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Acne Vulgaris:
Acne vulgaris is a self limiting disorder of teenagers and young adults.But 10-20% of adults may continue to experience this disorder. In adolescence, there is increased secretion of sebum from sebaceous glands. The glands get blocked with the retained sebum and kerotinous debris. Small cysts called Comedons are formed due to blockage of hair follicles. Proprionobacterium acnes is the cyst and caused production of fatty acids within the cysts. Thus causing infection of the cyst and bursting of the cyst wall. The extrusion of oily, keratinous debris triggers a foreign body reaction develops.

These are of two types-
  1. Closed comedones = White heads.
  2. Opened comedones = Black heads.
The closed comedones are mostly associated with inflammatory lesions like papules, cysts and nodules. These are seen as small white heads with the naked eye or sometimes are not visible to the naked eye.
The Open comedones are seen as Black heads. These are more stable and have a dilated orifice (opening) at their peak. Material in these comedones can be easily expressed out. These rarely cause inflammatory cysts and nodules.
The earliest lesion seen is mildly inflammed comedone at the forehead. Later cheeks, chin and nose are involved. Chest and back are also not uncommon.
Usually Scarring is not seen in case of acne lesions but in case of large inflammatory cysts and nodules, they may leave significant scarring. Helmets, chin straps may produce friction on the comedone scausing their burst and subsequent inflammation. Cosmetics containing comedogenic substances (glucocorticoids, lithium etc) or drugs that may cause acne (phenytoin, phenobarbital, glucocorticoids) may produce acneiform lesions.
Washing face with a mild soap to avoid accumulation of oil and debris, avoiding over cleaning and rubbing of the skin, maintaining good hygiene and trimming of nails etc prevent and reduce the incidence of Acne.
Topical agents (agents applied locally, on the site) - Retinoic acid, Benzoyl peroxide, salicylic acid are useful in altering the epidermal desquamation and comedome formation. They aid in resolution of previous cysts.
Topical antibacterial agents - Benzoul peroxide, azelaic acid, topical erythromycin, clindamycin.
Acne Rosacea:
It is an inflammatory disorder predominantly affecting the central face. Mostly seen in women but males are the severe sufferers. It is rarely seen below the age of 30. Initially flushing is seen over the face as a reaction to hot drinks, emotional stimuli, spicy foods, heat etc, but later the flushing becomes permanent. Papules , pustules and telangiectases become superimposed on the flush. Rosacea of long standing duration may cause connective tissue over growth (particularly of nose - rhinophyma). Rosacea is complicated by various eye disorders like blepharitis, iritis, keratitis which are sight-threatening and require an ophthalmic evaluation.

Topical metronidazole, sulfacetamide are useful. More severe diseases require oral tetracycline. Laser therapy is useful for residual telangiectasia. Glucocorticoids are best avoided.


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deepanjali said…
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