Acne Vulgaris

Acne vulgaris is a self-limited disorder primarily of teenagers and young adults
The permissive factor for the expression of the disease in adolescence is the increase in sebum production by sebaceous glands after puberty. The activity of bacteria (Proprionobacterium acnes) within the comedones releases free fatty acids from sebum, causes inflammation within the cyst, and results in rupture of the cyst wall. An inflammatory foreign-body reaction develops as result of extrusion of oily and keratinous debris from the cyst.The clinical hallmark of acne vulgaris is the comedone, which may be closed (whitehead) or open (blackhead).
The earliest lesions seen in adolescence are generally mildly inflamed or noninflammatory comedones on the forehead. Subsequently, more typical inflammatory lesions develop on the cheeks, nose, and chin The most common location for acne is the face, but involvement of the chest and back is common. Most disease remains mild and does not lead to scarring. A small number of patients develop large inflammatory cysts and nodules, which may drain and result in significant scarring. Regardless of the severity, acne may affect a patient's quality of life. If adequately treated, this may be a transient effect. In the case of severe, scarring acne, the effects can be permanent and profound. Early therapeutic intervention in severe acne is essential.
Treatment of Acne vulgaris
Treatment of acne vulgaris is directed toward elimination of comedones by normalization of follicular keratinization, decreasing sebaceous gland activity, decreasing the population of P. acnes, and decreasing inflammation. Minimal to moderate, pauci-inflammatory disease may respond adequately to local therapy alone. Although areas affected with acne should be kept clean, overly vigorous scrubbing may aggravate acne due to mechanical rupture of comedones. Topical agents such as retinoic acid, benzoyl peroxide, or salicylic acid may alter the pattern of epidermal desquamation, preventing the formation of comedones and aiding in the resolution of preexisting cysts. Topical antibacterial agents such as azelaic acid, topical erythromycin (with or without zinc), or clindamycin are also useful adjuncts to therapy