Acne: Understanding Its Causes and Types

Acne

• Chronic inflammatory disease affecting the pilosebaceous unit, commonly seen in adolescents aged 12-25.
• Most prevalent skin condition, associated with significant physical and psychosocial impacts.
• Acne pathogenesis involves follicular hyperkeratinization, increased sebum production, bacterial proliferation (Cutibacterium acnes), and inflammation.

Acne Lesions

• Microcomedo: Plug formed by epithelial cells, sebum, and bacteria; subclinical.
• Comedones: Expansion of microcomedo leads to papule formation; can be open (blackhead) or closed (whitehead).
• Papules and pustules: Result from inflammation around the pilosebaceous unit, presenting as erythematous lesions.
• Nodules and cysts: Deeper inflammation can cause painful lesions with scarring potential.

Acne Patterns

• T-Zone: Forehead and central face, typical for early acne.
• Hormonal Acne: Lower face acne, especially along the mandibles and chin.
• Truncal Acne: Occurs on shoulders, chest, and back.
• Acne Excoriee: Result of trauma from scratching or picking.

Acne Complications

• Pigment Alterations: Includes post-inflammatory erythema and hyperpigmentation.
• Scarring Types: Atrophic, hypertrophic, and keloidal scars resulting from acne lesions.

Acne Diagnosis and Treatment Considerations

• Diagnosis is clinical, with consideration of factors like hormonal influences (e.g., PCOS) and medications (e.g., steroids).
• Treatment involves evaluating lesion types, hormonal factors, psychosocial impact, and previous treatment adherence.

Topical Treatment Options

• Topical Retinoids: Comedolytic, mildly anti-inflammatory (e.g., Tretinoin, Adapalene).
• Topical Antibiotics: Anti-inflammatory and antibacterial properties (e.g., Clindamycin, Erythromycin).
• Benzoyl Peroxide: Antibacterial and mildly comedolytic; reduces risk of bacterial resistance.
• Azelaic Acid: Antibacterial, mildly comedolytic, and improves post-inflammatory hyperpigmentation.
• Dapsone: Anti-inflammatory for moderate to severe acne, with caution of yellow staining when used with benzoyl peroxide.
• Clascoterone: Androgen receptor blocker, indicated for patients over 12.

Systemic Treatment Options

• Oral Antibiotics: Doxycycline and minocycline are effective anti-inflammatory options. Use of subantimicrobial dosing for reduced resistance.
• Intralesional Steroids: For emergencies; risk of atrophy and dyspigmentation.

Rosacea

• Chronic inflammatory disorder typically affecting adults aged 30-50; familial in 10-20% of cases.
• Pathogenesis may involve vascular dysfunction, UV light exposure, genetic factors, and immune response issues.

Dermatophyte Infections

• Caused by fungi needing keratin for survival; include Trichophyton, Microsporum, and Epidermophyton.
• Transmission methods include human-to-human, animal-to-human, soil-to-human, and fomites.
• Clinical presentations vary by infected area: Tinea Corporis (body), Tinea Pedis (feet), Tinea Capitis (scalp), etc.

Tinea Pedis

• Most common dermatophyte infection with various subtypes: interdigitial, moccasin distribution, inflammatory, ulcerative, and bullous presentations.

Tinea Capitis

• Scalp infection primarily from Trichophyton tonsurans; common in children aged 3-7, notably in children of African heritage.
• Clinical signs include scaly patches, inflammation, and posterior cervical adenopathy.

Diagnostic and Treatment Approaches

• Diagnosis based on clinical examination and KOH testing.
• Treatment for localized disease includes topical antifungals; systemic therapy for extensive cases.
• Oral antifungals such as Terbinafine or Itraconazole may be prescribed as needed.

Case Discussions

• Presented clinical cases for analysis and treatment recommendations, underscoring the importance of tailored therapeutic approaches based on patient specifics.