Ted, age 17 years, has a severe case of acne affecting his face, neck, and back.

Question

Ted, age 17 years, has a severe case of acne affecting his face, neck, and back. Numerous pustules surrounded by inflammation are present, as well as blackheads and deep scars from prior lesions.

1.Based on the information in this case, discuss the types of lesions, how they formed, and the mechanism whereby they cause the tissue damage. (See Acne Vulgaris.)

2.Discuss the predisposing and exacerbating factors that may be involved in acne vulgaris, along with treatment and preventive measures. (See Acne Vulgaris.)

Explanation / Answer

1. Lesion in the above discussed case are of 'Acne vulgaris'.
- these lesiona are located on the face, neck, chest, and back(where the most sebaceous glands are located. Along the jaw line is a common location in adults).
- Blackheads are follicular plugs that are oxidized from being exposed to the air.
- Papules are small reddish-brown bumps, pustules are pus-filled lesions, may be found.
-Acne can result in scars, which can appear to be depressions or hyperpigmentation, which is dark red or brown marks at the location of lesion.

2. (A) PREDISPOSING FACTORS:-
(i)Age:- most commonly in teenagers.
(ii)Hormonal changes:- common in teenagers, women and girls, and people using certain medications(containing corticosteroids, androgens).
(iii)Family history
(iv)oily substances:-if skin comes into contact with oily/greasy substance.
(v)Friction/ pressure on skin.

(B) EXACERBATING FACTORS:-
(i) Hormones:-Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum.
- hormones worsen the acne.
(ii) Medication:- certain medication containing
corticosteroids, testosterone etc.
(iii) Diet:- certain diet including skim milk and carbohydrate rich foods as bread, and chips may worsen acne.
(iv) Stress:- stress can make acne worse.

(C) TREATMENT
(i) Topical medication:-
-Retinoids:- derived from vitamin A.
- It works by preventing plugging of the hair follicles.
-Antibiotics:-work by killing excess skin bacteria and reducing redness.
-Salicylic acid and azelaic acid:-salicylic acid may help prevent plugged hair follicles.
-Dapsone:- for inflammatory acne.

(ii)Oral medications:-the first choice for treating acne is tetracycline or doxycycline.
- best used in combined with topical retinoids.

(iii) Combined oral contraceptives.
(iv) Therapy:-
- laser and photodynamic therapy.
- chemical peel
- extraction of blackheads
- steroid injection.

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