This document provides information on acne vulgaris (acne), including its definition, incidence, anatomy and physiology of the skin, etiology, types, pathophysiology, clinical manifestations, assessment, medical and surgical management, and nursing management. It defines acne as a common skin disease characterized by areas of skin with seborrhea, comedones (blackheads and whiteheads), papules, pustules, nodules and possible scarring. It affects many adolescents and young adults due to increased hormonal activity during puberty which can overstimulate sebum production in hair follicles, sometimes leading to follicular blockage and inflammation. Treatment involves reducing bacteria, sebum production, inflammation and scarring

1. TOPIC
ACNE VULGARIS
PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING

2. ACNE VULGARIS
INTRODUCTION :-
Acne vulgaris is a common human skin disease that affects
the areas of skin with the denset population of sebaceous follicles,these areas
includes the face,the upper part of the chest & the back.
DEFINITION :-
1) “ Acne vulgaris is a common human skin disease,characterized by areas of skin
with Seborrhea (scaly red skin),Comedones (Blackheads & whiteheads),
papules (pinheads),Pustules (pimples),Nodules (large papules) & possibly
scarring.”
- en.wikipedia.org/wiki/Acne_vulgaris
2) “ Acne vulgaris is a common follicular disorders affecting susceptible hair
follicles,most commonly found on the face,neck & upper trunk.It is
characterized by Comedones,both closed & open & by papules,pustules,
nodules & cysts.”
- Brunner & Suddarth’s
3) “ Acne vulgaris is a inflammatory disease of skin,caused by chronic sebaceous
gland inflammation,characterized by comedones,papules & pustules of
sebaceous areas i.e. face,chest,back & resolving with scaring reaction.”
- Medical_dictionary.thefreedictionary.com
INCIDENCE :-
Acne affects 40-50 million people in the United States.Acne is
the most commonly encountered skin condition in adolescents & young adults
between ages 12 & 35.Both genders are affected equally,although onset is slightly
earlier for girls,reach puberty at a younger age than boys.

3. ANATOMY & PHYSIOLOGY OF SKIN :-
The skin has a surface area of about 1.5-2 meter square
In adults & it containes glands,hair & nails.
There are 2 main layers : Epidermis & Dermis.
FIG. : THE STRUCTURE OF SKIN
EPIDERMIS :-
 The epidermis is the most superficial layers of the skin & it is the thikest on the
palms of the hands & the soles of the feet.
 There are no blood vessels or nerve endings in the epidermis.
 These are several layers (strata) of cells in the epidermis,which extend from
the deepest Germinative layer to the surface Stratum corneum (a thicks horny
layer).
 The cells on the surface are flat,non-nucleated,dead cells or squames in which
cytoplasm has been replaced by the fibrous protein keratin.
 The colour of the skin is affected by the 3 main factors :-
1. Melanin :- A dark pigment derived from the amino acid,tyrosine & secreted
by Melanocytes in the deep germinative layers.It protects the skin from the
harmful effects of sunlight.
2. The level of oxygenation of hemoglobin & the amount of blood circulating
in the dermis give the skin its pink colour.

4. 3. Bile pigment in blood & Caratenes in subcutaneous fat give the skin a
yellowish colour.
DERMIS :-
 The dermis is tough & elastic.
 It is formed from connective tissue & the matrix contain collagen fibres
interlaced with elastic fibres fibroblasts,macrophages & mast cells are main
cells found in the dermis.
 The structure in dermis are :-
1. BLOOD VESSELS :- Arterioles from a fine network with capillary branches
supplying sweat glands,sebaceous glands,hair follicles & the dermis.The
epidermis has no blood supplies.
2. LYMPH VESSELES :- These form a network throughout the dermis.
3. SENSORY NERVE ENDINGS :- Sensory receptors which are sensitive to touch,
change in temp.,pressure & pain are widely distributed in the dermis.
4. SWEAT GLANDS :- It is widely distributed throughout the skin & are most
numerous in the palms of the hands,soles of the feet,axillae & groins.They are
composed of epithelial cells.Some ducts open into the skin surface or pores &
other open into the hair follicles.
5. HAIR :- These are formed by a down growth of epidermal cells into the dermis
called hair follicles.
6. THE SEBACEOUS GLANDS :- These consist of secretory epithelial cells derived
from the some tissue as the hair follicles.They secrete an oily
substances,sebum into the hair follicles.
FUNCTION’S OF THE SKIN :-
1. Protection
2. Regulation of body temperature
3. Control of body temperature
4. Formation of vitamin-D
5. Sensation
6. Absorption
7. Excretion

5. ETIOLOGY :-
The main causes of acne is multi-factorial.Acne develops as a
result of blockage in follicles.Formation of plug of keratin & sebum is the earliest
change.
--- Various factors that may cause acne such as :
(1) Hormonal :- Hormonal activity such as Menstrual cycles, Puberty,Pregnancy &
such disorders like polycystic ovary syndrome,may contribute to
the formation of acne. The male hormone androgen, can over
stimulate the production of sebum in some people.
(2) Genetic or Heredity
(3) Infectious :- Bacteria in the pores. Propionibacterium acnes is the anaerobic
bacterium that causes acne.
(4) Diet :- A high glycemic load diet & cow’s milk have been associated with
worsening acne.
(5) Drugs :- Certain drugs like corticosteroids,glucocorticoides,corticotrophin,
Phenobarbital,phenytoin,lithium,isoniazid & halogens can cause acne.
(6) Other precipitating factors are :-
- Exposure to industrial compounds.
- Trauma or rubbing from tight clothing.
- Cosmetics
- Emotional stress
- Oil from skin care products & cosmetics
- Cooking oil
- High humidity or pollution

6. TYPES :-
The two main types of lesions are Non-inflammatory and
Inflammatory.
(1) NON-INFLAMMATORY :-
These lesions are called comedones and can
result in whiteheads or blackheads.
WHITEHEADS BLACKHEADS
(2) INFLAMMATORY :-
These are consists of pimples,papules,pustules,
nodules & cysts.Nodules are large, painful, solid lesions that are lodged deep
within the skin. Cysts also lay deep within the skin but are filled with pus.Both
types can produce scarring.
PAPULES PUSTULES

7. NODULES CYST
PATHOPHYSIOLOGY:-
During childhood,the sebaceous glands are small & non-
functioning.These glands are under endocrine control,especially by the androgens.
During puberty,androgens stimulate the sebaceous glands,causing them to enlarge &
secrete a natural oil,sebum.which rises to the top of the hair follicles & flows out
onto the skin surface.
During puberty
Stimulation of androgen
Stimulation of sebaceous glands
Enlarged glands
Secretion of natural oil,sebum
Flows out onto the skin

8. CLINICAL MANIFESTATION :-
(1) The primary lesions of acne are comedones.
 Closed comedones i.e. whiteheads are obstructive lesions formed from lipids
or oils & keratin that plug the dilated follicles.They are small & whitish papules.
 Open comedones i.e. blackhead,in which the contents of the ducts are in open
communication with the external environment.It result not from dirt but from
an accumulation of lipid,bacterial & epithelial debris.
 Some closed comedones may rupture,resulting in an inflammatory reaction
caused by leakage of follicular contents like sebum,keratin or bacteria into the
dermis.
(2) Propionibacterium acne,that live in the hair follicles.
(3) Erythmatous papules : mild papules heal on their own without treatment &
deeper papules may result in scarring of the skin.
(4) Inflammatory pustules
(5) Inflammatory cysts : cyst may result in scarring of the skin.
ASSESSMENT & DIAGNOSTIC FINDINGS :-
 The diagnosis of acne is based on the history & physical examination,evidence
of lesions characteristic of acne & age.
 Acne does not occur until puberty.
 Oilyness is more prominent in the midfacial area.
 When there are numerous lesions,some of which are open,the person may
exude a distinct sebaceous odour.
 Women may report a history of flare-ups a few days before menses.
MEDICAL MANAGEMENT :-
The goal of management are to reduce bacterial
colonies,decreased sebaceous glands activity,prevent the follicles from becoming
plugged,reduced inflammation,combat secondary infection,minimize scaring &
eliminate factors that predispose the person to acne. The therapeutic regimen
depends on the type of lesions like comedones,papules,pustules & cyst. There is no
predictable cure for the disease but combinations of therapies are available that can
effectively control its activity.

9. NUTRITION & HYGIENE THERAPY :-
 The restrictions of a specific food or food product associated with a flare-up of
acne such as chocolate,cola,fried foods or milk products should be promoted.
 Maintenance of good nutrition equips the immune system for effective action
against bacteria & infection.
 For mild case of acne,washing twice each day with a cleansing soap may be all
that is required.
 These soaps can remove the excessive skin oil & comedo in most cases.Oil free
cosmetics & creams should be chosen by the patient.
TOPICAL PHARMACOLOGICAL THERAPY :-
BENZOYL PEROXIDE :-
 Benzoyl peroxide preparations are widely used because they produce a rapid &
sustained reduction of inflammatory lesions.
 They depress sebum production & promote breakdown of comedo plugs.
 They also produce an antibacterial effects by suppressing Propionibacterium
acnes.
 Initially Benzoyl peroxide causes redness & scaling but the skin usually adjusts
quickly to its use.
 Benzoyi peroxide,Benzoyl erythromycin & Benzoyl sulfer combination are
available.
 Vitamin A acid applied topically is used to clear the keratin plugs.
 Improvement may take to 12 weeks.
 The patient is cautioned against sun exposure while using the topical
medication because it may cause sunburn.
TOPICAL ANTIBIOTICS :-
 Topical antibiotics suppress the growth of Propionibacterium acnes,reduce
superficial free fatty acid levels,decreased comedones,papules & pustules &
produce no systemic side effects.
 Common topical preparation includes Tetracycline,Clindamycin &
Erythromycin.

10.  SYSTEMIC PHARMACOLOGICAL THERAPY :-
ANTIBIOTICS :-
 Oral antibiotics such as tetracycline,doxycycline,penicilline & minocycline,
administered in small doses over a long period are very effective.
 Therapy may continue for months to year.
 The tetracycline is contraindicated in children younger than age 12 & in
pregnant women.
 During pregnancy they can affect the development of teeth in infants.
 Side effects of tetracycline includes photosensitivity,nausea,diarrhea,
coetaneous infection & vaginitis in women.
 In some women,broad spectrum antibiotics may suppress normal vaginal
bacteria.
ORAL RETINOIDS :-
 Synthetic vitamin A compounds i.e. Retinoids are used in patients with nodular
cystic acne.
 Isotretinoine is also used for active inflammatory pustular acne that has a
tendency to scar.
 It reduces sebaceous gland size & inhibit sebum production.
 The most common side effects are cheilitis (inflammation of the lips).
HORMONE THERAPY :-
 Estrogen therapy including progesterone estrogen preparations suppresses
sebum production & reduce skin oiliness.
 Estrogen is not administered to male patients because of undesirable side
effects such as enlargement of breast & decrease in body hairs.
surgical MANAGEMENT :-
 It consist of comedo extraction,injections of corticosteroids into the inflamed
lesions & incision & drainage of large,fluctuant or nodular cystic lesions.
 Cryosurgery (i.e. freezing with liquid nitrogen)may be used for nodular & cystic
acne.
 Patients with deep scars may be treated with abrasive therapy ( i.e.
dermabrassion ),in which epidermis & some superficial dermis are removed.
 Comedo may be removed with a comedo extractor.

11. NURSING MANAGEMENT :-
 Major nursing activities include patient education,particularly in proper skin
care techniques & managing potential problems related to the skin disorders
or therapy.
PREVENTING SCARING :-
 Prevention of scaring is the ultimate goal of therapy.
 The chances of scaring increases the grade of acne increases.
 Grade III & IV ( 25 to more than 50 comedones,papules or pustules ) usually
require longer term therapy with systemic antibiotics.
 Patient should be warned that discontinuing these medications can increase
the chances of deep scaring.
 Hyperpigmentation or hypopigmentation also may affect the tissue involved.
PREVENTING INFECTION :-
 Female patient receiving long term antibiotic therapy with tetracycline should
be advised to watch sign & symptoms of oral or vaginal candidiasis,a yeast like
fungal infection.
PROMOTING HOME & COMMUNITY BASED CARE :-
 Patients are instructed to wash the face & other affected areas with mild soap
& water twice each day to remove surface oils.
 They are cautioned to avoid scrubbing the face because acne is not caused by
dirt & cannot be washed away.
 Mild abrasive soaps & drying agents are prescribed to eliminate the oily
feeling.
 Patient are instructed to avoid excessive abrasion because it causes minute
scratches on the skin surface.
 All forms of friction & trauma are avoided,including propping the hands against
the face,rubbing the face & wearing tight collars & helmets.
 Patients are instructed to avoid manipulation of pimples or blackheads.
 Cosmetics,shaving creams & lotions can aggravate acne,these substances are
best avoided.

12. THANK YOU
CLASS