1. ACNE VULGARIS
-Nisarg Kothari

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

3. 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.

5. 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.

7. 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.

8. 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.

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

13. 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.

15. 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.

16. 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.