Acne vulgaris is the most common skin condition affecting teenagers, characterized by inflammatory and non-inflammatory lesions on the face, neck and upper trunk. It peaks in late teens and usually stops by age 25. Factors like hormones, stress, and certain foods can aggravate acne. Treatment involves topical medications for mild to moderate acne and oral antibiotics or hormones for more severe cases. Complications may include scarring. Proper long-term treatment and management is important to prevent recurrence and worsening of acne over time.

1. ACNE VULGARIS
DR. BIJAY KR.YADAV
Holly vision technical campus
Shankhamul, Kathmandu

2. ACNE VULGARIS
Acne vulgaris is a follicular disorder affecting sebaceous glands of the face,
neck and upper trunk characterized by both inflammatory and non-
inflammatory lesions.
• It is the most common dermatoses affecting teenagers.
• Aggravated form of acne which are large and infected it is called as
nodulocystic acne.
Incidence :-
• Peak incidence in late teen age years.
(M = 16 – 19 yrs, F = 14 – 16 yrs)
• It starts after adolescence and by the age of 25 yrs most patients stop
having acne.
• Both sexes equally affected.

3. CO-FACTORS (AGGRAVATING)
 Premenstrual
 UV radiation(Excessive sunlight may either
improve or flare acne).
 Stress
 Sweating
 Smoking
 Mechanical or Frictional forces
 Greasy or occlusive products
 Diet- high glycemic & milk

4. Etiology :-
A. Causative organism
 Propionebacterium acnes
B. Risk factors :
 Age – Adolescence (14 - 19 yrs)
 Environment – Hot and Humidity
 Food – Oily food, Spicy food
 Drugs – Steroids, Anticonvulsant, OCP
 Others
- Emotional and stress factors
- Genetics
- Poor hygiene

5. PATHOGENESIS
 Increased sebum production.
 Hyperkeratosis of pilosebaceous duct.
 Colonisation of duct with propioniform bacteria.
 Inflammation.

6. GRADES OF ACNE (PILLSBURG’S)
 Grade 1: comedones,( open or closed) occasional papules.
 Grade 2: papules, comedones, few pustules.
 Grade 3: Pre-dominant pustules, nodules, abscesses.
 Grade 4: mainly cysts, abscesses, scars

7. ACNE GRADING
 Mild
 Moderate
 Severe
 < 20 comedones, or < 15 inflammatory
lesions, or < 30 total lesions.
 20 to 100 comedones, or 15 to 50
inflammatory lesions, or 30 to 125 total
lesions
 > 5 cysts, or total comedone count > 100,
or total inflammatory lesion count > 50, or
> 125 total lesions

8. Gade 1; comedones Grade 2: Papules, pustules

9. Grade 3: Papulo-
pustules
Grade 4: papulo-pustules,
comedones, cysts

10. MANAGEMENT
1. General measures :
 Face wash with warm water 2-3 times a day
 Avoid spicy food, oc-pills, skin exposure etc.
2. Topical therapy :
Topical therapy alone is indicated for mild to moderate lesions
a. Mild lesions :
I. Benzyl peroxide 5 % gel, twice daily
II. Topical antibiotics
• Azithromycin ointment
• Erythromycin ( 2% lotion & 3% cream)
• Clindamycin phosphate 1% lotion
• Tetracycline lotion
b. Moderate lesions :
• Topical Retinoids : Isotretinoin 0.5% cream
• Salicyclic acid 3-5%

11. 3. Systemic therapy :
- In severe acne
- Not responding to topical therapy.
a. Antibiotics :
I. Tetracycline : ( most common )
250 mg 4 times a day taken in empty stomach initially for 4-5
weeks.
Followed by maintenance dose of 250-500 mg daily for several months
II. Erythromycin : 250 mg QID for 4-5 wks
followed by maintenance dose of 250-500 mgs for several months
III. Doxycycline 100-200 mg
IV. Clindamycin 150 mg
V. Azithromycin 500 mg

12. b. Estrogens : Ethinyl estrodiol 100 mg/day for few
months
c. Antiandrogen :
 cyproterone acetate 50-100 mg/day on 5- 14 day
of cycle to enhance the effect of sebum reduction
 Spironolactone 1 mg /kg/day for facial lesions.
2mg/kg/day for truncal lesions for 15-20 wks.

13. COMPLICATIONS:
 Post-inflammatory hyperpigmentation.
 Ice-pick scars
 Atrophic/ Hypertrophic scars
 Psychiatric disturbances-depression.
 Keloids

14. COMPLICATIONS;
Ice-pick scars Hypertophic
scar Atrophic
scar

15. CONCLUSION:
 Acne typically recurs over years and maintenance
therapy is an important component of acne
management.
 The preventive effect of topical retinoids and for
antibiotic resistance makes topical retinoids ideal.
 Any treatment started must be continued for at least
6 wks before changing.
 Though acne remits with age, scars can be life-
long.