Acne is a common chronic disorder affecting the hairfollicle and sebaceousgland, in which there is expansion and blockage of the follicle and inflammation. There are several variants.
Who gets acne?
Acne affects males and females of all races and ethnicities. It is prevalent in adolescents and young adults, with 85% of 16 to 18 year-olds affected. However, it may sometimes occur in children and adults of all ages.
What causes acne?
Acne is due to a combination of factors. The exact mechanisms are not fully understood.
As for mild acne plus a tetracycline such as doxycycline 50–200 mg daily for 6 months or so
Erythromycin or trimethoprim if doxycycline intolerant
Antiandrogen therapy with long-term cyproterone acetate + ethinylestradiol or spironolactone may be considered in women not responding to low-dose combined oral contraceptive, particularly for women with polycystic ovaries
Isotretinoin is often used if acne is persistent or treatment-resistant
Intralesional steroid injections can be useful for acute larger acne lesions
Severe acne
Referral to a dermatologist
If fever, arthralgia, bone pain, ulcerated or extensive skin lesions, blood count should be arranged and referral is urgent
Oral antibiotics are often used in higher doses than normal
Oral isotretinoin is usually recommended in suitable patients
What is the outlook for acne?
Acne tends to improve after the age of 25 years but may persist, especially in females.
Treatment with isotretinoin can lead to long-term remission in many patients.
Bibliography
Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30. PubMed
