Acne vulgaris.(Women's Health Adviser)

Acne vulgaris is the most common dermatologic disease in the world, affecting 85% of people aged of 12-24 years. Normally associated with the teenage years, acne can persist into middle age, occurring in 8% of adults aged 25-34 and up to 3% of those aged 35-44.

Diagnosis

Acne is a multifactorial disease involving a combination of hyperkeratinization in the sebaceous follicles, excess sebum production, and overgrowth of the bacteria Propionibacterium acnes. The growth of bacteria in follicles that have been plugged by sebum sets up an inflammatory cascade that results in erythema and swelling. Pustules may heal without scarring, but the nodules and cysts found in severe cases can cause significant scarring.

Inflammatory skin lesions located on the face, chest, or back are typical of acne vulgaris. Comedones--either blackheads or whiteheads--are the hallmark lesions of the disease; papules, pustules, or nodules may also be apparent.

The presence of comedones can be used to differentiate acne vulgaris from acne rosacea. In rosacea, the patient may have papules and pustules in addition to erythema and inflammation, but comedones will be absent. The erythema of rosacea is commonly exacerbated by emotion, alcohol, caffeine, or spicy foods. Red papules and pustules in the central third of the face and in the absence of comedones suggest rosacea.

Acne is hormonally mediated. Androgens increase sebum production and exacerbate the disease. When estrogen levels fall, women may experience a flare-up. This can occur regularly as part of the menstrual cycle or as estrogen falls at menopause. Conversely, acne may subside when estrogen levels are high, such as during pregnancy.

Acne in combination with other androgen-dependent symptoms, such as coarsening of the voice, facial hair growth, increased libido, and alopecia, may signal an underlying endocrine disorder. When these symptoms occur in treatment-resistant acne, the possibility of Cushing's disease or polycystic ovary syndrome should be investigated with appropriate blood tests.