Upon completion of the chapter, the reader will be able to:
Describe the pathophysiology of acne.
Assess the signs and symptoms of acne in a presenting patient.
List the goals of treatment for patients with acne.
Select appropriate nonpharmacologic and pharmacologic treatment regimens for patients presenting with acne.
Identify adverse effects that may result from pharmacologic agents used in the treatment of acne.
Develop a monitoring plan that will assess the safety and efficacy of the overall disease state management of acne.
Create educational information for patients about acne, including appropriate self-management, available drug treatment options, and anticipated therapeutic responses.
Acne vulgaris is an inflammatory skin disorder of the pilosebaceous units of the skin. Although most commonly seen on the face, acne can also present on the chest, back, neck, and shoulders.1 Acne is not just a self-limiting disorder of teenagers. The clinical course of acne can be prolonged or recur, resulting in long-term physical complications, such as extensive scarring and psychological distress.2
EPIDEMIOLOGY AND ETIOLOGY
With an estimated 40 to 50 million people affected, acne vulgaris is the number one skin disease in the United States. Acne affects approximately 85% of adolescents and adults aged 12 to 25 years, with severity of acne correlating with pubertal maturity.3 Additionally, acne may persist beyond puberty and has been found to affect 64% and 43% of individuals into the 20s and 30s, respectively. Acne is more likely to occur in males during adolescence and females during adulthood. Individuals with a positive family history of acne have been shown to develop more severe cases of acne at an earlier age. Prevalence of acne among ethnic groups is similar.2,3
The link between diet and acne has continued to be controversial, with emerging evidence suggesting a link to foods with high glycemic indexes as well as dairy products (ie, skim milk)—partially due to the hormones in the milk; however, no specific dietary changes are recommended in the management of acne.2,4,5, Local irritation from occlusive clothing or athletic equipment, oil-based cosmetics or beauty products, prolonged sweating or environments of high humidity, and a variety of medications may also worsen acne.6
The development of acne lesions results from four pathogenic factors: excess sebum production, keratinization, bacterial growth, and inflammation.1
The pilosebaceous unit of the skin consists of a hair follicle and the surrounding sebaceous glands. Sebum is released by the sebaceous glands and naturally maintains hair and skin hydration. Increased androgen levels, especially during puberty, can cause an increased size of the sebaceous gland and production of abnormally high levels of sebum within those glands. Keratinization, the sloughing of epithelial cells in the hair follicle, is also a ...