NURSING CARE AND HEALTH TEACHING

1. ACNE VULGARIS
CLASS BY : ALBERT BLESSON , NURSING TUTOR , COLLEGE OF NURSING ,AIIMS PATNA

2. ACNE VULGARIS
Acne vulgaris is an inflammatory disease of pilosebaceous units, skin glands, and hair
follicles, that appears as comedones, pustules, nodules, and nodular lesions.
This disorder, which tends to run in families, affects nearly 85% of adolescents with a
westernized lifestyle, although lesions can appear as early as age 8.

3. Acne affects boys more commonly and more severely; however, it typically
occurs in girls at an earlier age and tends to affect them for a longer time, sometimes into
adulthood.
Although key factors in the pathogenesis of acne vulgaris are genetics and
inflammation, the disorder is also influenced by follicular epidermal hyperproliferation with
plugging of the follicle, excessive sebum production, and the presence and activity of
commensal bacteria Propionibacterium acnes.
With treatment, the prognosis is good

4. Pathophysiology
Acne eruptions are initiated by increased sebum production activated by
androgenic hormones.
Sebum is secreted into dilated hair follicles containing normal skin bacteria. The
bacteria secrete the enzyme lipase, which reacts with sebum to produce free fatty acids to
trigger inflammation.
At the same time, keratin produced by the hair follicles combines with sebum to
form plugs in dilated follicles.

5. Signs and Symptoms
• Pain and tenderness around the area of the infected follicle
• Acne lesions, most commonly on the face, neck, shoulders, chest, and upper back
• Area around the infected follicle that appears red and swollen
• Acne plug that may appear as a closed comedo, or whitehead (if it does not protrude
from the follicle and is covered by the epidermis), or as an open comedo, or blackhead
(if it protrudes and is not covered by the epidermis)
• Inflammation and characteristic acne pustules, papules or, in severe forms, acne cysts
or abscesses
• Visible scars

6. Treatment
• Benzoyl peroxide (powerful antibacterial)
• Antibiotics (e.g., tetracycline, minocycline, doxycycline, trimethoprim/sulfamethoxazole, clindamycin, daptomycin,
or topical clindamycin or topical erythromycin)
• Retinoid-like agents (including topical tretinoin, adapalene, tazarotene, or isotretinoin)
• Oral isotretinoin (Amnesteem)
• Birth control pills (e.g., estrogen/progestin combinations such as ethinyl estradiol, drospirenone, and levomefolate;
ethinyl estradiol and norethindrone; ethinyl estradiol and norgestimate; ethinyl estradiol and drospirenone) or
spironolactone to produce antiandrogenic effects (in females)
• Intralesional corticosteroid injections
• Exposure to UV light (but never when a photosensitizing agent, such as isotretinoin, is being used)
• Cryotherapy
• Acne surgery with manual extraction of comedones
• Superficial peels using glycolic or salicylic acid

7. Nursing Diagnosis
• Impaired skin integrity
• Deficient knowledge
• Disturbed body image

8. Nursing Considerations
TIP: Remember, not all patients with acne are teenagers!
• Assist the patient in identifying and eliminating predisposing factors.
• Encourage good personal hygiene and the use of oil-free skin care products. Discourage picking, scratching, or squeezing the
lesions to eliminate secondary bacterial infections and scarring.
• Discuss possible complications of using long-term antibiotics or oral contraceptive pills, including sensitivity reactions, GI
disturbances, higher risk of cardiovascular events, deep vein thrombosis, breast/cervical, liver cancer, and liver dysfunction.
• Remember that tetracycline is contraindicated during pregnancy because it discolors the fetus’s unerupted teeth.
• Monitor liver function studies and serum triglyceride levels when isotretinoin is used.
• Be alert for possible adverse reactions associated with using isotretinoin, including possible skin irritation, dry skin and mucous
membranes, and elevated triglyceride levels.
• Encourage the patient with acne to verbalize his feelings, including embarrassment, fear of rejection by others, and disturbed
body image. Note the importance of body image in growth and development. Encourage him to develop interests that support a
positive self-image and de-emphasize appearance.

9. Nursing Management
• Administer prescribed medications, which may include acne products containing benzoyl peroxide (explain that these
products initially cause skin redness and scaling but that the skin adjusts quickly); topical agents, such as vitamin A acid; and
antibiotics such as tetracycline.
• Provide client and family teaching
• Advise the client that heat, humidity, and perspiration exacerbate acne. Explain that uncleanliness, dietary indiscretions,
menstrual cycle, and other myths are not responsible for acne.
• Explain that it will take 4 to 6 weeks of compliance with the treatment regimen to obtain results.
• Instruct the client to wash his face gently (do not scrub) with mild soap twice daily.
• Instruct the client not to squeeze blackheads, not to prop hands on or rub the face, to wash hair daily and keep it off the face,
and to use cosmetics cautiously because some may exacerbate acne.
• instruct the female client to inform her health care provider if she is possibly pregnant. Some medication, such as systemic
retinoic acid, have teratogenic effects, therefore a pregnancy test is required prior to treatment and strict birth-control
measures are use throughout pregnancy.

10. How Acne Develops

12. Comedones of Acne

13. Teaching About Acne
• Explain the causes of acne to the patient and his family. Encourage the patient to seek medical treatment if
extensive acne develops
• Make sure the patient and his family understand that the prescribed treatment will improve acne more than a
strict diet or excessive scrubbing with soap and water. Advise using sunscreen whenever outdoors to prevent
aggravating the skin.
• Instruct the patient receiving tretinoin to apply it at least 30 minutes after washing his face and at least 1 hour
before bedtime. Warn against using it around the eyes or lips. Explain that after treatments, the skin should
look pink and dry and that some amount of peeling is normal in the morning when tretinoin has been applied at
night. Tell the patient that if the skin appears irritated, the preparation may have to be weakened or applied less
often. Advise the patient to avoid exposure to sunlight while wearing the solution or to use a sunscreen.

14. • If the prescribed regimen includes tretinoin and benzoyl peroxide, advise the patient to avoid skin irritation by using one
preparation in the morning and the other at night. Also advise the patient that acne typically flares up during the early course
of treatment, probably because early, developing lesions are uncovered.
• Instruct the patient taking tetracycline to do so on an empty stomach. Advise him not to take tetracycline with antacids or
milk because it interacts with their metallic ions and is then poorly absorbed. Explain that some studies suggest that a diet
high in cow’s milk and carbohydrates is associated with increased occurrence and severity.
• Tell the patient taking isotretinoin to avoid vitamin A supplements, which can worsen adverse effects. Warn the patient
against giving blood during treatment with this drug and to avoid alcohol ingestion. Also, teach how to deal with the dry skin
and mucous membranes that usually result during treatment. Instruct the female patient about the severe risk of
teratogenicity. Encourage the patient to schedule and follow up with the necessary laboratory studies.
• Teach the patient and his family techniques to maintain a well-balanced diet, get adequate rest, and manage stress.
• Inform the patient that acne takes a long time—in some cases, years—to clear. Encourage continued local skin care even
after acne clears

16. • REFERENCE
LippincottVISUAL NURSING
A Guide to Diseases, Skills, and Treatments
Third Edition