Skip to Main Content

  icon Rare
  icon Not so common
  icon Common
  icon Low morbidity
  icon Considerable morbidity
  icon Serious

++

Acne Vulgaris (Common Acne) and Cystic Acne

++

ICD-9: 706.1 ○ ICD-10: L70.0 Image not available.

++

  • An inflammation of pilosebaceous units, very common.

  • Appears in certain body areas (face, trunk, rarely buttocks).

  • Most frequently in adolescents.

  • Manifests as comedones, papulopustules, nodules, and cysts.

  • Results in pitted, depressed, or hypertrophic scars.

++

Epidemiology

++
Occurrence
++

Very common, affecting approximately 85% of young people.

++
Age of Onset
++

Puberty; may appear first at 25 years or older.

++
Sex
++

More severe in males than in females.

++
Race
++

Lower incidence in Asians and Africans.

++
Genetic Aspects
++

There is a multifactorial genetic background and familial predisposition. Most individuals with cystic acne have parent(s) with a history of severe acne. Severe acne may be associated with XYY syndrome (rare).

++

Pathogenesis

++

Key factors are follicular keratinization, androgens, and Propionibacterium acnes (see Fig. 1-3).

++

Follicular plugging (comedone) prevents drainage of sebum; androgens (quantitatively and qualitatively normal in serum) stimulate sebaceous glands to produce more sebum. Bacterial (p. acnes) lipase converts lipids to fatty acids and produce proinflammatory mediators (IL-I, TNF-α) that lead to an inflammatory response. Distended follicle walls break, sebum, lipids, fatty acids, keratin, bacteria enter the dermis, provoking an inflammatory and foreign-body response. Intense inflammation leads to scars.

++
Contributory Factors
++

Acnegenic mineral oils, rarely dioxin, and others.

++

Drugs. Lithium, hydantoin, isoniazid, glucocorticoids, oral contraceptives, iodides, bromides and androgens (e.g., testosterone), danazol.

++

Others. Emotional stress can cause exacerbations. Occlusion and pressure on the skin, such as by leaning face on hands is a very important and often unrecognized exacerbating factor (acne mechanica). Acne is not caused by any kind of food.

++

Clinical Manifestation

++
Duration of Lesions
++

Weeks to months.

++
Season
++

Often worse in fall and winter.

++
Symptoms
++

Pain in lesions (especially nodulocystic type).

++
Skin Lesions
++

Comedones—open (blackheads) or closed (whiteheads); comedonal acne (Fig. 1-1). Papules and papulopustules—i.e., a papule topped by a pustule; papulopustular acne (Fig. 1-2). Nodules or cysts—1–4 cm in diameter (Fig. 1-4); nodulocystic acne. Soft nodules result from repeated follicular ruptures and reencapsulations with inflammation, abscess formation (cysts), and foreign-body reaction (Fig. 1-3). Round isolated single nodules and cysts coalesce to linear mounds and sinus tracts (Fig. 1-4). Sinuses: draining epithelial-lined tracts, usually with nodular acne. Scars: atrophic depressed (often pitted) or hypertrophic (at times, keloidal). Seborrhea of the face and scalp often present and sometimes ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.