ACNE VULGARIS

Acne is very common in puberty and it usually regresses in early adulthood.
Sometimes it persists up to age 30 or lifelong. Sebum production
(patients complain of "oily skin") is the most important factor in acne. It
occurs on the face and the upper trunk as blocked sebaceous gland ducts
(forming comedones= blackheads and whiteheads), which may progress
to inflammatory papules, pustules and nodules. Acne may be very mild to
very severe. In severe acne conglobata, acne lesions blend together to
form large inflammatory areas with cysts and scar formation.
Management of acne
- Stop the use of vaseline, oil or ointments and greasy cosmetics which further block
sebaceous ducts.
- "Peeling" of the comedones with benzoylperoxide 5-10% gel or tretinoin 0.01-0.1%
cream or gel, apply at night since both are photosensitisers. Salicylic acid 1-10% in
an alcoholic solution. Alcoholic solutions remove excess sebum. Dilute methylated
spirits with an equal amount of water to a 35% solution.
- For pustular/inflammatory lesions: topical clindamycin 1% lotion, erythromycin 2%
lotion. If severe, use systemic tetracyclines, e.g. doxycycline 100 mg twice daily until
substantial improvement (may be a month or more) followed by 100 mg once daily
until acceptable or cleared, which may take many months.