Mastering Acne Vulgaris: Comprehensive Insights for Effective Management and Treatment
Doctor explains the clinical features, treatment options, and potential complications of acne vulgaris, a chronic inflammatory skin condition. Learn how to manage acne at home and when to seek professional help.
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Topic Breakdown
Acne vulgaris is a chronic inflammatory skin condition that primarily affects the face, back, and chest, but it can also impact other parts of the body. This condition is characterized by the blockage and inflammation of the pilosebaceous unit, which is the medical term for the hair follicle, hair shaft, and sebaceous gland. Understanding acne vulgaris, its clinical features, treatment options, and potential complications can be beneficial for both health professionals and patients.
Let's begin by discussing the clinical features of acne vulgaris. Acne most commonly affects the face but can spread to the neck, chest, back, and sometimes more extensively over the body. Several different types of acne spots can occur simultaneously, and these can be categorized into superficial lesions, deeper lesions, and secondary lesions.
Superficial lesions include open and closed comedones, which are known as blackheads and whiteheads, respectively. Papules are small, tender red bumps, and pustules are white or yellow spots that might look like they could be squeezed, but it's important not to squeeze them.
Deeper lesions include nodules, which are large and painful red lumps, and pseudocysts, which are cyst-like fluctuating swellings. Secondary features of acne include excoriations, which are picked-out or scratched-at spots, erythematous macules, which are red marks from recently healed spots, and pigmented macules, which are dark marks from old spots. Scarring in various forms can also occur.
Individual acne lesions usually last less than two weeks, but deeper papules and nodules may persist for months. Acne is graded by its severity, ranging from mild to moderate to severe. This grading is important because treatment options vary by severity.
If you have acne, there are several measures you can take at home to manage it. According to the UK National Institute for Clinical Excellence (NICE) guidelines, all people with acne should avoid over-cleaning their skin, as this can cause dryness and irritation. It's also important to use a non-alkaline skin wash product twice daily on acne-prone skin. If you're unsure which skin product to use, speak to your local pharmacist for advice. Avoid oil-based skincare products, makeup, and sunscreens, and make sure to remove makeup at the end of the day. Persistent picking or scratching of lesions can increase the risk of scarring, so try to avoid this if you can.
Despite these home measures, you may still find your acne troublesome. If so, there are medications available that vary depending on the severity of the acne. In the UK, people with mild to moderate acne should be offered a 12-week course of one of the following first-line options, which should be applied once daily in the evening: a fixed combination of topical adapalene with topical benzoyl peroxide, a fixed combination of topical tretinoin with topical clindamycin (an antibiotic), or a fixed combination of topical benzoyl peroxide with topical clindamycin. These medications are applied directly to the skin and can take up to eight weeks to work. They may irritate the skin, especially at the start of treatment.
For moderate to severe acne, patients should be offered a 12-week course of one of the topical agents mentioned above, plus either an oral antibiotic like oral lymecycline or oral doxycycline, taken once a day. Alternatively, a topical azelaic acid can be applied twice daily with either oral lymecycline or oral doxycycline once a day. Follow-up should be arranged at 12 weeks to assess whether the person's acne has improved and whether they have experienced any adverse effects.
In certain circumstances, it may be necessary to refer a patient to a dermatologist. This is needed if mild to moderate acne has not responded to two completed courses of treatment, moderate to severe acne has not responded to previous treatment that includes an oral antibiotic, the person has acne with scarring or persistent pigmentary changes, or their acne severity or acne-related scarring is causing or contributing to persistent psychological distress or a mental health disorder. Acne can significantly impact a person's confidence and lead to long-term mental health consequences.
Potential complications of acne include skin changes such as scarring, post-inflammatory hyperpigmentation (where the skin looks darker), or depigmentation. Psychosocial problems, such as depression or anxiety, can also occur. Urgent referrals should be made for people with acne fulminans, a very severe form of acne associated with systemic symptoms such as fever, malaise, and loss of appetite. These individuals need to be assessed within 24 hours by the on-call hospital dermatology team.
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