© Springer Nature Switzerland AG 2021
P. Treadwell et al. (eds.)Atlas of Adolescent Dermatologyhttps://doi.org/10.1007/978-3-030-58634-8_1

1. Acne

Patricia Treadwell1  
(1)
Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
 
 
Patricia Treadwell
Email: ptreadwe@iupui.edu
Keywords
AcneAcne vulgarisComedonesTopical retinoidsDapsone gelIsotretinoin

1.1 Introduction

Acne vulgaris is a chronic inflammatory dermatosis. The pathophysiology of acne has four main components:
  1. 1.

    Androgen-mediated stimulation of sebaceous gland activity

     
  2. 2.

    Abnormal keratinization resulting in follicular plugging (comedone formation) in the pilosebaceous unit (PSU)

     
  3. 3.

    Proliferation of Cutibacterium acnes (formerly Propionobacterium acnes) in the follicle

     
  4. 4.

    Inflammation.

     

1.2 Epidemiology

Acne vulgaris is the most common skin disorder in the United States. Acne can be noted at any age; however, adolescence is by far the most affected age group. Greater than 80% of adolescents have acne vulgaris lesions.

1.3 Clinical Findings

The characteristic lesions of acne are blackheads (open comedones) (Fig. 1.1), whiteheads (closed comedones) (Fig. 1.2), papules, pustules, nodules (Fig. 1.3), and cysts. The distribution tends to be in areas of the greatest density of the sebaceous glands which is face, upper back, and chest (Fig. 1.4). A combination of the various lesions may be present in any particular area.
../images/446896_1_En_1_Chapter/446896_1_En_1_Fig1_HTML.png
Fig. 1.1

Open comedones of the posterior neck

../images/446896_1_En_1_Chapter/446896_1_En_1_Fig2_HTML.jpg
Fig. 1.2

(a) and (b) Closed comedones of the forehead and chin

../images/446896_1_En_1_Chapter/446896_1_En_1_Fig3_HTML.jpg
Fig. 1.3

Acne papules and nodules with some scarring

../images/446896_1_En_1_Chapter/446896_1_En_1_Fig4_HTML.png
Fig. 1.4

Acne lesions of the back

1.4 Laboratory

Diagnosis is most often made based on clinical findings. No laboratory test is pathognomonic.

1.5 Treatment

This publication is not conducive for a comprehensive discussion of all available acne treatments. A summary will be provided and the reader is referred to the references below for guidelines for treatment options including algorithms, mechanisms of action, and side effects.

Many patients have already used OTC products when they arrive at the office. Nonprescription recommendations include gentle cleansing, use of non-comedogenic moisturizers and sunscreen, avoiding occlusion, and frequent pillow case changes.

Acne prescription treatment regimens include the following:

  • Topical retinoids

  • Topical salicylic acid, benzoyl peroxide, topical antibiotics, and dapsone gel

  • Systemic antibiotics

  • Hormonal therapies

  • Oral isotretinoin

1.6 Prognosis

Prompt treatment of acne can minimize long-term scarring. Post inflammatory hyperpigmentation (PIH) (especially in skin of color) is typically bothersome. PIH can be treated in addition to meticulous sun protection.