<h1>Acne vulgaris, Pathogenesis and its clinical features</h1>

Author: Dr Izharul Hasan
Acne vulgaris primarily involves the pilosebaceous follicles,i.e. the sebaceous glands, ducts, and the distal part ofthe hair follicles into which they open. The lesions includekeratinous plugs in the ducts (comedones), inflammatorypapules, pustules, nodules, cysts and scars.
Pathogenesis The best-defined factors determining the occurrence ofacne vulgaris are androgenic stimulation of the sebaceousglands and the commensal anaerobic bacterium Propionibacteriumacnes, which heavily colonizes active pilosebaceous follicles. Although the onset of acne around pubertyis explained by the increased output of androgens at thattime, it is much less clear why the disease becomes quiescentwithout any measurable change in the hormonalmilieu or numbers of propionibacteria. The basis for thedisorder of keratinization in the sebaceous ducts whichproduces the comedones is uncertain. Inflammatorylesions are mainly derived from closed comedones. Possible mediators of inflammation include freefatty acids, bacterial cell wall components and enzymes,and the patient\'s complement system. The pus in acnelesions is sterile and a consequence of inflammation, whichis often so severe that scarring results.
Clinical features Acne can occur in infants, but is usually mild and due tothe influence of transplacental hormonal stimulus. In olderchildren acne often represents the beginnings of puberty,but may not occur until the mid-teens or beyond. The areasaffected are those with maximal numbers of pilosebaceousfollicles: the face, upper trunk and shoulders. Comedonesare either open (blackheads) or closed (small whitishpapules). The inflammatory lesions are erythematous,varying from papules through pustules to nodules andlarge collections of pus (wrongly) called cysts.The more destructive lesions heal with scarring, which isusually pitted but is hypertrophic or keloidal in those sopredisposed. The course of acne can be erratic and thereare often premenstrual exacerbations.Lesions resembling acne can be provoked by halogenatedhydrocarbons, mineral oils, tars, greasy cosmetics,and drugs.
Management Acne can have serious psychological effects and should notbe ignored on the basis that it will get better sooner orlater. Mild cases often respond to topical agents alone, e.g.benzoyl peroxide 2.5-10gel, or topical retinoic acid. Thelatter is more irritant, but often more effective when comedonesare the predominant feature. If there is insufficient response after a few weeks\' treatment, or if the acne is ofmoderate severity, an oral antibiotic should be used inaddition (or instead, if topical therapy proves too irritant).Tetracyclines and erythromycin are equally effective,usually in a dose of 0.5 g twice daily for several months.Topical antibiotics, e.g. 1 clindamycin, can also be effective.For females with moderate acne, hormonal modulationwith the antiandrogen cyproterone acetate may bemore effective. This drug must be given with an oestrogenin the form of a low-dose oral contraceptive pill. Patientswith severe and destructive acne usually need treatmentwith oral isotretinoin. This vitamin A analogue is highlyeffective but has a number of adverse effects, notablyteratogenicity, and in the UK is restricted to hospital use.Other measures sometimes used include intralesionalcorticosteroids for inflammatory nodules and cysts, anddermabrasion, a surgical technique to improve scarring.
Article Source: http://www.articlesbase.com/health-articles/acne-vulgaris-pathogenesis-and-its-clinical-features-2831392.html
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drizharnium@gmail.com, Bangalore India
Hi Friends, I am Izhar, love all of you, and  I\'d like to write about my interest, and here i am sharing about my opinion, prevention regarding to many diseases, maintaining  views for Health, Beauty & Younger looking Secrets at article base.