Acne Vulgaris

Acne vulgaris, commonly called acne, is inflammation of the pilosebaceous glands. These are the glands which produce oil for the hair. Acne is more likely to occur in adolescent males and is associated with testosterone level and the ingestion of "greasy" foods—food containing trans-fatty acids (TFA). TFA are synthetic alterations of naturally fatty acids and are present in processed foods, candies, and potato chips.

Table 20-1. Medication for systemic therapy.

Non-Hormonal Treatment

Hormonal Treatment

Antibiotics, oral

Corticosteroids

Tetracycline

Anti-inflammatory actions: high dose

Erythromycin

Androgen suppressant action: low dose

Minocycline

Sex hormones (for women only)

Trimethoprim-sulfamethoxazole

Estrogen (oral contraceptive medication)

Isotretinoin, oral

Antiandrogens

Inflammation of the pilosebaceous glands form papules, nodules, and cysts on the face, neck, shoulders, and back as a result of keratin plugs at the base of the pilosebaceous oil glands near the hair follicles.

The increase in androgen production that occurs during adolescence increases the production of sebum, an oily skin lubricant. Sebum combines with keratin to form a keratin plug. An individual has little control over acne except to eat a nutritionally healthy diet and practice good hygiene. Acne is significantly influenced by age, heredity, stress, hormonal changes, and onset of puberty. All of these are beyond the patient's control.

Acne is treated by gently applying a cleansing agent several times a day to the skin. Vigorous scrubbing should be avoided. In addition, the patient can administer topical anti-acne medication such as keratolytics. These include benzoyl peroxide, resorcinol, and salicylic acid that dissolves keratin, the outer layer of the epidermis.

The patient should undergo systemic treatment if he or she has a severe case of acne vulgaris that results in scarring, has persistent hyperpigmentation, or when topical treatment fails (see Table 20-1).

A list of drugs utilized in the treatment of skin disorders is provided in the Appendix. Detailed tables show doses, recommendations, expectations, side effects, contraindications, and more; available on the book's Web site (see URL in Appendix).

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