| ID | 214 |
|---|---|
| Name | ACNE VULGARIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | |
| Introduction | Acne vulgaris is a self-limited disorder of teenagers & young adult in which the androgen causes increase sebaceous gland activity. Plugging of hair follicles by keratin causes retension of sebum producing the characteristic comedo. The clinical hallmarks of acne vulgaris is comedo, which may be closed (white head) or open (black head). These may become secondarily infected with bacteria. The earliest lesions in adolescence are generally mildly inflammed and non inflammatory comedones on the forehead followed by more typical inflammatory lesions on the cheeks, nose and chin. The most common location for acne is the face, but the chest and upperback may also be involved. The skin is usually greasy. It usually disappears in early adult life after the residual scarring. |
| History | |
| Etiology | Etiology: Unknown. Predisposing factors: 1. Androgen imblalance (specially in puberty) 2. Heriditary and familial. Exciting factors: 1. Excess carbohydrate intake & fats. 2. Food allergies. 3. Food rich in iodine 4. Gastrointestinal disturbances. 5. Endocrine disorders. 6. Psychogenic factors. 7. Vitamin deficiency. 8. Ingestion of halogens. 9. Contact with chemicals- tar and chlorinated hydrocarbons. 10. Drugs- Corticosteroids, androgenic steroids, lithium, oral contraceptives, anticonvulsants etc. 11. Propionibacterium acne. Acnegenic foods: Milk, eggs, cheese, chocolate, nuts. Food containing bromide and iodide. Excessive sweets. Starchy and greasy foods. |
| Clinical Features | |
| Preventions | |
| Treatment | Treatment: A. General measure: 1. All unnecessary medicines containing bromide & iodide to be avoided. 2. Avoid exposure to cosmetics (creams, powder) oils and greases, woolen garments and fur. 3. Avoid fatty, spicy foods alcoholic beverages, chocolates, nuts. 4. Avoid contact with tar, oil etc. 5. Abdominal disturbances, anemia, malnutrition, infection, constipaion & worm infestation to be treated if present. 6. Frequent wash of the face with warm soap water or local detergent (cetrimide) to degrease the skin and rub with soft towel. 7. Dandruff if present- should be treated with selenium sulphide 2.5% & shampoo, 1-2 times daily. 8. Treat the emotional disorders. B. Lacal treatment: 1. Topical benzoyl peroxide cream or lotion (2.5-10)% be used for peeling. 2. Sulphur containing pastes, or lotion- these apply at bed time and wash at morning to produce desquamation and remove keratin. 4. Erythromycin lotion for local application. 5. Tretinoin (retinoic acid- vitamin A) lotion, cream or gel for comedo acnes- at bed time (it may be irritating). 6. Removal of comedos by comedo extractors. 7. If local applications are ineffective expose to ultraviolet rays 3 feet away from lamp thrice a weeks for 6 week courses in graded dose. Or, Sun bath daily in graded doses. 8. In cystic acne- incision and drainage if needed or intralesional injection of triamcinolone acetonide 3mg/ml 9. Dermabration of superficial flat scars. C. Systemic treatment: 1. Antibiotics-Low dose tetracycline or erythromycin 250mg twice daily for 6 months, or azithromycin 500mg once daily for 3 days in a week for 6 months in severe cases. Contraindication: Pregnancy & children below 10 years- where minocycline 200mg daily orally for 5 days, then reduce to 50-100mg; Or, erythromycin 250mg 3 times daily upto response and then reduce the dose. 2. Menstrual acne- (rarely used) Stilbesterol 0.5-Img daily for 3 months. Complication: Pigmentation, break-through bleeding etc. 3. Isotretinoin used in severe cystic cases. Dose: 0.5-lmg/kg/day for 4-6 months. Contraindication: Pregnancy. 4. Prednisolone 7.5-15mg daily for 6 months (90% cleared or improved) |
| Complications | |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
© Pakistan Drug Directory. All Rights Reserved.
Designed By: Pakistan Drug Directory Team