ACNE VULGARIS -Nisarg Kothari

DEFINITION It is a chronic inflammatory disorder of sebaceous follicles associated with adolescence. Age: normally occurs between 11-30 years. - on peak: 14-16 years in females 17-19 years in males.

ETIOLOGY Four Factors: 1. Androgens: increase androgen production-increased activity of sebaceous glands-increase sebum production, clinically as Seborrhoea(oily skin) 2.Follicular Keratinization: abnormality of keratinization- obstruction of follicles. 3. Propionibacterium acnes: increased 4. Heredity: organ response to androgens-may be controlled genetically.

PATHOGENESIS Non-inflammatory papules of acne: -Due to abnormal follicular keratinization -formation of keratotic plugs at follicular ostia-obstruction to the flow of sebum and dilatation of the follicle.

Inflammatory papules and pustules: - develop from non-inflammatory lesions. - follicular obstruction in combination with excess sebum production may lead to internal rupture of the follicular wall. - several proteases and lipases of dermis contacts with sebum-acute inflammation. Increased bacterial count-adds to inflammation as bacteria break down fatty acids in the sebum into short chain fatty acids-initiate inflammation. Acute and severe inflammation: formation of tiny abscesses around follicles. -when deep may form pseudocysts. In the severest acne: numerous pseudocysts, draining sinuses, and hypertrophic scars.

MORPHOLOGY According to clinical severity, a simplified grading of acne is: Grade-I [Non-inflammatory acne, Comedonal acne]: - skin coloured papules(whiteheads, closed comedones) 1-2mm in diameter with a central whitish dot-follicular opening. - little larger, conical papules with a central dilated follicular pore-blackheads or open comedones.

2. Grade-II [Papulopustular Acne]: - multiple erythematous, conical, follicular papules, 2-4mm in diameter, some of these topped by tiny pustules.

Grade-III [Papulonodular Acne]: - larger 5mm in diameter erythematous nodules. - larger and deeper pustules may also occur. Grade-IV [Nodulocystic Acne]: - large skin coloured and erythematous indurated nodules. - such painful nodules progress slowly to form painless cystic swellings-ultimately rupture and heal with scars. - such scarring may be hypertrophic and be then associated with discharging sinuses. - large open comedones are common. - nodulocystic acne-Acne Conglobata.

DISTRIBUTION Face- forehead, cheeks, nose and chin. Other regions: upper back, chest, shhoulders and upper arms. Nodulocystic variety: lower back and buttocks. Aggravate in hot and humid weather, under stress, injudicious use of oils and oily skin care products. In female: premenstrual flares are common-indicate hormonal imbalance.

PHYSIOTHERAPY UVR Dose: E2 are used- peeling or desquamation Effects: - accelerate skin growth because peeling of the surface will remove the lesions and open the blocked ducts. - produce a non-specific inflammatory reaction- control infection. - sterilize the skin surface temporarily. - some pigmentation which may serve to make the papules less obvious.