Acne Vulgaris: an Understanding

Acne is chronic inflammatory disease of pilosebaceous glands. It is mainly characterized by seborrhea, formation of comedones, papules and pustules. Less commonly symptom like nodules, deep pustules and in some cases scarring is seen.

Four factors are involved in pathogenesis (1) Seborrhea (increase sebum production) (2) Hyper cornification of pilosebaseous duct (3) Colonization of pilosebaseous duct by P. acne (propionobacterium acne) and (4) Inflammation.

Natural History:

The problem of acne usually starts in adolescence and in many case resolve spontaneously by mid twenties. Regarding acne, different studies show different data. In one USA study, prevalence of acne in mid teens was virtually 100%. But only 20% needed medical intervention. If the acne is mild it is called physiological acne. In females acne develop earlier than males, may be due to earlier onset of puberty. Prepubertal acne is very uncommon. In fact acne can be the first sign of puberty.

Acne resolve spontaneously but slowly in mid twenties. But in a significant proportion acne persists beyond mid twenty (25 years of age). In some countries like Denmark there is a reduction in cases of acne which may be due to use of oral contraceptives. But in many countries acne cases are increasing along with mean age of acne, which is going in the mid twenties. Factors which causes resolution of acne are not clearly understood; studies on acne are also inconclusive and due to improved management prevalence and severity of acne has reduced.

Genetic factors:

Many studies has shown that genetic factors influence acne. In a study it was seen that boys with acne had parents with acne were 45% and boys without acne had parents with acne were only 8%.

Twin studies also confirm the effects of genetic factor on acne. Comedone numbers also similar in monozygotic twins but not in dizygotic twins. Patients with persistent acne have strong family history of persistent acne. But in adolescence acne there is no or insignificant history of persistent acne. There is decrease incidence of acne in patients with atopic dermatitis may be due to less sebum production in patients with atopic dermatitis.

Racial studies provide an interesting insight of genetic and environmental factor in acne. Acne in African Americans is less than white Americans but Black Americans have more severe acne than the Japanese. In Canada acne is less among Inuits, who eat a diet rich in fish. But when they adopt western diet with more saturated fat there is marked increase in acne. Same type of changes has been observed among the Japanese who settled in Hawaii and eat American style.

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