Acne Pathophysiology and Impact

Acne

• Acne is the 8th most prevalent disease worldwide, according to a 2010 study.
• It's an inflammatory disorder of the pilosebaceous glands, leading to lesions primarily on the face.
• Peak prevalence occurs in females between 14-17 years and males between 16-19 years.
• Acne significantly impacts quality of life, causing stress, low self-esteem, and embarrassment.
• It can also contribute to anxiety and depression.
• Long-term effects include scarring and worsening psychosocial impacts.
• Annual spending on OTC acne products is $607 million.

Pathophysiology

• Acne originates from processes within the pilosebaceous unit, a structure in the dermis.
• This unit includes the hair follicle and sebaceous glands.
• Sebum, a protective oily substance produced by the sebaceous glands, is involved.
• Factors contributing to acne include excess sebum, follicular bacteria colonization, and disruptions in keratinization.
• Inflammation also plays a role.
• Acne triggers include diet, hormonal changes, stress, and medication.

Clinical Presentation

• Acne lesions can be categorized as non-inflammatory or inflammatory.
• Non-inflammatory lesions include open comedones (blackheads) and closed comedones (whiteheads).
• Inflammatory lesions include papules (redness and inflammation) and pustules (redness, inflammation, and purulence).

Grading

• Acne severity ranges from mild to severe.
• Mild acne involves only a few papules and pustules, with some comedones.
• Moderate acne features numerous papules and pustules.
• Severe acne displays extensive pustules, papules, and nodules resulting in significant inflammation.

Etiology Subtypes

• Different forms of acne can exist, like acne cosmetica, acne excoriee, acne mechanica, chloracne, and more.
• Drug-induced acne is a possibility caused by specific medications.
• Hormone-induced acne is a common cause.

Treatment Goals

• Treatment aims to reduce and alleviate acne severity.
• Preventing future lesions, scarring, and hyperpigmentation is essential.
• Improving patient quality of life is a key goal.

Non-Pharmacologic Management

• Avoiding acne triggers is crucial, including certain foods, irritants, stress, and excessive cleansing.
• Maintaining proper hydration is recommended.
• Gentle cleansing and avoiding harsh products are suggested.
• Consider mild soaps or non-soap cleansers.
• Limiting the use of physical treatments (brushes, scrubs, heating devices, and light therapy) is advised.

Pharmacologic Treatments

• Discussing various pharmacologic treatments, including adapalene (Differin), benzoyl peroxide, salicylic acid (beta-hydroxy acids), alpha-hydroxy acids, and dicarboxylic acids.
• Details on their effects, usages, side effects, and concentrations are provided.
• Example products are mentioned throughout these notes.
• Side effects such as irritation, dryness, bleaching, and potential photosensitivity are also noted.

Product Selection Considerations

• Only mild acne may be effectively treated with OTC products.
• Creams/lotions might be less irritating than gels/solutions.
• Products have multiple vehicles and strengths.
• Ointments should be avoided as they can worsen acne.
• Starting with the lowest strength available and increasing gradually is advised.

Special Populations

• Recognizing differences in acne treatment strategies based on factors like age, pregnancy, and other medical conditions is paramount for targeted and effective interventions.

Patient Case

• A female, Ms. Marshall, who is distressed about acne, is discussed. Specific symptoms, including location, type, and severity, are outlined here.

Follow-Up Guidelines

• Procedures for contacting patients, monitoring their conditions, and providing further interventions are specified here, including suggested timeframes for follow up based on the patient's situation.