Tuesday, February 3, 2015

Acne vulgaris

Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). Acne can present as noninflammatory lesions, inflammatory lesions, or a mixture of both, affecting mostly the face but also the back and chest.
Acne vulgaris is characterized by noninflammatory, open or closed comedones and by inflammatory papules, pustules, and nodules. Acne vulgaris typically affects the areas of skin with the densest population of sebaceous follicles (eg, face, upper chest, back). Local symptoms of acne vulgaris may include pain, tenderness, or erythema.

Systemic symptoms are most often absent in acne vulgaris. Severe acne with associated systemic signs and symptoms, such as fever, is referred to as acne fulminans. Severe acne, characterized by multiple comedones, without the presence of systemic symptoms, is known as acneconglobata. This severe form of acne frequently heals with disfiguring scars. Additionally, acne vulgaris may have a psychological impact on any patient, regardless of the severity or the grade of the disease. Treatment of acne vulgaris should be directed toward the known pathogenic factors, including follicular hyperproliferation, excess sebum, P acnes, and inflammation. The most appropriate treatment is based on the grade and severity of the acne.
The following medications are used in the treatment of Propionibacterium acne vulgaris:
  • - Retinoid-like agents (eg, topical tretinoin, adapalene, tazarotene, isotretinoin);
  • - Antibiotics (eg, tetracycline, minocycline, doxycycline, trimethoprim/sulfamethoxazole, clindamycin, topical clindamycin, topical erythromycin, daptomycin);
  • - Selective aldosterone antagonists (eg, spironolactone);
  • - Estrogen/progestin combination oral contraceptive pills (eg, ethinyl estradiol, drospirenone, and levomefolate; ethinyl estradiol and norethindrone; ethinyl estradiol and norgestimate; ethinyl estradiol and drospirenone);
  • - Acne products (eg, erythromycin and benzoyl peroxide, clindamycin and tretinoin, clindamycin and benzoyl peroxide, azelaic acid, benzoyl peroxide, Generic Azelex);
Details generics available here!
Systemic antibiotics are a mainstay in the treatment of moderate-to-severe inflammatory acne vulgaris. These agents have anti-inflammatory properties, and they are effective against P acnes. The tetracycline group of antibiotics is commonly prescribed for acne. The more lipophilic antibiotics, such as doxycycline and minocycline, are generally more effective than tetracycline. Oral antibiotic use can lead to vaginal candidiasis; doxycycline can be associated with photosensitivity; and minocycline has been linked to pigment deposition of the skin, mucus membranes, and teeth. You can visit my twitter account and follow me.

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