION
• Female patients receiving long-term antibiotic
therapy with tetracycline should be advised to
watch for and report signs and symptoms of
oral or vaginal candidiasis, a yeastlike fungal
infection
Teaching Patients Self-Care.
• Taking prescribed medications, patients are instructed
to wash the face and other affected areas with mild
soap and water twice each day to remove surface oils
and prevent obstruction of the oil glands.
• Caution the patient to avoid scrubbing the face.
• Patients are instructed to avoid manipulation of

pimples or blackheads.

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Acne Vulgaris

Family history of acne

dirt, but from an accumulation of lipid, bacterial, and epithelial

• Some closed comedones may rupture, resulting in an

inflammatory reaction caused by leakage of follicular contents

of certain skin bacteria, such as Propionibacterium acnes

• The resultant inflammation is seen clinically as erythematous

papules, inflammatory pustules, and inflammatory cysts.

• They depress sebum production and promote

• They also produce an antibacterial effect by

• Topical antibiotic treatment for acne is common.

• Topical antibiotics suppress the growth of

• Common topical preparations include

• Oral antibiotics, such as tetracycline,

• Major nursing activities include patient

• Manipulation of the comedones, papules, and

• Caution the patient to avoid scrubbing the face.

• Patients are instructed to avoid manipulation of

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