1 University of British Columbia, Vancouver, British Columbia, Canada. 2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract: Acne vulgaris is a chronic pilosebaceous inflammatory disorder that affects almost 85% of those aged 12 to 24 years. Its pathophysiology is an interplay between androgenic activity, follicular epidermal hyperproliferation, retention hyperkeratosis, and Cutibacterium acnes infection. Strong evidence exists for high glycemic index diet as a trigger. Diagnosis is clinical and management is based on lesion types, with options including retinoids, benzoyl peroxide, antibiotics, oral contraceptives, and spironolactone.
Acne vulgaris is the most common skin condition observed in adolescent and pre-adolescent patients and has a significant psychological burden.
The plugged follicles of acne allow for Cutibacterium acnes overgrowth which triggers the release of heat shock proteins, porphyrin, proteases, and squalene peroxides, leading to inflammation.
Topical retinoids are used for open and closed comedones, while topical antibiotics and benzoyl peroxide are used for inflammatory lesions. Oral antibiotics are added for moderate to severe inflammatory acne. Hormonal therapy and isotretinoin are used to target the excess sebum production.
Acne may reflect an underlying disease. Patients that present before 7 years of age may have an underlying endocrinopathy. For women with acne, the possibility of polycystic ovary syndrome (PCOS) should be addressed.
Acne lesions can be non-inflammatory, in the form of open or closed comedones, and/or inflammatory, in the form of papules, pustules, and nodules. Treatment should be targeted to the type of acne the patient presents with.
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